Squash and AF

[AndyFoz]

Hi All, I'm new to this site. I was first diagnosed with AF 4 years ago. I've been lucky in that I normally only get 3 or 4 episodes per year. I know that binge drinking will do it (Christmas party), but I also play squash 3-4 times per week and sometimes this will bring it on. Very sary when it happens, heart rate can reach 185 (I've just turned 56 by the way) and it lasts anything up to 12 hours. On my last episode, 3 weeks ago, I was hospitalised. Had to undergo an Angiogram as they noticed something strange on the ECG. Ended-up being diagnosed with mild CAD. Now I'm really scared of any exercise. I've gone from 4 games of squash per week to nothing. Going a bit stir crazy on the settee. Are there any other squash players on here who can reassure me?

[BobD Volunteer]

Over exercise has been shown to be a cause let alone trigger for AF but that I suspect depends on how good a squash player you are. I had a girl friend years ago who was VERY good and could stand in one place and exhaust her opponent into a dripping mess in five minutes while she never bothered to take her track suit top off.

AF is one of those mongrel conditions where what can be good for one person can be very bad for another so my advice is everything in moderation and listen to your body.

Rather than worrying about squash you really need to learn all you can about AF from AF Association website and actively find a sensible way forward Andy. You don't mention what treatment plan is in place or what drugs you are currently taking although you have had some tests. Have you had an echocardiogram to check for any possible structural or functional abnormalities and have you had any blood tests? Have you discussed anticoagulation? Your risk factors may be low but AF makes us five times more at risk of stroke so a proper risk assessment is important. Look up CHADSVASC on AF website. All these things are important.

Sadly AF is almost always progressive so now may be a good time to become pro-active in both limiting your risk of events by looking hard at lifestyle issues like diet,. alcohol, stress , good hydration etc and taking control of your treatment be learning how you can improve your outlook and who is best to treat you. Not all doctors or even cardiologists know too much about AF so a specialist in arrhythmia like an electrophysiologist is the person to see if others do not give you the necessary support.

[AndyFoz in reply to BobD]

Hi Bob and Orchardworker, thanks for answering. Yes, I've been reading a lot about AF, especially on this website. My Dr told me about the increasesd stroke risk and I'm taking asprin for that. I've been prescribed statins for the CAD. I've also been given 1.5mg of Bisoprolol but haven't started those yet. My slight worry there was these reduce your heart rate. My resting heart rate in normal rhythm is 45-50, so didn't fancy it going too much lower than that. Had blood tests, all Ok. Waiting for an echo cardiogram. I had one 4 years ago, that was ok. My dilemma is: I want to exercise to keep the CAD at bay, BUT I don't want to keep triggering the AF. A possible EP referral was mentioned if things get worse. I looked-up my local hospital (the JR in Oxford) and they do have an EP department. I suppose I just wondered what exercise other people on this site are able to do: cycling, tennis etc? Someone mentioned a magnesium supplement helping, any suggestions on that or other supplements. I know potassium is good and I'm trying to eat more bananas. Thanks, Andy

[BobD Volunteer in reply to AndyFoz]

Andy aspirin has no benefit in stroke prevention in AF and has not been recommended since 2014. Whilst having no benefit it can still cause digestive problems (cause harm) so net is a bad thing unless there are other reasons to take it. You should do a CHADSVASC2 risk assessment to find out if you need anticoagulation.

Yes bisoprolol wil slow your heart rate and for many that would be a bad thing. It will also slow YOU down. Maybe best to take it only when an event takes place rather than full time but discuss with your doctor.

Bisoprolol is generally the first drug doctors will offer and ruins many lives in my view. There are other rate control drugs and several rhythm control drugs such as flecainide which may prevent AF events from happening. Again my own personal view but it is pointless taking a drug which isn't helping.

Because AF is not life threatening per se the main aim of treatment is improved quality of life so treatment tends to be a journey of experiment often leading to ablation and whilst I am a great fan , having had three and now AF free, this may not be your chosen route.

Keep asking questions.

Bob

[AndyFoz in reply to BobD]

Thanks Bob, the hospital did my CHADSVASC2 score when I was in there. They said it was 0.

