Sunday, February 20, 2011

Monday Rundown Part 2: Be Still My Beating Heart

Ok, so I don't want my heart to be still, but it could slow the heck down. I have a naturally fast heart rate. My "resting" heart rate when awake is in the 70s. Most athletes run in the 40s-50s. When I did my VO2 max testing, we found that I don't get anaerobic when running until a heart rate of 192. My target heart rate during a race is in the mid-190s. Bottom line, my heart is fast.

Several years ago, I was seen for palpitations. I wore a monitor, and was found to have periodic early heart beats called PVCs (Premature Ventricular Contractions). They are not dangerous, but can be annoying. Each beat after one of these abnormal beats tends to be more forceful, and in people who are symptomatic there is the sensation of your breath being taken away.

Once every six months or so, starting in 2005, I would have a brief episode of SVT (Supraventricular Tachycardia). This is a heart rhythm that is more annoying for me than dangerous, but becomes an issue if it impacts your lifestyle. Once every six months isn't really an issue. Mine was always happening during or after exercise, and always when I bore down or had a "vasovagal" (i.e. bending over to untie my shoes or to stretch). The second I stood up, I went into a rapid heart rhythm.

Working with cardiologists, I have the benefit of running things by a doc. I had decided that it wasn't worth medication or intervention yet. Things went downhill a bit in the past 6 months. It started with IronGirl in August. While treading water waiting for the swim start, I emptied my bladder. (This sounds gross to non-triathletes, but to the rest of us is totally natural). Just the act of bearing down a bit while exerting myself (basically it splits a heartbeat into two heartbeats) caused me to go into SVT. My heart rate went from 120 to the 190s. I had to decide then and there whether to race or not. I decided to try, taking it easy on the swim. Eventually the rhythm "breaks", going back to a normal rhythm. It broke midway through the swim and I was able to keep going.

I had several more episodes this fall and winter....
- Once while doing planks at the gym after a workout. I stood up and there I went. I feel fine in the 190s when it is a normal rhythm, but absolutely crummy when it is abnormal.
- On the treadmill in the gym at work (I was a dummy on this one, because I didn't get an ECG while it was happening even though I was in the hospital. It would have helped me identify the rhythm).
- Christmas Eve while sitting at dinner (after some wine). This is the only time it has happened when not exercising, and took longer to break than usual.
- Once while walking briskly from my car back to my office

This past Wednesday, I went running with my marathon buddy Katy. It was going to be an easy 3.4 mile run outside (it was a beautiful day). We got to the halfway point, 1.7 mi away from work. I had a cramp in my toe, so I put my foot up on a post to stretch. When I put it back down and took a few steps running, my heart was off to the races. Again, I was in the 180s while running and felt like I was pushing it but felt fine. Suddenly I was 208 and felt awful. I tried to jog and hope it would break, but then my arms got heavy and I felt like I could pass out. We walked for a few minutes, then I tried again. I tried to bear down and break the rhythm, but I couldn't. Eventually I decided that I would rather stay in the rhythm and actually get an ECG. We walked/jogged back to work, and I went straight to the ER. I told the ER doc (a friend of mine) that I needed an ECG right away, and then she could register me. I wouldn't sit down until they were ready for the ECG- I actually walked in place to keep it going. (This sounds crazy perhaps, but I hit the point where I needed an answer). So we got the ECG. My heart rate had slowed down to 147, but it was still an abnormal rhythm. We had an answer, and the cardiologists I work with thought they would need to give me medication to convert the rhythm. Thankfully the rhythm broke (which I knew it would). Of course the ER staff was awesome to me, which makes all the difference in the world. Have I mentioned that I love the people I work with? (Thank you Emily, Angela, UJ, Paula, and of course Darcie!)

So I've hit the point where I have to do something. While this isn't life-threatening it is impacting my quality of life. The choices are medical therapy or ablation. I meet with an electrophysiologist (cardiology version of an electrician) who I know and like on Thursday. He is moderate in terms of aggressiveness, which I appreciate. This will be a big decision to make.

Medication: (Beta Blocker)
Pros: Non-invasive, relatively inexpensive each month, relatively effective, may help with my migraines though did not work when I had them as a child
Cons: Cost over time, Being on a cardiac medication indefinitely, lowers the heart rate and the ability of the heart to respond to exercise- this means my heart rate zones may change and it may affect my endurance (other side effects include fatigue, decreased libido, if being a Mom and working full time doesn't already cause these).

Intervention: (Ablation)
Pros: 95% effective at getting rid of the arrhythmia, No medications needed, curative rather than treatment
Cons: Invasive procedure (a catheter is placed into the femoral vein and fed up to the heart, the irritable tissue is ablated), 1% or so risk of needing a pacemaker (lower risk in people under age 45). I don't know yet what the recovery time is for the procedure, and what it would mean for racing.

So I have a lot to think about. I'm composing my questions for Thursday, and I may give the meds a month before I make any decisions (I started the Beta Blocker last week). Since this isn't life-threatening, just bothersome, I have time to make a decision. Trying to stay upbeat (no pun intended) about this one. I am so thankful for Tommy being supportive through all this, and for Katy who I know was mortified I might drop during our run on Wednesday but didn't get freaked out. Of course I'm doing a crummy job in terms of my "Healthy in 2011" goal, but what can you do?


  1. Kiersten - I loved this post!

    My first reaction was: OH NO, poor Kiersten, that is awful, why does she have to deal with this??

    My second reaction: What an interesting condition - and I loved your play-play and details of your symptoms and events...

    You are very well-spoken and you are awesome at "dumbing down" medical terms so that normal people like me completely understand what you are talking about!

    I think you are making the right move giving the more conservative treatment method a chance before an invasive surgery... I really hope that all goes well for you one way or another!!

  2. Well, as you know, my wife just went through an ablation. Her doc has green lighted her to begin exercising again (2 weeks post ablation). He's told her that there's really no limit as to what she can do, with the exception being that she's not to push her heart rate to her max (which without VT she wasn't able to do anyway). So, having lived through what she's gone through, if it were me, I'd say do the ablation (of course it's just me).

    Best of luck. Lots of thoughts and prayers.

  3. Glad they finally were finally able get enough info to properly diagonis and develop a plan to treat it. An invasive process on the old ticker would scare the heck out of me, so take your time and and make sure you are comfortable with your decision. Good luck.