Anyone here dealing with or dealt with cardiac issues?

Training
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Background…38, living with ankylosing spondylitis. No previous history of heart issues, but since having Covid in early 2022 I found that I couldn’t adapt to my cycling training and never was able to find my 2021 form. As a result of this I went to my doctor and we did an echocardiogram and that revealed the following:

CONCLUSIONS

  • Left ventricular ejection fraction is visually estimated at 45% (was at 60% in 2016 which was when my last echo was)
  • Mild diffuse hypokinesis is present.
  • An atrial-septal aneurysm is present.
  • Large PFO present with right to left shunting at rest.
  • Compared to the previous study dated 8/3/16, left ventricular function has declined.

Moving forward my cardiologist has ordered a cardiac stress MRI and wants me to start a low (25 mg) dose of metoprolol.

I’m not nervous, but I’m curious what to expect being on metoprolol. Anyone else here dealing with something similar? Any cardiologists on this forum that would have time to chat?

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I am 31 and have been on 25mg metoprolol for a little over a year now for constant PVC’s that are likely from having Covid. I had a stress test along with wearing a holter monitor for a few days and everything checked out fine. When I first started metoprolol my HR was capped at 140ish bpm (max HR was around 180 before) and I felt limited on threshold efforts and above. Because of that, I stuck with mostly z2 for the remainder of 2022 without any real performance loss.

I started SSB LV in 2023 and have been adapting quite well and am getting close to my previous fitness even though my HR is capped around 155bpm now. I haven’t tried any V02 but haven’t had issues with threshold workouts and have been adapting well so far.

I can tell a big difference in HR when I workout just after taking my dose (<110bpm for Z2) or if I wait until the end of the day when it starts to wear off (115-125bpm for Z2) but performance isn’t different between the two times of the day.

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A friend. He bikes 5 hours as week. He is 72. His main complain is that he does not improve and that he feels stuck on 3rd gear on threshold efforts and above.

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Yeah, heart meds can feel like a governor on the throttle. It’s a little strange. It also takes them some time to dial in dosages and stuff. Make sure you tell the docs everything going on which will give you the best chance at optimal care

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Have been dealing with this situation of finding the right balance for almost a year. Every time I think we (the cardiologist and myself) have found the “mix” it changes…

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I am a physician, but I’m not a cardiologist (yet).

Background information: I’m 27, and I’ve been playing football (soccer) all my life. At childbirth, I’ve been diagnosed with a VSD (ventricular septal defect), which, upon continuous monitoring through to 7 years of age, has been incorrectly concluded to have closed.

Fast forward to last year (26 years of age), having a bit of time on my hands during a hospital shift, I decided to get a screening echocardiogram. They found an ASD (atrial septal defect), which is similar to a PFO. My defect is hemodynamically stable, with a net left-to-right shunt. Initially, I didn’t mind it at first since I was in a relatively benign state. However, I began to take this seriously when I started cycling as a hobby/sport last year and was able to monitor my heart rate. Noticing that I ran at HRs of 170-180 at Zone 2, I knew that my inappropriate HR response was because of my ASD, and so decided to go for definitive advice and treatment from senior doctors and cardiologists.

This year, I was started on Ivabradine (Coralan), a medication similar to metoprolol and other beta blockers in that it lowers heart rate, but it does NOT have a significant effect in exercise capacity and stroke volume. In fact, I can now run my Zone 2 workouts at 120-130 bpm (just like normal people). It was a wonder drug to me. FTP increased by almost two-fold!

Next month, I will be undergoing surgery to definitively deal with the defect. I am both anxious for the surgery, yet excited to see how I feel after full recovery.

