Sinus Arrest in Trained Athletes

May 13, 2011
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I've got a question for the forum.

Recently a good friend had a series of sinsus arrests (sinus node dysfunction) resulting from a vaso vagal synchronicity problem . He is a mid-40's trained non-elite athlete (skier, runner) who is in very good shape (has been so for 10 years) and recently set lifetime running personal bests. After a multitude of tests, the doctors could not isolate the specific cause of the issue, bringing it to unknown cardiac origin. All incidents occured while sitting or standing, never during exercise and not necessarily related to recent heavy exercise.

Treatment (after 10 days in hospital) was a choice between a pacemaker (which apparently only works in a portion of cases like this) and ensuring that he stays well hydrated with a saliine solution. The second was chosen for the time being. No incidents have occured since release.

No genetic issues whatsoever related to cardiac problems before age 90. He (and others in the family) have a history of leg cramps during exercise and high levels of sweating (one sibling has ended up in the hospital/medical tent a few times from excessive electrolyte loss after exercise). No clinic related issues or tendencies either.

Does anyone have any understanding or information about this form of sinus node dysfunction, particularly as it relates to trained athletes? Any help or links would be appreciated.

Thanks.
 
Jul 17, 2009
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Random Direction said:
thanks - some good links - unfortunately not much specific discussion that I could find on the specific issue.
join and post and check in and add as you will find and share info.

Allow me to suggest that the mountains of empirical evidence form study all these doctors have are based on the general population and cardiovascular disease. finding a Doctor with experience with endurance athletes is difficult but even so their sample survey in each area of study at that level is too small to be conclusive.

Has your friend been referred to an electro- physiologist?

Interesting you mention hydration. I am no doctor. but there is a renewed interest of research on the effects of dehydration on our electrical system

I know this is not your diagnosis (v tach) but here is a link to a cyclist with electrical issues. he blogs his prognosis http://v-tach.blogspot.com/

Also google Hayden roulsten http://haydenroulston.co.nz/ He is a former Kiwi cycling champ who had eletrical issues (now with Trek-shack) and was told to abandon the sport. He chose to go with a holistic health approach called Reiki and he says he is cured
 
May 13, 2011
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boeing - thanks. I'll dig in more tomorrow - time to hit the hay tonight. It seems like it is some weird electrical issue for him. Since my better half is a Reiki Master, I'll ask her for her thoughts.

Not sure if he was referred to an electrophysiologist - will ask him.
 
Mar 12, 2009
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Medical diagnosis aside perhaps a re-assessment of physical activities is in order. Maybe shorter more fast twitch based pursuits? Not all are cut out for endurance.
 
Jul 17, 2009
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Tapeworm said:
Medical diagnosis aside perhaps a re-assessment of physical activities is in order. Maybe shorter more fast twitch based pursuits? Not all are cut out for endurance.
this is an interesting point and worth more study
 
Nov 25, 2010
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PROSTATE ....
At age 'mid-40s' this probably doesn't apply to your friend, but can for us 'older guys'.

Age-related enlargement of the prostate can cause the need for frequent urination during usual sleep hours.
If one reduces their intake of water in an attempt to prevent having to 'get up during the night', it might result in inadequate hydration - especially if complete re-hydration has not be achieved from prior exercise.

I used to restrict my water intake for several hours prior to going to bed, but I now actually have better results drinking several cups of decafe green tea during the evening prior to going to bed.

Jay Kosta - age 63
Endwell NY USA
 
Jul 17, 2009
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Jay if Reiki worked for Roulsten maybe Tantra works too :eek: can I get a script for that?

Random Direction: Did you consider the irony between your thread and your username?
 
May 13, 2011
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Yeah I noticed how it took a right turn to Prostate and then a u-turn to Tantra. As for the fast vs slow twitch side, sure he probably was more meant for rugby than running, however it is hard for an endurance athlete to kick the habit after 25 years :)

Should be interesting to see what the sweat test comes back with.
 
Jul 17, 2009
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http://www.cyclingnews.com/news/reborn-walker-overcomes-tachycardia-makes-return-with-drapac

the lack of information related to heart conditions in endurance sport is interesting to me and good RD brought it up again here.

You would think athletes like Roulston, Kirchen and Walker now and Perhaps even a Len Bias could offer researchers a case study or atleast share with the public how they managed or didnt manage symptoms.

How can a news story from CN about a potential complete recovery comeback from Tachycardia like Walker here not attempt to ask about the past diagnosis and symptoms management that prompted recovery?
 
May 13, 2011
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Thanks Boeing - I saw that as well. Though my friend's condition is not Tachycardia (in some ways it is the opposite - all of a sudden the heart stops beating and then the other natural pace makers kick in and it starts again) given his general health it would be the last thing that one would expect. The only couple of weird things are: (1) excessive sweating during exercise; (2) muscle cramping during long runs and marathons; (3) his heart stopping randomly while at rest; (4) setting PBs in mid-40s after years of trying to reach a time goal.

Hell, we even tried to replicate what occured in hospital (with me on the phone), but the self carotid massage didn't work - probably because the issue was from the heart, not the artery.

