Health question for cardio experts

56 is getting up there

need to order RBC Mass to really eval.

might need phlebotomy

I say start Aspirin 325/day

JMO

First, I am not a cardiolgy expert but am a physician with some background in exercise physiology.

It is not clear to me if the hgb level and the HR are related. The hgb should not go up in respone to a cardiac condition unless it somehow resulted in chronic hypoxemia, which is less common in cardiac than in pulmonary conditions. A right-to-left shunt caused by a cardiac abnormality, could cause this and possibly be related to both. Some primary blood disorders (polycythemia vera) can lead to an elevated hgb and would be expected to cause excessive fatigue, but I am not aware of any association with a low HR.

The low HR by itself may be physiologic, but the HR increase to only 85 with exertion, particularly if there is feeling more winded, is definitely abnormal unless your friend is on a medication such as a beta blocker. Multiple cardiac abnormalities could cause this problem.

I think that an EKG, an echocardiogram, and an oxygen saturation would be helpful in figuring out the problem. I don't think that anyone will be able to give you an honest answer to whether or not it is okay to train harder without knowing the results of these.

Thanks for the responces so far. We ran an EKG and as I mentioned the only thing that showed was the PVC, one of those things that people live with everyday. We know some local docs that may sneak him in for an O2 saturation test. I will bounce all your ideas off him tomorrow and will keep you all posted.

Could the elevated hematocrit be "athlete's anemia" at work? Should we test him for iron? He doesn't really complain about fatigue though, just the being winded while running outside his comfort zone. I should prolly mention too that there is no way this guy is dehydrated.

You might want to consider the possibility that your friend is magnesium deficient and hypometabolic following his substantial weight loss.

Those PVC's are a possible symptom of magnesium deficiency of course; and magnesium deficiency does sometimes affect iron loading -- he could be overloaded, and some of that is influencing his hematocrit. Magnesium has a role in glycolytic energy production and also in clearing calcium from the muscle cell following muscle contraction. If he isn't clearing calcium (review particularly the function of the SR)his active muscle could be experiencing increased oxidative damage. My guess is he's just shutting down as a protective mechanism, with a sort of mild hypoxia. A lowered resting metabolism would confer many advantages in this scenario. And that mild hypoxia might push up his hematocrit.

I wouldn't faint to hear that your friend is a bit insulin resistant right now. Another possibility is that his low magnesium levels have decreased the functioning and durability of those RBC's so the 58 is misleading; the real question here is is that oxygen getting unloaded. Not necessarily. Reminds me of that Youtube clip of people getting stuffed into trains in Tokyo. More RBC wouldnt necessarily be better.

I would guess this is not a good time to increase his training load. In a 45 year old endurance athlete, you want

to look for a high HRmax, not a blunted HR response, which could be confused with favorable training adaptations.

If you have any other questions, you can email me.

dsrunner

dsrunner@juno.com

http://www.ironoverload.org/diagnosis.html

Another suggestion I have would be to check the maximum heart rate. As you probably know, it should be 220-age which would be 175. Anything too far off this suggests a problem. The other findings (low resting HR and high hgb) may represent problems but could also be normal varients. I don't think that an iron level would help unless you are concerned about iron overload, which is a fairly uncommon condition that would likely have other manifestations than the ones you described. As you said, PVC's tend to be a benign finding and are not likely related to this problem.