Yes, the Bisoprolol I have not been keen on. Indeed, I did just what you said and asked if I could take it when an event occurs. They said it's not really "a pill in the pocket" but I could try that way and that's what I've decided to do. Unfortunately, they will not give me Flecainide because of my mild CAD. That's a bit of a shame.

How long did you have AF before your first ablation? From you what you said, it's not necessarily 100% successful first time? Can you do everything now without worrying (exercise, drink in moderation)?

Cheer, Andy

[BobD Volunteer in reply to AndyFoz]

Hi Andy. I was finally diagnosed with AF in 2004 although had it ten years before and useless doctor. I had my first ablation in 2006 and two more in 07 and 08 before my AF was stopped. The second worked for about 9 months and then breakthrough events began. Understand that ablation is/ was then, very much a new science with the first RF ablations in UK around mid nineties and results have improved although it must be considered as an ongoing treatment. I do still get occasional arrhythmias and ectopics but not AF and take no drugs for arrhythmia only blood pressure.

A recent echo showed heart in good condition for age but I am quite unfit since arthritis stopped my hillwalking. I make no allowances for diet whatsoever despite being on warfarin and drink more wine than I probably should.

I also survived radical prostatectomy five years ago followed by both hormone and radiotherapy and still kick a--e, just not as hard as I used to. 71 going on 40 by the way. Growing old is mandatory. Growing up is optional so I just bought a BMW coupe and my wife a FiestaST3 to be rebellious and so that my sons do not waste my money drifting.

[Hidden]

Hi Andy, approach change positively, be determined to find the benefits of a different lifestyle. I used to love pushing myself in sports but also now enjoy different things and better health all round e.g. walking was boring, but walking x2 per day 1 mile with Nordic poles is more like a sport and choosing a Nature trail with plenty of social contact with twitchers and others makes it work.

We all get locked into our routines and think that's me and there's nothing else out there that will do it. This is your opportunity and a perfect excuse to experience new stuff! Good luck.

[MarkS]

Hi Andy,

I played hockey for about 15 years when I had AF. Hockey is similar to squash in that it needs sudden bursts of movement. I think it was very beneficial as being fit reduces the symptoms of AF. So I'd encourage you to keep it up. 3 or 4 times a week shouldn't be a problem. I wouldn't take a beta blocker all the time, just PiP.

In terms of treating the CAD, you might want to look up vitamin K2 which can reduce calcium build up on arteries.

Mark

[AndyFoz in reply to MarkS]

Thanks Mark,

I appreciate that. I need to get back on the court, have a gentle knock and see how that goes. Part of the problem is that I've frightened myself after having been admitted to hospital (overnight) and then finding out I had mild CAD. People would normally describe me as very fit, so the CAD bit came as a bit of a shock. May be there is some hereditary part, I don't know?

Yes, I also like the idea of the "PiP". Unfortunately they won't give me flecainide, which as I understand it, is the normal "PiP" for this. That's because I have the mild CAD. So, I'll have to give the Bisoprolol a go as a "PiP" instead.

Thanks for the tip about the K2 as well. I've also been looking at Magnesium supplements, I believe I read where these are good for heart rhythm.

Did you used to get your AF whilst in a hockey match? I assume you stopped a took a pill?

Cheers, Andy

[MarkS in reply to AndyFoz]

Hi Andy,

CAD can be hereditiary. It's good that it's been found now, you might actually thank AF for that as you've caught it early enough to do something about it! I know a number of men who've dropped dead in their 40's & 50's from undiagnosed heart problems.

Magnesium is worth trying as well. However it may well be that the CAD is causing the AF though the relationship is complicated, see the post from Dr John Mandrola:

drjohnm.org/2013/08/heart-d...

Cheers

Mark

[andst in reply to MarkS]

Hi Andy

I feel a bit of a killjoy here but when i was first diagnosed with AF in my late 40s i was advised strongly by a cardiologist to stop playing squash. This he explained was not due to AF at all but the sheer strenuousness of the game. He explained that during intense strokeplay that involved lunges it was possible for plaque to break free from the the artery walls and cause heart attack or stroke and he did not like to see the over 40s playing such games at all. I admit though i carried on playing for several more years until my knees wore out. Probably best to get the opinion of your cardiologist before carrying on especially as you have CAD.