Now, going back to your case, I have to preface that although I am a physician, I am not /your/ physician. Given that, I do think we have several considerations and questions to be asked here:

  1. Starting metoprolol and its effect on exercise capacity and symptoms. If you’re experiencing a fast heart rate, shortness of breath, and limitations in exercise, then metoprolol might be able to help you in making your heart beat slower and prevent those symptoms above. When your heart beats slower, it is able to fill up more blood, and hence it might be able to pump blood more effectively. Your endurance workouts might feel better, but your maximum efforts might feel a bit blunted.
  2. Consider a conversation with your doctor with other medication options such as ivabradine. Nevertheless, I don’t think you have much to worry about with starting these medications. If you have a smartwatch with an HR monitor such as an Apple Watch, it would be useful to keep a record of your HR trends during these times: (1) at rest while awake, (2) during sleep, and (3) during exercise. You should be keeping a heart rate of about 50-70 at the least while asleep, less than 100 while awake and at rest, and less than your age-predicted max heart rate during exercise. Watch out for symptoms of blurring of vision, dizziness, general weakness, as these might be symptoms of having too high of a dose of beta blockers. In your case, starting on 25 mg shouldn’t be problematic, and you might be given higher doses later on. However, you might feel a bit weird during the first few days.
  3. A large PFO with right to left shunting at rest. In the long run, I do think this should be your primary concern. What is the eventual goal of your cardiologist? Has he told you if you were amenable for surgical repair? Or is the conversation leaning towards managing symptoms and continuing medications to prolong a good quality of life?
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I had a heart attack (on a ride) followed by 3x bypass, during my recovery I was on the same dose of metropol.

For me it really limited my heart rate. Not in a bad or painful way, I just could go so hard. After around 4-5 months I was having low HR and low blood pressure so my doc took me off the metropol. It was like I got an extra gear back with my riding.

That being said, sometimes you need to have that extra gear removed and work with limitations in order to recover.

Best of luck with your plan moving forward.

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Thank you. I’m curious, are you just not able to push hard or you are, but you don’t get the same heart rate response as before? Kind of want to know what to expect…will threshold, VO2, and anaerobic efforts be off the table?

I’m anxious to know how long I will need to be on this medication. Can I ask your age?

Nothing like this. What actually prompted my second echo was A) I have an underlying condition that can increase my chances of heart issues…consider it a diagnostic measure. But more so B) last season I never felt like I was adapting to any of my training, and just generally never felt fit on the bike…I knew something was up. No palpitations or any shortness of breath or weird arrhythmias to speak of. Honestly would have never gotten an echo if it wasn’t for the above mentioned reasons.

I’m in the process of speaking with another cardiologist who is also a competitive cyclist and he says that metoprolol is literally the worst medication. I’m hoping we can explore some other options once we find out the results of my cardiac MRI.

I’ve spoken to two cardiologists about this. Neither showed much concern unless I was a scuba or saturation diver. Which I am not. It sounds like the jury is still out on whether or not to leave the PFO alone or address it. As of now I don’t believe I have ever experienced any complications from it. I guess we’ll see? I’m eager to see how you do after your surgery.

Thank you so much for your thoughtful and educational reply. This is a really weird time for me, but it seems like this is some sort of viral induced myocarditis. I’m just hoping that it’s recoverable and that I’m not stuck with this deficiency.

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Wow. Thank you for sharing, that must have been a very scary experience. What sort of diagnostics helped inform your doctor that you were good to ween off metoprolol? Did you have follow up echo’s to see the efficacy of the drug or was it through additional MRIs? I’m curious how long I’ll have to be on this medication.

Fully agree with you, it’s best to dial it back if that means more longevity. So be it.

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Had a heart attack and 2 stents last May and 3 more in July (family genetic curse… ) at age 67.

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Both. The heart takes a little longer to rev up, but the bigger factor is I can’t rev as hard. I can do short VO2 max now, but it took a while. I am 1 1/2 years out from an MI (STEMI). I lost about 40% of my FTP. I’ve slowly been building myself up. Within 15% of my best. Some of it is the medications and most is the muscle damage from the MI. But while it seems like a big setback, a near death experience like that actually makes you appreciate what you can do and how lucky we are

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Op, just wondering, but with no history of heart issues, why did you have the same scan back in 2016? It sounds like an atypical procedure for a person in their earlier 30s.
-early 30s guy

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I forgot to mention that. I was getting excruciating headaches after hard efforts. GP ordered an echo after seeing a PVC on a 12-point ECG that was done as a diagnostic test. Thankfully it was not an issue.

