Palpitations When Exercising

[James77]

Hi all,

I can empathise with most of the posts on here and my experience seems similar to yours in some ways, Lucy, although mines is quite unique. I’ll try to summarise but I’ll probably ramble as I’m pretty good at that 😉

So basically I’ve always been pretty fit and healthy: I’m 37, BMI 23, average heart rate 50 at rest (sometimes even 46 😳) BP 110/60, never smoked and don’t drink very often. I have been involved in sports most of my life but gave up for a few years and decided to get back to it at about 29; lifted weights 2-3 times per week, jogged occasionally and did HIIT a couple of times per week on and off. I’ve always had health anxiety to a degree and found that the training and health anxiety started to develop a negative relationship in so much as I was monitoring my BP too regularly and checking my pulse several times per day etc which I think only serves to feed the anxiety, ultimately. A good friend got me into the heart rate monitoring via the Polar watch and chest strap - in hindsight I think this was the worst thing I could’ve done as I’ll explain.

Anyway, all my troubles started when I was out a Sunday run almost exactly 2 years ago...I started off on a new programme to build my endurance and got off to a normal start of around 150bpm and gradually kicked it up a bit until I got to quite a steep hill about 35 minutes in and went up it relatively slowly which seen my heart rate climb to 175bpm (not far off max) and required a fair bit of effort. I can’t remember exactly why, because it’s not like me to stop, but I decided to take a seat at the top of the hill and sit on the kerb as a breather (bearing in mind my HR is close to max at this point), the seasoned runners reading will know that this is a real no-no in running (as I was about to find out), I sat down and immediately felt the most horrid sense of dizziness I’ve ever experienced along with my lungs feeling like they were having the air literally sucked out of them and to my alarm the heart rate on the watch was dropping sharply, at one point to as low as 35bpm as recorded on the Polar app, before promptly spiking all the way back up to 189bpm when I stood up (panicked and delirious), before dropping back down to post exercise rates as I slowly walked back home, shaking and terrified thinking I’d basically just had a heart attack or some other major heart issue! The whole thing probably only lasted a moment or so but I really thought it was the end. It was terrible.

I knew then and there that innocent or not, I’d end up not training hard again for a while and I was right. I read up online about how during running our legs pump blood back up through our circulatory system as our heart circulates the rest (in a phenomenon called secondary heart - if I’m not mistaken) which seemed to explain why running hard and stopping/sitting abruptly would cause such severe symptoms; there were also a lot of anecdotal stories online of people who’d nearly passed our (some had actually fainted) from the same mistake. So I went through the next 4 months tentatively doing some weights and HIIT as well as a few slow runs to build my confidence up but that doubt was always there: “what if my heart is weak, or abnormal or defective” (I’m sure most of you hear this same annoying negative voice a lot!). I eventually decided to really ramp up the training in an attempt to prove to myself that I was as fit as could be and that I was just being stupid. So I went to do some intensive stair runs which would make a marine wince, and I completed 8 rounds at absolute all out effort! No issues with palpitations or the like and I was delighted on my slow run home so I decided to finish with 2 more short interval sprints, lamppost to lamppost (all the while worrying about palpitations and checking the Polar watch). On the last interval I took my HR up to around 179bpm (6 below my max) and then stopped and started walking having completed the workout, but as my heart rate decreased it got to 135bpm then I felt a less than subtle thump/thud in my chest (clearly a pvc or something similar) which immediately set my adrenaline off and took my heart rate shooting right back up to maximum briefly before settling back down to a normal rate once I calmed down! On the Polar graph on the app it actually looks like I had done a final interval even though this was the pvc and subsequent panic.