Yes, a good in-depth study or CN article on the issue, potential causal factors, correlations, and symptoms management would have been good - particularly since this thread had just started going.

Would love it if Roulston, Kirchen or Walker could share their stories here - might help some others.
 
Jul 17, 2009
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We lost a friend of here in OC yesterday on the Coffee Crew ride

RIP

That is now 3 life changing events in the local cycling world that I am aware of. this one ended in tragedy. really sad day. the heart is a complicated organ. sometimes you just never know

Respects to friends and family
 
May 13, 2011
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Respects and condolences indeed.

Luckily my friend is going strong, having skiied over 100 km last weekend - the issue for him is only at rest.
 
Jul 17, 2009
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http://www.cyclingnews.com/news/did-merckx-ride-with-potentially-lethal-heart-problem

New biography cites Italian cardiologist

Eddy Merckx rode throughout his outstanding career with a heart problem that could have killed him at any moment, according to an Italian cardiologist. Dr. Giancarlo Lavezzaro made the claims in a new biography of Merckx to be published tomorrow, according to the Belgian newspaper De Morgen.

In “Eddy Merckx, the Cannibal” by Daniel Friebe, Lavezzaro claims that anyone presenting an equivalent cardiogram today would be denied a license.
 
May 13, 2011
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An update for this thread: 2.5 years after the series of issues and a choice made in hospital to increase salt intake throughout the day (instead of having a pacemaker installed), my friend has had no recurrences and indeed set 5km and marathon personal bests and completed several ultras. Seems like the issue was lack of electrical conductivity in the heart caused by excessive sweating and insufficient intake of salts. Blood salt levels were fine, but not tissue. (Does anyone have a link to a study on blood vs tissue levels of electrolytes?)
 
Sep 30, 2009
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I don't have a link, but i do know that the body will try to equalize substances where it can. If you are a profuse sweater, and you are only replenishing with plain water, then you end up diluting your blood salts. In turn your body will release electrolytic salts from muscle tissue back into the blood to equalize things. This is one of the reasons that you develop muscle cramps during exercise.

Blood salts are quick to recover as you rehydrate, unlike the salts within your muscles. This recovery/imbalance can be made more severe in the heart by a sodium/potassium/calcium imbalance. A sweat test can determine if your friend is sweating an excess proportion of sodium to potassium. Too much sodium lost means it is scavenged from other available sources (heart included), and an electrolyte imbalance occurs. The sodium is responsible for for exciting the heart muscle cell, and calcium is responsible for cardiac cell contraction, while potassium is responsible for stopping that contraction and initiating a refractory period where the heart cannot contract again.

If your friends episode(s?) occured shortly after exercise, then this is probably the problem.
 
May 13, 2011
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Interesting post two-thirds. I'll check in with him about salt balances in his sweat. Makes some sense what you say given high sweat levels, lots of exercise over many years and the supplementation working. Actual issues - there were at least 4 or 5 all occurred at rest and tended to be clustered with each other.

Here's my sweat analysis which I had done after his incidents - since my friend is my brother, perhaps there is some sort of relationship. I've been having lots of muscle tightness and incredibly slow recovery recently - been wondering if it is salt related (I do supplement with exercise but ended up on saline IV after super long hikes in hot weather internationally - twice).

Pace - moderate
Sweat - 1.7 liters per hour
sodium - 51 mmol per litre
other electrolytes - not measured
 
Sep 30, 2009
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See if you can have a test done where they measure for sodium as well as potassium. Sodium, potassium, and calcium are required for muscle contraction. Calcium is something that usually isn't a component of sweat, but you can test for that as well. What you ideally want to do is have this tested several times a year, both while in a well rested state, as well as after a period of heavy exercise. What you are looking for is to establish a baseline electrolyte reading for year round average, rested, and exerted. You will be able to check sweat sample electrolyte make-up against blood electrolyte level and how each one differs the more you exercise. Sodium makes up most of the electrolyte component of sweat, which is also the catalyst required to initiate a muscle contraction. Lose too much sodium, means relatively more calcium and potassium around = a less excitable muscle cell.

Using your posted sweat test numbers, you want to take a test that continues to push you harder and longer. You want to see how that 51mmol/L changes. Does it dip and then start to claw itself back? That means that sodium is being scavenged from sources outside of the blood.

In all truth though, you may never find the root cause of why this happens,as this can be hormonal or even have to do with neurotransmitter imbalances as well, but that doesn't mean that you won't be able to find strategies for managing the condition.
 
May 5, 2010
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Random Direction said:
I've got a question for the forum.

Recently a good friend had a series of sinsus arrests (sinus node dysfunction) resulting from a vaso vagal synchronicity problem .

So, in layman's terms, is he experiencing an irregular heart beat? Is his heart actually stopping for a brief period or beating erratically?
 
May 13, 2011
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TigerFish said:
So, in layman's terms, is he experiencing an irregular heart beat? Is his heart actually stopping for a brief period or beating erratically?
Simply, he is going along in daily activity, heart beating normally. Then it stops, he passes out and then the heart restarts itself after a 5 seconds or so. Tired afterwards, but fully capable. No irregular heartbeat or any other signs. Nothing clinic related except a propensity for compression socks recently.
 

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