But yeah, a likely dehydration issue lead to me knowing more about my heart. It’s funny how things happen.

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I started taking Meoprolol 20mg/day about 12 years ago. Started mtb biking again not too long after, after 20 years off the bike. I was given the Metoprolol primarily for high HR (resting in the mid 80s), but also for the benefit of helping with some arrhythmias, including PVCs. About 4 years we went down to 10mg/day because I finally complained about the light-headedness I was experiencing due to the med pulling my blood pressure down to avg 92/60 (I had normal BP before starting the Toprol), and that helped.

My riding was almost all trail riding, unstructured, so I usually had too much intensity. I did learn about HR zones, and almost always rode with chest strap, for obvious reasons, and have gotten very familiar with my HR and zones and how it reacts to varying stimuli.

I never had much limitation on my max HR. I would hit 172 a number of times a year, usually on hot, humid days climbing a steep sandy hill toward the end of a ride. My issue always seemed to be that I didn’t really have any zone 3 or 4. My HR seemed like it was always either at z2 or all out, and was really hard to keep it anywhere in between, like I had no base fitness. I ride year-round and had been at 4-6 hrs per week, so seemed like I should have had a better base than I was experiencing. I just couldn’t seem to improve beyond a certain point (but wasn’t very successful doing z2 to any degree, due to spiking HR at any hills).

I stopped taking the metoprolol a year and a half ago (doctor issues, didn’t refill my Rx), so I went with it. I had stopped for a couple weeks previously to see if I saw any improvement or detriment, and my EP didn’t seem too concerned, so I wasn’t too worried about stopping all together. I also started trying to do some consistent z2 on my stationary bike last year, starting at 30 mins a few times a week, then to 45 mins 4-5x per week, and now I’ve settled in with 1 hour at 3-4x per week (but doing another 3x of higher intensity stuff). Since I quit the Toprol, I’ve seen 174 bpm max on rides several times (so it’s up a couple BPM), and saw 176 once (I think this was an error). My resting HR was mid 70s, and is now in the upper 50s if I get good sleep, 61 if not. My power is up 30% at my preferred z2 HR. Oh, and my LTHR went up from 154 to 157. So, a lot of information, but some combination of stopping the med and building a good base have made a huge difference for me.

TLDR, max HR was 2bpm lower, LTHR is up 3 bpm, z2 power is up significantly, from some combination of stopping Metoprolol and doing more, consistent z2 training, and can’t tell how much is correlation vs causation (sorry, I can’t ever seem to isolate one change at a time).

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Update…

Didn’t take any of the prescribed meds. I wasn’t convinced by my PA that it was necessary. (Side note: One of my biggest frustrations with the American medical system is how specialists will let their less informed PA’s handle most of the workup.)

Back in May I underwent a cardiac stress MRI to further investigate and assess for etiologies of the underlying cardiomyopathy; exclude inducible ischemia. The findings were positive, and we also noted an increase in injection fraction.

Impression:

  1. No inducible ischemia on regadenoson cardiac MR imaging.
  2. Visually, the left ventricular systolic performance was at the lower limit of normal. The calculated left ventricular ejection fraction was 54% (N: 57-77 by Circle software).
  3. Delayed enhancement was not seen on today’s study. No evidence for iron overload or infiltrative cardiomyopathy.
  4. Normal LV volume.
  5. Normal LV mass.

SO, I’m still living with PFO and atrial septal aneurysm. However, I’m feeling a lot better fitness-wise than I was last season. I feel like I’m responding to workouts and races. Whereas last year I felt like I was being held back.

I’m going to work with a cardiologist to monitor my condition and take it from there. It sounds like most people with PFO (25% of the population) live their life w/o incidence. :crossed_fingers: :crossed_fingers:

From everything I’ve read, it doesn’t sound like PFO-closure is an option for me at this time. I would need to have a TIA or cryptogenic stroke to be considered for that procedure. I’m curious if anyone reading has had a PFO closed. I know that incidences of aFib are known to exist after closure—something else I’m not interested in getting.

