[Closed] Heart blip caught!

New cardiologist time!

You could consider (depending how well off you are) some sort of fitbit/smar****ch with a health focus. They can apparently report irregular heartbeats and potentially flag up issues. Might be of use maybe?

Yeh, I can't say I've been impressed, but where I live (Shetland) neither a second opinion or private is really an option.

I do have a miolink wrist watch that I can use, but I've not caught it like that before.

Was just more impressed that finally I saw some thing stand out so clearly on my own hrm (chest strap) trace so clearly. I wasn't paying attention to the hr at all until the pain, too busy looking at cadence, so I can confidently say I wasn't looking for/creating the issue psychologically.

i think i would be considering one of the more "serious" heart related devices.
seeing as whoop does HRV I would imagine (I am guessing) that it's heartrate raw data is going to be pretty good.
Same applies to the apple watch (the latest one(s))?

Sorry no cardiology experience but I think it’s cool that you’re a Shetlander. Was looking at sunrise/set times for Lerwick the other day 😬

i think i would be considering one of the more “serious” heart related devices.

I think I would be considering A&E for an ECG.

It wasn't so long ago that I had a repeated stress test and 24 hour halter monitor. Essentially he seems to think that what ever the issue is, it's minor enough that 'going' in to investigate further(such as ablation) could cause more harm than good. On the other hand I've also been put down as it being micro-vascular heart disease.

It's toooo long a story really, but it is a pain and doesn't inspire me with confidence doing stuff. I've had to get pick ups from a few rides this year when it got a bit too concerning and I was feeling nauseous and in real discomfort.

Scuttler; not a an actual Shetlander, but been here for 11 years. Yeh, it's getting pretty dull right now, still the days will soon be lengthening and the summer light is ace.

It wasn’t so long ago that I had a repeated stress test and 24 hour halter monitor. Essentially he seems to think that what ever the issue is, it’s minor enough that ‘going’ in to investigate further(such as ablation) could cause more harm than good.

Things evolve. Chest pain whilst riding? He needs to be informed because it could be a development.

I did tell him. I told him it comes on after hard, long, or hard (hilly) long rides/sessions, back to back rides on weekends and can come and go for a couple of few days afterwards depending on how much I did. His comment, that can't be your heart as you'd have had a heart attack by now, it can't just linger and come and go like that.

Well, it feels like my heart. It's on the left side of my chest and not pectoral muscle or lung, exertion brings it on and it eases with rest. Sounds like micro-angina to me. I say micro as my arteries have been declared clear with zero calcium score and cardiac MRI, and as afar as I'm aware, micro-vascular (small vessel) heart disease can come with micro angina which sounds like what it is.

TBH I'm so fekked off with it all I can't face trying to speak to the guy again. When I went last my wife couldn't come due to C19 restrictions, which was a shame as she's pretty good with questioning things when my head goes up my arse. He's also greek so I'm not sure if there's something lost in translation at times both way. And he obviously has no idea about people who are actually active and wanting to train.

Disclaimer: I am a doctor. I know and work with the people you're fed up with, including the individual you describe. I'm also not your doctor and don't know your background at all so I will limit my response to a few observations.

1) I realise the heart rate trace looks like a 'gotcha' and it is interesting that your power and cadence are demonstrably stable. Looking at that trace, it could be an adrenergic response to E.g. the pain or merely an artefact of data recording. True arrhythmias in this context are usually sudden on / offset, meaning the HR curve would spike up to its maximum quickly for, say a minute or five, before dipping abruptly down again. This is not what's happening in your case. Also, you've cropped the time data quite short - by my calculations, at your 40kph speed, the 'blip' is less than a minute start-to-finish which makes me think it's an over-smoothing artefact in the HRM software. Either way, based on the trace I don't think your heart rate is likely to be a cause of any symptoms.

2) You're had a lot of (expensive!) tests that you say are normal. This is reassuring and by the sounds of it, you have been investigated more extensively than most people would be.

3) NHS doctors are predominantly set up to keep people out major trouble, not enable them to train harder. Whilst I agree that we should spend more time on promoting (and enabling) healthy lifestyles, there is a point of diminishing returns and this is especially true when people present with somewhat vague symptoms and have a load of negative tests. In that context, a cardiologist could very reasonably say that your heart is in good nick and there's no risk of serious issues (beyond the background risk that everyone has, accepting that with a negative calcium CT your risk is probably slightly lower than an 'average' man in whom the calcium score is not known). Chasing down symptoms in low-risk people is likely to cause more harm than good. Whilst this is clearly frustrating from your point of view, this may be a symptom that you have to put up with.

it comes on after hard, long, or hard (hilly) long rides/sessions, back to back rides on weekends and can come and go for a couple of few days afterwards depending on how much I did. His comment, that can’t be your heart as you’d have had a heart attack by now, it can’t just linger and come and go like that.

4) I would agree with that final statement, or perhaps paraphrase it. Coronary pain that lasts that long is a heart attack and would usually show up on a blood test (or a cardiac MRI for that matter). Angina does not last for days.

Well, it feels like my heart. It’s on the left side of my chest and not pectoral muscle or lung,

5) Without wanting to sound facetious (though I realise it might), it's probably pectoral muscle or lung. Most people think musculoskeletal chest pain is coming from their heart - it's not really a difference that people can perceive accurately. If your cardiologist and a bunch of negative tests say it's not angina, then maybe it's not angina?

6) There are people in Sheffield and elsewhere that will absolutely see you privately to discuss all this if you wish. I am not one of them, though!

