Abby Normal
I’m not a doctor, so I’m not going to try to sound like one. I’m going to resist the urge, for today anyway, to use words like “atrial fibrillation” or “bradycardia.” But I don’t have to be a doctor to observe that sometimes my heart behaves in predictable ways, and sometimes it goes wildly off in unexpected directions. Sometimes if I feel my pulse, for example, I can feel a strong, steady, regular heart beat. I’m calling that “normal.” Sometimes though, the beat is not regular at all. I might feel three steady beats in a row, then a long pause, or maybe two beats coming very close together. Sometimes this irregular pattern might last for hours. This is not normal.
It seems to me that this is a problem primarily with rhythm. My heart can’t keep a steady beat, but over time, the rate (in beats per minute) is usually reasonable, given whatever activity I happen to be engaged in. This is problem number one. I notice it most often when I’m sitting still. It is a (usually) subtle feeling in my chest, it is obvious with my finger on my pulse, and it is easy to spot in an EKG. I believe that it is a precursor to problem number two, so I’m going to refer to it as "Stage 1."
You don't have to be a cardiologist to see the irregularity in the beat pattern
I like running quarter mile repeats, although my speed these days isn’t what it used to be. Regardless, when I run faster, my heart rate speeds up. When I stop running, and my heart rate immediately begins to slow down, I call that “normal.” Sometimes though, it doesn’t slow down, it actually speeds up, sometimes up to ridiculous numbers like 185 beats per minute. That isn’t normal.
This would appear to be a problem primarily with rate, although there is most likely a rhythm component as well. If I happen to have my Kardia handy during one of these episodes, it will tell me that I’m having “possible atrial fibrillation” . This is Stage 2. I associate this problem with exercise. That’s probably because I wear a heart rate monitor when I exercise. It might happen when I’m not exercising, but I’m not sure I would notice it. It’s also possible that it only happens when I exercise. Either way, it doesn’t last long.
Yikes!
Twice, while working out, and wearing my heart rate monitor, my heart has unexpectedly slowed down, slower even than my resting heart rate. This also seems to be a rate problem, but I’m not sure. I haven’t been able to capture it yet on an EKG.
So, there are three possible outcomes when things go wrong:
Stage 1: an irregular rhythm, even though the rate is normal
Stage 2: an inexplicably high heart rate, and probably also an erratic rhythm, usually triggered by exercise
A problem with a low rate, which is rare enough that I’m not going to worry about it
The good news is, I’ve been experiencing less of all of these things lately. I went through a discouraging period of a few weeks where it seemed to happen all the time. The irregular thumping in my chest became part of my body’s background noise, and the wild racing of my heart occurred with nearly every attempt at movement faster than a walk. Out of desperation, I tried every remedy that I had the power to implement, all at once. I cut out all caffeine and alcohol. I started taking magnesium supplements, pills that were leftover from a prescription given during my recovery from heart surgery. Two or three times a week, I ate marine n-3 polyunsaturated fatty acid-rich sardines for breakfast. I don’t know if it was one of these things, all of them, or some combination, but it seemed to do the trick. My heartbeat became noticeably steadier, and I was able to run again with some confidence. I thought, for a little while, that I had cured myself.
I feel my pulse frequently throughout the day, and count to fifty. Most of the time, I feel fifty strong steady beats. I don’t have good data on this yet, but I think that If I had a couple of beers last night and a cup of coffee this morning, the odds are greater that during my fifty-count I’ll feel a skip or two. I don’t know if it is one or the other or both, but I’m in the process of collecting data on this. Early returns suggest that beer is a more potent trigger than coffee.
When I say “most of the time,” I mean sitting at a stoplight, watching TV, or after taking my blood pressure in the morning. If I do the pulse test while I’m exercising (and I’m not counting walking here), even if things are going well and I’m feeling good, and there’s no suggestion of atrial fibrillation, if I do the pulse test, my heart rhythm is all over the place. If I do an EKG it usually says “normal,” or maybe “unclassified.” If I wait a minute or two and try again, things return to normal. Today I did my favorite workout, running 400 meters relatively fast, and walking until my heart rate goes back down to 100. During the walking recovery period after the first 4 “repeats” I did the 50-beat pulse test, and the skip-count was as follows: 8, 10, 5, 20. These numbers may be off a little, because I’m challenged by the task of counting to fifty and at the same time counting skipped beats, but you get the idea.
Sometimes during exercise, all hell breaks loose, and we go from Stage 1 to Stage 2. If I’m wearing my heart rate monitor, it shows my heart rate going up even if I slow down or stop. If I do an EKG, it usually says “possible atrial fibrillation.” Things usually go back to normal within a few minutes of walking it off. In this EKG, I happened to capture the moment when things went from chaos to relative order:
The longest episode I’ve timed happened last week, and it lasted 12 minutes. I’m not entirely sure, but I think I can make it go away faster by taking in a big breath, holding it, and puffing out my chest, Incredible Hulk style. But it doesn’t always work. There may be some logic to it though. There’s something called the “Valsalva Maneuver,” one of several strategies called “vagal maneuvers” that somehow affect the vagus nerve in a way that results in a slower heart rate. To perform the Valsalva Maneuver, do this: “Hold your nose, close your mouth, and try to blow the air out. This creates pressure in your chest that may activate the vagus nerve. Sitting or squatting may help. Try it for 10 seconds.” On a related note, when I run slowly, I typically inhale for three steps and exhale for 2 (for good reasons that I may address in a different post, but which make it nearly impossible to listen to music while I run), and when I run fast I inhale for two steps and exhale for one. During this period of heart surgery recovery, I avoid as much as possible going from a 3/2 pattern to a 2/1 pattern. When I’m going at a faster pace than a jog, this forces me to inhale deeply each time, the effect being a mini-valsalva maneuver on each inhalation. It also provides a natural intensity-limiter. I can only go so fast while maintaining a 3/2 pattern. As a result, I think I am less likely to go from Stage 1 to Stage 2. At least that's my current working hypothesis.
Sometimes Stage 2 happens even while I’m just doing easy warm-up jogging, and sometimes if I go ahead and run fast anyway, Stage 2 goes away.
More often, Stage 2 happens after I’ve been going harder for a while. Usually I stop and go home when this happens. But if I try again a couple of hours later, I can usually get in a good workout without any problem.
All of this becomes moot, given a little little luck. Next week I'm scheduled to have a cryoablation. This is a minimally invasive surgical procedure that is part voodoo and part techno-medical miracle, where they intend to snake tubes through blood vessels in my legs, use them to poke a couple of holes in my heart, insert a balloon, fill it with liquid nitrogen, and use it to freeze the life out of the assemblage of cells that they think are causing my heart to misbehave. My cardiologist is very confident, and has used, more than once, the word "cure." That's great, if I ignore the possible complications, which include inadvertent perforation of the heart, stroke, heart attack, narrowing of the pulmonary veins, damage to the esophagus, bleeding at the entry site in the leg, death, and...wait for it...atrial fibrillation.
I'll write my next post from the other side. Fingers crossed.