concerning echocardiogram results FINAL UPDATE 3/12/2024

[DHallerman]

I have an echocardiogram test scheduled in two days because, it seems, my afib might be coming back after surgery on it (catheter ablation) 13 years ago.

After reading the posts above, I wonder how stressful they’ll make my echo this week. I hadn’t considered the test could undershoot for active people, like us cyclists.

Dave

[TimD]

Originally Posted by hammerdocnomo

Important you know the signs and symptoms of Aortic Dissection and the importance of immediate care.

Typically the symptoms of it are sudden, severe chest or upper back pain described as a tearing or ripping sensation that radiates up into the neck or down the back. In your case you will need immediate emergency care without hesitation. Good luck.

I very recently had a conversation around this topic with a top cardiologist at Mass General. The practical advice I received was to call 911 immediately and tell them you are having an aortic aneurysm and need a CT scan immediately. Tell the same thing to the first people you meet at the ER. This will get you to the front of the line and drastically increase your chances of survival.

Interesting conversation.

Good luck. Just ride slowly and enjoy yourself.

Tim

[tv_vt]

OP, not sure if I saw what symptoms you were noticing that started you on this journey. What have you been feeling that made you concerned enough to start worrying about what was going on with your heart? Just curious what signs you felt.

Wishing you the best going forward. It's good you're on top of this.

[carpediemracing]

I don't have much to add other than to take things seriously.

I was talking with a local rider recently and learned that three cyclist deaths in the last few years that no one really talked about were all due to heart issues. Fitness was good to excellent, oldest was in their 50s, all three had some idea that something was happening with their hearts, and they all passed before they could get more definitive checks done.

Apparently I have an inverted T wave, or something like that. My then doctor suggested I carry a printout of my echocardiogram with his note on it (that it's normal for me to have this kind of heart beat) so if I get knocked out, the responding medical people don't think I'm having a heart attack. Alternatively, he suggested that if I want a day or two off, to go into an ER rubbing my chest and complaining of chest pain. The ECG would show a heart attack (? I'm not sure if that's necessarily 100% correct) and the hospital would have to hold me for observation.

I did a stress test, I was at threshold for forever, absolutely gassed, the crew working the medical place all came over to watch, and finally someone said that I'd done enough. They said a runner had come in and gone higher, but most of their patients weren't very fit. The treadmill I was on was labeled with a max weight, I think 450 lbs. There was another labeled 550 lbs. So those were the kind of folks they normally saw.

[rnhood]

Originally Posted by DHallerman

I have an echocardiogram test scheduled in two days because, it seems, my afib might be coming back after surgery on it (catheter ablation) 13 years ago.

After reading the posts above, I wonder how stressful they’ll make my echo this week. I hadn’t considered the test could undershoot for active people, like us cyclists.

Dave

I also had an ablation 13 years ago and, my afib comes and goes but doesn't require cardioversion. Whether you need a follow up ablation will depend on how bad or often the afib surfaces, how long the episodes last and whether or not they require cardioversion. My episodes don't last over 4 hours typically, and don't require cardioversion therefore it doesn't require any action. I wouldn't worry about a follow up ablation though, because approx. 60% of people who have had an ablation end up getting one more. It's just not uncommon. I speak mainly of paroxysmal afib, which doesn't have underlying heart defects.

[ldamelio]

Recently retired surgeon here with relevant specialty expertise. Your aortic root issue is quite different from the more common issues we face as older cyclists - a-fib and coronary calcification that can be hard to differentiate from and may overlap with coronary atherosclerosis.

Aortic root issues are both far less common and more difficult to prognosticate/treat than these other things. Expertise is rare and concentrated in a few leading academic medical centers.

The Cleveland Clinic is the world epicenter for complicated cardiovascular issues like this. I would be headed there with your echo results.

[dr50470]

As a PCP practicing in CT Yale New Haven has a CV surgeon that we used throughout the years for aortic root repairs/replacements.....https://medicine.yale.edu/surgery/ca...-elefteriades/
Patients loved him and his results were excellent.
Good luck and stay fit if you are anticipating surgical intervention.

[teleguy57]

Originally Posted by ldamelio

Recently retired surgeon here with relevant specialty expertise. Your aortic root issue is quite different from the more common issues we face as older cyclists - a-fib and coronary calcification that can be hard to differentiate from and may overlap with coronary atherosclerosis.

Aortic root issues are both far less common and more difficult to prognosticate/treat than these other things. Expertise is rare and concentrated in a few leading academic medical centers.

The Cleveland Clinic is the world epicenter for complicated cardiovascular issues like this. I would be headed there with your echo results.

Thanks for sharing your expertise, @Dr50470 and @ldamelio. After my initial visit with the leading cardio group here CC is top of my list.

[jcs7282]

Originally Posted by callmeishmael

My only suggestion would be to look for a sports-literate cardiologist. Many will be used to dealing with a sedentary patient group and their default position may simply be 'don't' when it comes to hard exercise, simply because they have rarely been faced with a patient with your lifestyle.

Good luck.

This ^ 100%. I am only 40 but have cycling/endurance sport-related cardio issues that surfaced in my late 30s. Ultimately, I am OK, but if I saw a standard cardiologist instead of a sports/performance-oriented specialist, the interpretation of my conditions (and path forward re: return to activity) could have been very different.

It's a long way from home for you, but the Mass General Cardio Performance center is probably among (if not the) the best of the best in the game. The number of signed olympic/professional sport jerseys addressed to / thanking the doctors inthe practice for their help that are decorating the walls there are confirmation of that.