At that point I was convinced I had a dodgy heart and with no other options I booked an appointment with a cardiologist privately, who I believe is one of the best in his field. I took the watch/app with me and explained everything in great detail to him, convinced he’d say I was explaining coronary heart disease or serious heart issue to a T, but he gave the info on the watch short shrift, barely glancing at the data and smiled sympathetically saying “nothing alarms me about this”! I’m thinking “what”?! He asked a few more questions and basically said it’s just palpitations and not to worry, however for peace of mind he recommended an ECG and an echo to which I agreed. The echo showed a structurally sound heart with no issues and as he gazed at the ECG reading he was in the middle of saying “yep, you’re absolutely fine.......” before mentioning that one of the leads showed a slight discrepancy to the corresponding lead above or below. He didn’t mention medical terms but went on to point at one of the traces where a flat line was and said “this line here should be the same as that line there” pointing at an almost indiscernible tiny squiggle (I didn’t have a clue what it meant) “but” he said “this is consistent with readings we get in young athletes and more often than not in African (or possibly Afro-Caribbean?) men”. He then dismissed it as being simply a “variant of normal” if I’ve remembered that term correctly. At this point my anxiety was having none of it and I think that was etched on my face when he informed me that he was happy with it, however, in any variant of normal they send the readings to fellow cardiologists to basically get a consensus on the readings. Therefore he said he’d send an email out and get back to me with what he assured me would essentially be the green light to keep training etc. Next day I got the call to say that they all agreed it was fine, not a totally uncommon reading and that I should train as normal. However, he recommended that I book back in in 5 or 6 years for another ECG just to check how things were because they are “more careful than ever these days”. Great I thought - that’s my anxiety winning the battle yet again then, because I know I’ll not be able to train confidently off the back of this. Again I was right and in the past 18 months I’ve been so paranoid to really go for it in training and I have all but given up on CV and only do weights 2-3 time’s per week, panicking in between sets as I feel my heart pump hard when resting! I get what I assume are PVC’s in the gym which manifest themselves as one of two symptoms: one is like a sucking feeling where my lungs feel like they exhale or contract momentarily (a bit like that sensation you get when a cold shower hits you) or I get a very noticeable thud in my chest or neck that makes it feel like my heart is going to pack in then and there! It’s horrid but I can handle it when weight training because I feel like I’m controlling it a bit more by taking a slightly longer rest or not doing as much weight. CV is so much harder however as it’s sustained exercising with higher heart rate.

So this past week (during lockdown!) I decided stuff it, I’m getting back into CV no matter what and got the exercise bike back out. I haven’t trained at CV for over a year so it was nail biting to get back on the bike as I slowly picked up the pace...as I got to a pathetic 130bpm I could feel the adrenaline kicking in (you know that turbo/boost sensation that kicks in in the chest) and I had to actually ease back because I couldn’t handle going hard. I went for 20 minutes at 120bpm and felt generally fine. The next day 25 minutes at 125bpm and the day after I suppose I started to get cocky and got up to just over 130bpm and felt great (really feeling like I was winning) with only 5 minutes left to go when THUMP! a huge PVC that I felt reverberate in my throat which, you guessed it, started the horrid adrenaline kicking in again and I had to get off! Aah! The anxiety winning again as I walked around my house with my heart beating ultra fast, me whiter than my skirting boards thinking I’m having a heart attack! Needless to say my heart settled down and I actually felt fine after it. The rational part of my mind tells me this is just anxiety and I’m fine but the negative side of my mind is trying to convince me that I have undiagnosed heart trouble. It’s so so frustrating and I just don’t know if I’ll ever return to normal again. I’d LOVE to go back to exercising properly again, it was such a release for me and I know how much it helped me mentally and physically.

I suppose the reason I’m posting is to get some feedback from you all with similar experiences and if you overcame it, how did you manage? Lucy, I think your heart rate ‘sweet spot’ theory is very interesting because I have actually nailed most of my PVC’s (if that’s what they are) down to a HR of around 130-135. I don’t get any when starting out or going higher up but they seem to sneak in at the 130-135 range. It’s very disconcerting and frightens the life out of me...I can’t just power through it as I feel I’d aggravate my ‘issues’ (imaginary or not) and end up doing serious damage. I feel like I need to get a second opinion and I’d also like to know exactly what the variant was in my ECG that young athletes and people of different ethnicities more commonly display. Would any of you know what that means??

