Vigorous exercise under the influence…

[Louis]

… of nasal decongestant ???

Last Wednesday (March 27th) I was at the end of one of the harder 2k rows I’ve done lately and since I typically sprint the last 500 or so meters, at the end my HR (displayed on the C2 rower, based on data transmitted by my Garmin chest strap) peaked at 171 bpm. (In my two previous, a bit less intense, workouts my max had been 167 and 168. These days I’d guess that my absolute max HR is in the low to mid 170s.) After the distance counted down to 0, I did what I usually do, which is take a few seconds to catch my breath, then I glanced at the HR display to see how well that was recovering, and to my surprise, instead of starting to come back down it was well over 200 bpm.

I checked the chest strap and the contact was good and the display still above 200. Other than being wiped out due to the effort, I felt fine and normal (for the end of a hard row). I then took my pulse manually at my wrist, and sure enough, it felt as if there was something irregular going on. Finally, maybe 30-60 seconds after I’d stopped rowing, I saw that my HR had dropped down to around 130 bpm, and it then continued going down.

Because I felt 100% normal I wasn’t too worried, but since it could potentially be a serious thing that a) could affect my health, or b) affect my training, I didn’t just dismiss the whole thing as nothing, or “bad data” from the Garmin. It then occurred to me that earlier that day I had taken a new-to-me nasal spray decongestant (Mucinex Sinus Max nasal spray, which contains oxymetazoline hydrochloride – see links below for more info) not because I had a cold, but to clear my left eustachian tube, which was blocked up. (I'd never taken this before, but I was going to fly to Boston on Thursday and the last time I flew with a cold and couldn't clear my ears the descent was very painful, so I took the decongetant to Wednesday as a test to see if it would help with my ear, and as it turns out, it did a good job of that. Normally if I have a cold that's bad enough to require decongestant I'm not going to be exercising much, if at all, but this time I didn't have a cold and was going pretty hard.) I looked up the nasal spray and found what you see below.

Yesterday I did another session on the erg (without any decongestant) and limited my HR to 150 BPM and had no issues at all. On Monday I have an appointment with my PCP, and we’ll see what he thinks of the situation. I’d like to do a stress test to see if they find anything strange and confirm that I’m fine.

Has anyone had something similar happen to them?

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https://www.mucinex.com/products/muc...-sinus-allergy

https://www.drugs.com/sfx/oxymetazol...e-effects.html

Serious side effects of Oxymetazoline nasal

Along with its needed effects, oxymetazoline nasal may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking oxymetazoline nasal:

• Blurred vision
• fast, irregular, or pounding heartbeat
• headache, dizziness, drowsiness, or lightheadedness
• high blood pressure

For Healthcare Professionals

Applies to oxymetazoline nasal: nasal solution, nasal spray.

Cardiovascular
Very rare (less than 0.01%): Tachycardia, palpitations, increased blood pressure

[2LeftCleats]

Regardless of whether or not the nasal spray caused it or it’s a Garmin glitch, I agree with getting an evaluation. Might or might not include a stress test, but a heart monitor worn for a period of time might provide more info.

[hypnos]

Normal heart rhythms cannot usually reach rates that high. It is possible that your 200+ HR was due to a dysrhythmia such as atrial fibrillation, atrial flutter, atrial tachycardia, or some form of supraventricular tachycardia (SVT). An ECG during the event would be necessary to diagnose. These abnormal rhythms can be triggered by systemic decongestants (pills) like pseudoephedrine. As my age advanced, I stopped using this med. On the other hand, oxymetazoline nasal spray is a pure alpha agonist that, when applied topically, constricts blood vessels in your nasal mucosa. Systemic absorption should minimal. Whatever drug that does get absorbed would not act on beta receptors in your heart. Stimulation of the beta receptors makes your heart beat faster/stronger, and can trigger tachy dysrhythmias. Therefore, your 200+ HR was probably unrelated to your use of oxymetazoline nasal spray. As a disclaimer, I'm just a knuckle-dragging anesthesiologist. Maybe there is a cardiac electrophysiologist here who could weigh in.

Cheers

[thwart]

Originally Posted by 2LeftCleats

Regardless of whether or not the nasal spray caused it or it’s a Garmin glitch, I agree with getting an evaluation. Might or might not include a stress test, but a heart monitor worn for a period of time might provide more info.

Looks like sound advice to me.

[buddybikes]

chill it down till you get medical opinion

[Louis]

Updates:

Originally Posted by hypnos

Systemic absorption should minimal.

Re: ^^^^ My PCP said the same thing. However, I assume (hope???) that there must be some absorption, since serious vascular issues are on the list of potential side-effects.

My PCP ordered three different things:

1) Three blood tests. I don't remember what they were all for, but one was for thyroid function. Done. I'm waiting for the results.

2) Stress test. He agreed that normally they wouldn't let me get my HR anywhere near the level where the issue occurred, but that there would be a cardiologist there, and they might be willing to tweak their protocol based on the purpose of the test. That's scheduled for a week from today.

I'm interested for three reasons: 1) It will hopefully allow me to talk to a cardiologist in person, 2) Depending on the issues at play, their instrumentation may allow them to gather useful data at lower heart rates that will either point to or eliminate diagnoses, without having to go to 99% of my max HR. I plan on specifically asking about that. 3) I will also ask them about the third thing below.

3) Holter monitor. I'm going to wait until after the stress test to decide on how to handle this one. There are at least two complicating factors: A) Without going through a lot of trouble, I can't wear one at work, so I'd have to do it over the weekend, and B) It isn't clear how hard I should push when I work out wearing the device. I'll ask the cardiologist at the stress test about that. Typically there isn't anyone else in the gym when I work out, so if there is a problem the machine may know, but if for whatever reason I keel over it won't be able to tell anyone about it. Obviously, I want to collect as much data as reasonably possible, but don't want to damage / kill myself doing it.

So, I'm going to have several workouts between now and the stress test. In the workouts I've done since getting back from Boston my avg and max HRs were avg = 147 max = 150, and avg = 155 max = 157. On the first one I limited myself to 150 max. In the second I was a bit more aggressive but backed off when I got to 155. I overshot a few times, which resulted in some time at 157. For my next few workouts I'll probably again limit myself to 155 for the first one, then 160 bpm.

Final comment: my PCP asked if I'd done any workouts since the issue first occurred and what happened. He didn't say anything like "You really need to be careful - I wouldn't do that again, if I were you." So, either he doesn't really care what happens to me (unlikely) or he doesn't think that I'm at a high risk of doing serious damage. He did say one did not necessarily need to go full bore in a workout, but I pushed back, saying that if you want to improve over time you do need to work hard(er). He did not say "You're nuts!"

More updates as warranted. If my posts on the forum suddenly stop, you'll know why...