Rapid decrease in fitness, abnormal EKG, anyone with experience?

The EKG is much more important than any of the blood stuff.

Post got cutoff with the "less than" symbol. A letsrun message board error thats been around for how long?

Arggh, now I have to retype all of this.

D-Dimer - Non-Detect (detection limit was .27 ug/ml)

My results from my PCP did not mention the Abnormal EKG, just a referral to the Cardiologist. PCP recommended taking a week off from running, which I did. I also took the liberty of going on an iron supplement (liquid ferrous sulfate taken with V8 on empty stomach and isolated from other food.) I did this because, while my HCT and ferritin are within normal range, they are low for me and seem to be a likely culprit. I mentioned this to the Cardiologist (who is in the same practice) and he said that was fine and added it to my chart.

Tuesday, I had my cardiologist appointment and he checked a few things and referred me for resting and treadmill echocardiograms. I have those scheduled for next Thursday. I noticed that on the order form the reason was "Dyspnea upon exertion and Abnormal EKG." So I followed up with the medical assistant as I wasnt aware of the abnormal EKG. They said that I had T-Wave inversion in leads v1, v2 and v3. They said this can occur naturally in some adults, but that given my symptoms and this pattern, that is why I was being referred for the echos.

From what I know, it seems the best case scenario is that all of this is nothing, and my fitness will improve with iron supplementation and an increased hematocrit. It also seems like a lot of things would point to a Pulmonary Embolism, if not for the negative D-Dimer. I hate to think about what the alternatives are...

So does anyone have similar experience? Ive got a week before I get these echo tests and I'm just looking to learn from other peoples personal experience.

Last year, I was running pretty decently early in the summer but around July/August it went to hell. I was trying to train for an October marathon and I couldn't hit any pace targets that I was able to hit a month or so earlier, and I felt generally like total trash while running even easy. While this was happening, I was also having frequent heart palpitations. These had been occurring for several months, where I'd feel my heart pound for 3-5 beats out of nowhere, very sporadically, but had worsened during the summer so that it was happening every few minutes, it seemed. I did not notice it while running, but the rest of the time it was uncomfortable and annoying. I wondered if the downturn in running performance was related (or the palpitations were caused by running, too?) so went to my PCP who did an EKG. It was abnormal -- he said that it was either 1) there was an actual abnormality with the left ventricle, as it suggested, or 2) as an endurance athlete, my heart is exceptionally muscular, so the EKG was misleading, or 3) because I am so thin, the leads are practically touching my heart, and again led to a misleading result. Still, he recommended I wear a Holter monitor for a day and also have an ECG.

The Holter monitor detected "supraventricular tachycardia" where my heart would speed up for a short period of time, then correct. The ECG suggested an abnormality with the left ventricle. I met with a cardiologist at this point who suggested that the ECG may simply not have calculated the area of the left ventricle correctly, so wanted a more quantitative picture and sent me for a cardiac MRI. This was a major drill, a VERY uncomfortable 3 hours. But the MRI showed my heart is structurally normal. The cardiologist was not at all concerned about anything after that, did not think the palpitations had anything to do with running or if they were, they were not a concern, and told me not to change my lifestyle (i.e., keep running as much as I want if I feel good enough).

So the reason for the palpitations was never determined and the cardiologist told me I will basically just have to live with it. They diminished in frequency over time -- I do still feel them occasionally, but not nearly so frequently. I do feel a lot better running this year than I did last year, so I am not convinced there was no connection. But the cardiologist was so not concerned, I have just tried not to be concerned either.

I don't know how your heart issues will resolve, but I guess the moral of my story is that even if EKGs and ECGs show something, it might not actually end up being something. I'd be interested in how your tests turn out ....

Thanks a bunch for the reply and your story. I hope that's the last you ever have to deal with any of it.