I’ve also noticed that I get postural palpitations where I get skipped beats when bending over or if I’m lying in a certain position in bed. I’ve read this is related to the vagus nerve apparently but what exactly is that all about, and why am I experiencing this now but not in the previous 35 years!

So what are the main symptoms you guys get in the gym? Do you get those horrible thumps and thuds up your chests and throats during exertion? And also those skipping weak ones that intermittently seem to disrupt breath for like a millisecond?! They feel so real and dangerous but when a cardiologist looks at you with almost sleepy eyes and a very “I’m not interested in any of this” look on his face it’s hard to know what to make of it all. It’s driving me up the wall.

Sincere apologies for this mega long post (I did warn you 😊) I just wanted to be as descriptive as possible. Any feedback would be great.

Thanks,

James

[Kristin1812 Heart Star]

Hi James. I was fascinated by your description. Thanks for the detail. I’m usually not v patient with long messages (sorry! It’s a personal flaw).

I recognise pretty exactly those ‘events’ And I know how frightening they were.

I will pick out the parallels. It may or may not help you.

I could exercise fine till HR is up to 130. Nothing heroic. Then I’d suddenly feel dizzy, tight chest and sick. I used to sit down, feel very ‘out of it’, occasional uneven HR then slowly I’d recover.

Consultant electrophysiologist was very sanguine. ‘Just lie down, or at least get your head well down. But best to slow down v gradually and not plump down suddenly and just stop.’

He recognised the symptoms exactly, explained why HR went down (dizzy etc’) as BP went up etc etc. He’d seen it often before and kind of said ‘Learn to cope with it’. He said he was sure it wasn’t AF, which is why I was sent to him, but he put a heart monitor in, just to double check.

I have coped. I get quite cross if I push it too much now, and fail to manage it, my exercise is now less intense. I keep below 125, but work longer.

(I will describe my age history etc if you do ask me. But I am so different in every other way that I thought you’d lose the parallels. I so recognised these episodes, and thought it could help. It frightened me just as much as you).

[James77 in reply to Kristin1812]

Hi Kristin,

Thanks for the reply, its always comforting to hear that someone else has had similar experiences and the cause was more or less benign. The trouble with heart concerns is that not only is it such a dynamic organ that we are constantly aware of, but us anxious people are able to affect its performance and rhythm just by thinking/worrying about it, which then brings about the old chicken and egg scenario: did the heart start to play up (albeit harmlessly) due to anxiety first and then the symptoms aroused the anxiety further which exacerbated the situation and made the heart jump about a bit more than it would have normally, sending us into complete panic, or was the heart playing up of its own accord due to an underlying problem that was aggravated by exercise. I certainly believe its the former but try telling that to me when my HR is sky high and I’m convinced I’m about to give up the ghost! All rational thoughts and theories abandon me in those moments. Part of me thinks ‘be brave and give the anxiety the f**k you by continuing’ but easier said than done.

So, did you get an actual diagnosis or was it put down to anxiety or some other benign cause? I don’t think cardiologists and all their training and experience miss major issues to be fair so it’s unlikely we have anything to worry about but I wish the symptoms would just go away...

[Kristin1812 Heart Star in reply to James77]

Hi James, it’s a cycle that somehow we have to break into, isn’t it?otherwise it consumes our thinking! Well it can mine!

I’ll check the letter the Electrophysiological Cardiologist sent. Make sure I get the wording right, if he did, indeed label it.

Later.

[James77 in reply to Kristin1812]

Exactly! I think it’s a case of breaking through that mental barrier and we can get back to normal.

Thanks Kristin, really appreciate your input here. Cheers...