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Was prescribed 25 mg X twice a day for NSVT for most of my forties. I actually only took it once a day unless I was a having an issues day. I didn’t notice a significant decrease in performance. I did get light headed in some situations because it made my resting heart rate 36, and I always had cold hands and feet. Actually riding though, I was probably a little slower but not enough T to frustrate me, heart could still get to high 180’s on full out efforts. Luckily my heart just healed itself and I stopped taking meds 5 years ago.

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How do you know when you should get a cardiac issue checked out? I recently was feeling quite fit and then got sick, probably Covid. Since I have recovered from all symptoms, my resting HR is about 10 beats higher than normal and my exercise heart rates are really high at super low efforts. My lactate is also quite high.

Some exact data from monitoring.

October - 240 watts = 2.0 mmol lactate - 140 heart rate
December 160 watts - 1.8 mmol lactate - 140 heart rate

RHR in October 38-40 bpm
RHR in December 46+

Heart also feels like it is just super active and really beating hard and I have noticed more shortness of breath.

I hate going into a doctor unless I know something is wrong because they always look at me crazy when I think something is wrong because even though something is wrong for me I am still on the quite healthy range of things for normal person.

Do you think this is something worth getting checked out?

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PA’s can generally suck! I was having ‘chest pain’ and called my doc and was told to ‘come on down’… I arrived and the PA hooked me up to their EKG machine and started looking a little panicked. She grabbed the trace and left he room (to fax the trace to the doc who was at a different area for some reason) and came back in with questions like ‘Did you drive yourself here’, and ‘Is there someone who can pick you up’. I asked why, and she offered to call an ambulance. Freaked a little and pissed that it seemed like a wast eof time, I drove myself ot the ER. They were waiting for me and got me on a gurney and wheeled me into the critical care room and within seconds (it seemed) was wired for sound. I knew the doc on duty and asked him what the heck was going on. He seemed confused too expecting me to come in near death. After all that workup, and a night in the CCU observation floor, I found out I was completely fine, and the brain dead PA had put the pads for the EKG on without prepping the area first! I ran into that doc at a party a couple of days later, and he was joking about my ‘Second coming’, and ‘Amazing resurrection’. He said he saw the pad still stuck to my chest hairs but since I was believed to be in ‘massive cardiac distress’, they had to ‘run the game plan’. He recommended that I never have that PA touch me again, and she never did. I changed doctors later that week.

BOTH of them should have known that the EKG was garbage, and SHE should have known how to do the damn test he right way at a minimum!! :roll_eyes: :rage: :rage: :person_facepalming: :person_facepalming:

Years before that I had a different PA prescribe an archaic drug for severe sinus congestion that was notorious for causing patients to spazz out from the over stimulating effect. A couple of days later, looking worse for the wear, I went back, saw the REAL doc, and he face palmed and left the room. He came back, apologizing, and put me on something way less stimulating. (PAs probably all aren’t bad, but physicians have to watch them like hawks, and in far too many ERs for instance, it could be 30 PAs for just a couple (or one) physician, so health care is a real mess in America, and only getting worse! The hedge funder Wall Street types only care about the bottom line on the financials. PA screw ups are just part of the cost of operation. And the pay PAs between a two thirds and half what they pay real board certified physicians. Cha-ching…

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If it doesn’t feel right it’s worth checking out, but ask around and see if you can find a cardiologist who frequently deals with endurance athletes. Mine is a Cat 3 so knows what to expect from cyclists. Makes a big difference.

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I never know when it’s time. I have to get pretty frightened by the symptoms, but I have really bad anxiety, and I know from experience the anxiety has the ability to magnify any symptoms. That being said, I have learned that my primary doc is really good about getting me in when I’ve waited too long and am stressed about it.

How long were you sick for? Either way, covid can take a lot out of you. I was only feeling cruddy (mostly easily winded and some dizziness) for a few days, but it was a slow road back to fitness (took a couple weeks before I was even in z2 for more than an hour). I was winded, and my HR was most certainly higher than pre-covid. Almost 2 months before I recorded my first ride with any z4 HR in it.

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