[OtayBW]

Originally Posted by flying

This is a real problem these days & I know their busy but......Like you we all need to be vigilant

Yes!

Originally Posted by callmeishmael

Interesting; in the UK, I believe standard practice is that you must hit 90% of your theoretical max HR, or declare yourself too exhausted to continue, for a test to be valid (of course, assuming no adverse changes are visible prior to reaching that point).

I would also urge that any cardiac tests, even standard ECGs where possible, are performed by a cardiologist. I have a (benign) heart conduction abnormality that shows as a non-typical ECG pattern. It was first interpreted by my primary care GP as evidence of a historic heart attack, something dismissed by a cardiologist in <5 minutes. While all's well that ends well, the ~7 days waiting for an appointment were not fun.

To keep this to the OP's question, it's another example of the importance of ensuring you see an absolute expert if you have the opportunity.

Yes. Interesting.

[OtayBW]

Originally Posted by markie

I too get some heart pain when going all out. I did a dress test a while back and they cut that early before I really got maxed out. But last year I did a stress echo and they let me go till I was about to pass out. They didn’t see anything which I guess is good and some peace of mind. I made sure that it was clear with my doctor and the stress echo team that there was only any point in it if I could max out. Luckily everyone was on board. That was in Umass in Worcester.

That's where I went! After my first stress test that failed >MHR, they scheduled me immediately for a cardiac cath at UMass Wocester. Cardiologist was confused because I 'came up clean as a whistle'. This led to several other nuclear etc., stress tests that all came up with that same (failed) result at >MHR. I ultimately got a clean bill of health from 3 Cardios and went on to ride many thousands of miles in the years to come - of course, with plenty of climbing and time >MHR. So, go figure. It's just that the local Dr gives me a 10 min stress test after pronouncing that I had a heart attack recently which, I think, was completely inadequate.

Sorry, back to your regular programming....

[flying]

Originally Posted by DHallerman

I have an echocardiogram test scheduled in two days because, it seems, my afib might be coming back after surgery on it (catheter ablation) 13 years ago.

After reading the posts above, I wonder how stressful they’ll make my echo this week. I hadn’t considered the test could undershoot for active people, like us cyclists.

Dave

For myself seems like when it comes to PAC's or PVC's didnt matter.

Back in August I had a real tough cyclist stress test/ echo at a Sports cardiologist & they couldn't reproduce my odd deal I had all thru July

Now after 5 month of no problems its back for the past two weeks random spikes to 200bpm but at least their just spikes that only last a second or two each.

The tough part is actually getting into a cardiologist while its happening

[teleguy57]

For those suggesting sports-specific cardiologists, how does one identify them? Is there a specific certification, training or designation to look for? Or is it more asking questions, and if so, what to ask about? When I review the bios on the cardiologists in our local group there are some comments about them individually being runners, rowers, etc. but none of them specifically state anything about athletic focus of their study or practice....

Originally Posted by tv_vt

OP, not sure if I saw what symptoms you were noticing that started you on this journey. What have you been feeling that made you concerned enough to start worrying about what was going on with your heart? Just curious what signs you felt.

Wishing you the best going forward. It's good you're on top of this.

No acute symptoms; have had occasional PSVT episodes since I was in my early 30s; had an echo 10 years ago with a new primary care doc given a family history of some CV stuff. At my regular checkup early January we decided since I was experiencing a few more SVT bouts and it was 10 years since my last echo we should add that the mix. And thanks.

[OtayBW]

Originally Posted by flying

For myself seems like when it comes to PAC's or PVC's didnt matter.

Back in August I had a real tough cyclist stress test/ echo at a Sports cardiologist & they could reproduce my odd deal I had all thru July

Now after 5 month of no problems its back for the past two weeks random spikes to 200bpm but at least their just spikes that only last a second or two each.

The tough part is actually getting into a cardiologist while its happening

You can have them outfit you with a Holter monitor which collects (and records) data in real time as you wear it over a ~day or two.

[DHallerman]

Originally Posted by rnhood

I also had an ablation 13 years ago and, my afib comes and goes but doesn't require cardioversion. Whether you need a follow up ablation will depend on how bad or often the afib surfaces, how long the episodes last and whether or not they require cardioversion. My episodes don't last over 4 hours typically, and don't require cardioversion therefore it doesn't require any action. I wouldn't worry about a follow up ablation though, because approx. 60% of people who have had an ablation end up getting one more. It's just not uncommon. I speak mainly of paroxysmal afib, which doesn't have underlying heart defects.

Thanks for your note, and yes paroxysmal afib for me. After seeing the results of my wearing a Holter monitor, my cardiologist told me to revisit the doctor at NYU-Langone (Chinitz) who did the surgery in 2010, the cardio saying for a “touch up” and noting how better tools today (not unexpected) but it still might be the same 7-8 hour job as before.

But if the heart rhythm doctor agrees, I’m ready for another surgery because afib interferes with my cycling in two big ways: I go slower, especially on uphills, because too often I start feeling tightness in my chest. And now, since the cardio told me to go on a blood thinner (Eliquis, better than the old rat poison) to decrease the odds of a stroke, I feel a need to be more cautious than usual on my bike, with bleeding more likely if an accident occurs.

Dave, who couldn’t get an appointment with Chinitz until the end of March which maybe says something about the prevalence of heart rhythm problems like afib and the American medical “system”