Can you clarify one thing? Are you using EKG and ECG interchangeably or one for Echo and other for Electro? I asked cardiologist if ECG and EKG are they same and he said yes and are used interchangeably for Electrocardiograms. He said echocardiograms are referred to as echo's or ultrasounds.

I have been in the boat of having some abnormal heart readings, felt the anxiety, but ultimately cleared by a cardiologist.

Twice as an adult (between age 35-40) I went to the emergency room with chest pains while lying down, and diagnosed with pericarditis (the same thing that Centro suffered from). It is essentially an inflammation in the sac the surrounds the heart, and can be caused by viruses, autoimmune conditions, or other factors. For some reason I took it in stride the first time, but it freaked me out the 2nd.

Following the 1st occurrence I had an ECG (i.e. the ultra-sound) which came back perfectly normal. The 2nd time, I did not do the ultrasound, but had a few visits with a cardiologist with an EKG each time. This is off the of my head, but I think he said I had reverse re polarization, and he used another medical term I can't recall. I asked him about every way that I could if this was something dangerous, or had long term health consequences, and he reassured me each time, that this condition by itself was nothing threatening.

Anyway, you are right to take this seriously, but you may well have nothing to worry about (other than your October marathon not looking good). I have also recently experienced a severe bout of anemia, and in my case I wasn't able to hold 10 minute miles without walking every couple minutes. Once my iron was back up, I felt far better.

Through my research it seems that reverse re-polarization is likely the same thing as T-Wave Inversion, but I could be totally wrong. Right now this article is giving me some reassurance: http://electrophysiology.onlinejacc.org/content/jcep/1/1-2/92.full.pdf

I've noticed a heart palpitation thing myself in the last several years when training a lot in the summer heat.

BouldeRunner wrote:

Thanks a bunch for the reply and your story. I hope that's the last you ever have to deal with any of it.

Can you clarify one thing? Are you using EKG and ECG interchangeably or one for Echo and other for Electro? I asked cardiologist if ECG and EKG are they same and he said yes and are used interchangeably for Electrocardiograms. He said echocardiograms are referred to as echo's or ultrasounds.

The EKG was the electrocardiogram in the doctor's office ... the ECG was an echocardiogram. Sorry for the confusion, but my doctor(s) said both "echo" and "ECG" for it.

heart troubles wrote:

The EKG was the electrocardiogram in the doctor's office ... the ECG was an echocardiogram. Sorry for the confusion, but my doctor(s) said both "echo" and "ECG" for it.

Well if Doctors cant agree on what to call these tests, how the hell are letsrun posters supposed to figure it out!

This is good information, because I think I'd get really worried if the Echo tests came back with bad news, but it sounds like even if that happens, it may still be nothing.

BouldeRunner wrote:

heart troubles wrote:

The EKG was the electrocardiogram in the doctor's office ... the ECG was an echocardiogram. Sorry for the confusion, but my doctor(s) said both "echo" and "ECG" for it.

Well if Doctors cant agree on what to call these tests, how the hell are letsrun posters supposed to figure it out!

This is good information, because I think I'd get really worried if the Echo tests came back with bad news, but it sounds like even if that happens, it may still be nothing.

I guess it just depends on what the abnormality is (if there is one). Mine said the left ventricle was abnormally shaped but the way it calculates volume for that side is just not well-defined. If they end up putting you through the cardiac MRI, ask them to tell you exactly how the procedure will go for you, because they did not tell me and I wasn't really mentally prepared for the hours of intermittently holding my breath inside the MRI tube. I hope it turns out OK for you. I think in general it's scary to have heart issues hanging over one's head, but as I told my doctor, "I'm a runner, I need my heart."

ECG = EKG

Echo = echocardiogram

It takes courage to reach out with these concerns. One of the primary aspects of reading an ECG, and this applies perhaps more so to somebody with your fitness, is to look at prior ones. If this is not available, you may be onto something with the lower Hgb/Hct values. Note that t-wave inversion is a complex subject, with possible benign and non-benign implications. This should be sorted fully by the cardiologist.