7) I genuinely hope you can feel better soon. Good luck with it all.

Thanks Superficial I appreciate that input. I know I sound ungrateful, but I'm just incredibly frustrated with it all over the period of a couple of years.

It doesn't just impact on my cycling and lifestyle, but an active job too.

My first ecg stress test showed lots of pvcs and he said signs of angina. He queried electrical issues, but then with me being male, 50, and admittedly bad family history went down the CAD route until tests ruled it out. I don't drink or smoke, but do need to lose weight.

Other ecgs have been a mix of pvcs, but not so bad or obvious lately . I have had a few instances of what was put down as svt with hr around 220bpm on my hrm.

The current diagnosis in the absence of something more concrete is micro vascular heart disease.

I'm an awfully long way from Sheffield with an overnight ferry and 300mile drive, but thanks or the thought. Last I looked Edinburgh is the closest for private, but we can't afford that.

If I may offer a non-medical suggestion:

I've had irregular heartbeats for a long time mostly associated with caffeine and interestingly diet soft drinks - manifesting as ectopic beats. I'm not overly concerned because if I lay off the caffeine and drinks I'm fine.

However I've noticed that I get more susceptible if I've had more training stress, by which I mean more intense riding whilst trying to maintain a calorie deficit. In that case, taking several weeks off helps reset everything. Maybe try a period of rest?

Molgrips, yeh I did that. I've only started to try to build back up the last couple of weeks. Been sticking to the turbo as its so controllable, the zwift gravel Grinder plan stop my boom and bust habit, and set a lower ftp to keep the effort down somewhat.

I'd did realise I wasn't doing myself any favours stubbornly carrying on like I was before and have felt much better for my break. But yeh, maybe I should give it some more time off.

I do drink caffinated tea regularly , but only decaf coffee other than the odd time I'm out for one. Fizziness is only sparkly water.

How much tea? There are a lot more chemicals and stimulants in tea than just caffeine.

2-3 pint mugs 🤔

I used one of these https://www.alivecor.co.uk to capture my PVCs and show the cardiologist. But it's only useful if you use it when the event happens - easier for me because they went on for a while. Have you asked the GP to refer you for a 24hr ECG, so they can capture the events?

For me aside from avoiding alcohol, caffeine stress etc. what worked was magnesium supplements. I've gone from years of PVCs to now only occurring when I'm ill and no issues drinking coffee and alcohol.

Bizarrely my undergraduate thesis was on searching for active magnesium transport in heart cells as there was a suspicion at the time that it was a cause of a number of heart issues and I didn't think about it until after a period of beta blockers which did hee-haw. Of course it may just be a placebo effect!

More info here: https://openheart.bmj.com/content/5/2/e000775

Disclaimer, I'm not a doctor and this isn't medical advice!!

Yeh they've seen them on ecgs, stress test and 24hr monitoring.

I've tried some supplements and things like coq10 and k2 but it's been pretty hit and miss. I'll see what I've still got and try to be more consistent.

I have had a few random spikes on my hr monitor recently, but unlike you no chest pain.

Ended up running 2 monitors at same time and as the spike only ever appeared on one of them i kind of put it down to dodgy data.

@superficial are arithmias usually longer than a second or 2 as my 'blips' don't last very long, certainly they never show as anything more than a very sharp rise and fall with a peak of a second or so..

Those two blips of mine cover about 40secs. I'd not have noticed if it wasn't for the ache in my left chest which made me look at the hr trace as I was just looking at cadence.
Big coincidence that I feel the discomfort, so look, and there is that trace?

Hey, PVCs sound like what I have.

I'll try the magnesium. Although I take multi-vitamins which should have it in.

I’ll try the magnesium. Although I take multi-vitamins which should have it in.

I'd imagine a multi vitamin has fairly low doses, and not all supplements are absorbed equally - I take Magnesium citrate 100mg.

Good luck!

Those two blips of mine cover about 40secs. I’d not have noticed if it wasn’t for the ache in my left chest which made me look at the hr trace as I was just looking at cadence.
Big coincidence that I feel the discomfort, so look, and there is that trace?

It's plausible that you're experiencing ectopics which are usually felt as a bump in the chest but some people can find them painful in and of themselves. As other have noted though, without an actual ECG (rhythm strip at least) at the time of symptoms it's just speculation.

@superficial are arithmias usually longer than a second or 2 as my ‘blips’ don’t last very long, certainly they never show as anything more than a very sharp rise and fall with a peak of a second or so..

To flip your question on its head, 'blips' of a second or two identified on a HR strap or watch are extremely likely to be artefact. Any arrhythmia can in theory last any length of time, but some arrhythmias will last 5-10 minutes at a very fixed rate (+/- 1-2bpm) which is quite characteristic when you see it on a HR trend. The longer the period of fixed, elevated HR goes on, the more convincing it is.

I've had patients who have shown me convincing HR monitor trends from Garmins, Apple watches and FitBits - they can be a useful tool but it's important to recognise the deficiencies of these devices.

Ended up running 2 monitors at same time and as the spike only ever appeared on one of them i kind of put it down to dodgy data.

That's a good idea.

So, just had a call from the GP surgery, ironically while I was on the turbo.

My 24hr halter monitor back on 26th October has shown up some sort of issue and I've now got a phone consultation on Christmas eve as it's the soonest available. I deliberately did a hilly ride and a turbo session ramping effort up to VO2 during the monitoring to try to ensure they had a chance to see something.

At least they didn't say stop what you're doing and come in now lol.