A matter of the heart III
Posted: Sun Jun 26, 2016 3:14 pm
Okay, final episode (for now).
Following on from my last posting on this I had a further appointment with the top York NHS cardiologist, who commented that my situation had "caused much discussion in case conferences" - they apparently really don't get many fit people with heart problems (and herein lies a problem, really). By this stage, after a couple of months of relative de-training, my weird ECG blips were smaller, so he looked at the training diary info I'd taken in ("can I keep this?"), noted that it looked possible it was all exercise-related, and duly booked me and my thickened heart muscle in for a stress echocardiogram and an MRI scan.
The stress echocardiogram was actually fun; they did a scan, stuck me on a treadmill until my HR hit 160+ and then did another one. The key ingredient - through pure chance - was that the specialist interpreting the imaging was a keen cyclist, and he quizzed me about my training and racing. At the end of the session he hoisted a pair of thumbs and said "if I just knew you rode a bike, I'd be worried by what I saw. But knowing you do lots of high intensity stuff, I'm happy that there's nothing there that isn't a result of that". However, he did comment that heart arrhythmias would one day probably put an end to my competitive activities; but "one day" might still be a long way off, and I might simply get unacceptably crap at it before then anyway.
The MRI scan was a very sci-fi experience, but showed no problems beyond the "abnormalities" already identified, and a couple of weeks later I got a letter from the consultant cardiologist telling me no further investigation was needed. So, where does this leave me? Well, I've now spoken to quite a few middle-aged racing cyclists who have had similar problems but are still at it, whether through simply accepting occasional problematic episodes, or by having cardiac ablation. I've got a four-month hole in my training, but have been using the time productively to rebuild muscle which I lost during an ill-judged winter of training last year. It probably sounds daft, but I need to complete the rebuilding of trust in my heart to hold up when at extreme levels of stress, but I guess that's just part of a process of getting a race head back on.
If there's an underlying message in all this to pass on, it's that the health service does not know how to deal with abnormally-trained people, and while "misdiagnosis" would be a word too far, the changes which serious cycling brings about certainly cloud the specialists' vision, and there are very mixed views in the medical professions about high levels of exercise. As you head into your fifties and beyond, take on board information from your peers, and be prepared to question the standard wisdoms. But also be sensible and remember - I'm not a cardiologist
Following on from my last posting on this I had a further appointment with the top York NHS cardiologist, who commented that my situation had "caused much discussion in case conferences" - they apparently really don't get many fit people with heart problems (and herein lies a problem, really). By this stage, after a couple of months of relative de-training, my weird ECG blips were smaller, so he looked at the training diary info I'd taken in ("can I keep this?"), noted that it looked possible it was all exercise-related, and duly booked me and my thickened heart muscle in for a stress echocardiogram and an MRI scan.
The stress echocardiogram was actually fun; they did a scan, stuck me on a treadmill until my HR hit 160+ and then did another one. The key ingredient - through pure chance - was that the specialist interpreting the imaging was a keen cyclist, and he quizzed me about my training and racing. At the end of the session he hoisted a pair of thumbs and said "if I just knew you rode a bike, I'd be worried by what I saw. But knowing you do lots of high intensity stuff, I'm happy that there's nothing there that isn't a result of that". However, he did comment that heart arrhythmias would one day probably put an end to my competitive activities; but "one day" might still be a long way off, and I might simply get unacceptably crap at it before then anyway.
The MRI scan was a very sci-fi experience, but showed no problems beyond the "abnormalities" already identified, and a couple of weeks later I got a letter from the consultant cardiologist telling me no further investigation was needed. So, where does this leave me? Well, I've now spoken to quite a few middle-aged racing cyclists who have had similar problems but are still at it, whether through simply accepting occasional problematic episodes, or by having cardiac ablation. I've got a four-month hole in my training, but have been using the time productively to rebuild muscle which I lost during an ill-judged winter of training last year. It probably sounds daft, but I need to complete the rebuilding of trust in my heart to hold up when at extreme levels of stress, but I guess that's just part of a process of getting a race head back on.
If there's an underlying message in all this to pass on, it's that the health service does not know how to deal with abnormally-trained people, and while "misdiagnosis" would be a word too far, the changes which serious cycling brings about certainly cloud the specialists' vision, and there are very mixed views in the medical professions about high levels of exercise. As you head into your fifties and beyond, take on board information from your peers, and be prepared to question the standard wisdoms. But also be sensible and remember - I'm not a cardiologist
As you say there is a psychological component as well and its about reassuring yourself that it is ok to give it full gas sometimes because there is no getting away from the fact that you have to if you want to race. Looking forward to seeing you on the bike racing again.