It would also help to compare your current MCV (red cell volume) to previous ones. An RDW increase could also point to potential causes. Lastly, be mindful of testosterone levels, as testosterone does contribute to red cell production.

You ferritin is absolutely in the gutter. You want it to be up around 100+. Should be taking at least 3mg/kg/day of elemental iron.

justafewthoughts wrote:

It takes courage to reach out with these concerns. One of the primary aspects of reading an ECG, and this applies perhaps more so to somebody with your fitness, is to look at prior ones. If this is not available, you may be onto something with the lower Hgb/Hct values. Note that t-wave inversion is a complex subject, with possible benign and non-benign implications. This should be sorted fully by the cardiologist.

It would also help to compare your current MCV (red cell volume) to previous ones. An RDW increase could also point to potential causes. Lastly, be mindful of testosterone levels, as testosterone does contribute to red cell production.

No prior ECG available to compare to. I was definitely relieved to see that I have a higher likelihood of the benign implications based on the above linked article. Thats definitely eased my stress.

Mean Cell Volume is at 93.9 currently. This isn't an indicator I am familiar with and I don't have my previous labs in front of me for comparison. Any help is appreciated.

What is RDW?

Im currently on about 1/6th of the elemental iron recommendation mentioned above. I feel like I would want to ask my doctor before taking that much iron. Aren't there risks associated with that big of a dose?

BouldeRunner wrote:

[quote]justafewthoughts wrote:

Im currently on about 1/6th of the elemental iron recommendation mentioned above. I feel like I would want to ask my doctor before taking that much iron. Aren't there risks associated with that big of a dose?

Yes, you risk feeling a lot better.

Assuming you're about 70-80kgs, if you're taking 35-40mgs/day of elemental iron it's going to take "forever" to get your levels up in the 100 range. I've read through a ton of the available literature and the upper range of supplementation is 5mg/kg/day in studies that have to be approved beforehand to ensure they aren't risky from a medical standpoint. If you're currently at .5mg/kd/day and not having GI issues, go up another .5mg/kd/day each week, paying close attention to your regularity.

Your doctor is going to tell you that's too much, that much is almost a guarantee. I can also just about guarantee they haven't read any of the thousands of studies regarding ferritin and endurance athletes and so have no clue as to what information is available.

Had a similar issue this summer. After 30 minutes was just exhausted. Had an abnormal EKG. Went to two cardiologists. Second one diagnosed Wolff Parkinson White syndrome that involves an extra electrical impulse. Having an ablation soon.

Yay.

Thanks to everyone who chimed in on this.

My echocardiogram and treadmill ordeal came back normal. No signs of hypertrophic cardiomyopathy, which would be the main concern with the t-wave inversion. Doctor said, that with that ruled out, there isnt much of a reason to keep chasing the source of the t-wave inversion.

Additionally, with further discussion, we're on the same page that the hct/hgb and ferritin are the culprit for performance. Fortunately Ive been able to get to 45.8 hct, and 35.1 ferritin in 6 weeks. He said thats a great response to the iron supplement, but that 40 is necessary to not feel the effects and 50 should be the goal to have a buffer. That bump in hct is proportional to the minor gains in fitness I have seen recently as well.

He also is pretty well-versed on iron absorption and said that there is recent evidence that every other day, is better than every day. He also said that .5 mg/kg is a LOT, and not to take more than that. I did a few days of 10 ml and it did a number on me digestively, so Im happy with this plan.

Definitely sounds like low iron. I was referred to a cardiologist when I had dizziness, intense fatigue in training. My heart was totally fine.

Take iron with vitamin c, as it helps with absorption. I usually take it before bed (empty stomach, not interfering with my diet). Give it a few weeks to feel better. Sounds like you're well on your way!

Ferritin is too low. You want it to be closer to 100