When his doctor told him he had atrial fibrillation, a heart arrhythmia, Evan was disbelieving. A runner for 25 years, he felt that his heart was invincible. He was fit and thin with low cholesterol and blood pressure. And, at least until recently, his cardiovascular system had the kick to carry him to the finish line.
The proof was there, though, in the electrocardiogram printout. And, recently, some of Evan’s runs had become labored, making him feel he was out of shape, even though he knew that he wasn’t.
Atrial fibrillation, also known as Afib, is often caused by serious heart problems or even heart surgery. But it’s also the most common heart problem diagnosed in athletes, some of whom have relatively healthy hearts. Evan later learned that three of his former running buddies had also been diagnosed with Afib.
Studies have found that athletes are particularly vulnerable to this arrhythmia, and some have theorized that it may be brought on by dehydration or inflammation associated with chronic training. A cause/effect relationship has not been proven, however. Afib is common in the general population, and it could well be that it’s the one heart condition that does not respond to regular exercise.
What Evan is most concerned about at this point is the future. Will he be able to run, cycle or perform other vigorous activities?
When he was first diagnosed, his primary care doctor told him to take it easy for awhile. He ordered tests, such as an ultrasound of the heart and an exercise stress test, to see if the arrhythmia was associated with another serious heart condition.
When these tests showed that his heart was otherwise normal, his doctor told him that he could and should continue to exercise, although he might have to change his routine a bit.
Effects Vary Greatly
Atrial fibrillation is an arrhythmia caused by an abnormality in the upper chambers of the heart, known as the atria. The atria beat more rapidly than the lower chambers (ventricles) resulting in an irregular, chaotic rhythm.
There is no immediate danger in this type of arrhythmia, but it does increase the risk of blood clots and of stroke. About a third of strokes in persons age 75 and over are associated with atrial fibrillation. To reduce this risk, most patients are prescribed an anticoagulant such as warfarin or the newer blood thinning drugs such as Pradaxa, Xarelto or Eliquis.
The effects of atrial fibrillation vary greatly with the individual. Some persons never feel symptoms; some have palpitations–extremely rapid heart beats that are likely to send them to the emergency room; others simply get tired more easily during routine activities.
When the heart is in abnormal rhythm, it does not work as efficiently in pumping blood to working muscles. Before Evan’s diagnosis, on the days when his runs had become labored, his heart was actually acting like that of a person who was out of shape. Non-athletes who develop atrial fibrillation might have to sit down and rest frequently while performing routine daily activities.
For many persons, especially at first, this abnormal rhythm comes and goes. The trigger may be stress, caffeine, alcohol, dehydration, exercise or even lack of exercise. Sometimes it occurs for no reason at all that can be determined.
Evan was no longer able to run long distances as he had previously. But he could still get his heart rate up riding an exercise bike or using a combination of running and walking. He learned that it was best for him to ease gradually into a workout and to cool down afterward.
He also did resistance training on weight machines. As his doctor advised him, he was careful not to lift a weight heavy enough to force him to strain or hold his breath.
Evan wore a heart rate monitor while exercising, but these devices are not always all that informative for a person with atrial fibrillation. They measure the average time between heart beats rather than actually counting beats.
A better method is taking your pulse frequently or using the “perceived effort” approach. You’ve probably reached a good target heart rate when your body tells you the workout is “somewhat hard.” That’s not a leisurely stroll in the park, but you should be able to talk in complete sentences without gasping for breath. And you should work up a sweat within a few minutes.
One approach that seems to work well for many patients is interval-type training. Every 10 minutes or so, increase the intensity for a minute or two and then back off to a moderate pace. That will help build fitness even if the abnormal rhythm is creating some limitations.
If there are no other serious heart problems, there is no harm–and many benefits–derived from increased fitness. For some patients, fitness may even lessen the frequency and severity of Afib episodes.
As with any exercise program, it’s important to be gradual in adding either duration or intensity. And you should stop immediately if you feel dizzy or lightheaded.
Caution is called for with any activity that could result in trauma–a fall from a bicycle or even a treadmill. If you are on warfarin or another anticoagulant drug, such a fall could cause bleeding in the body or the skull that requires prompt medical attention and monitoring.
Aside from the increased risk of suffering a stroke, one of the most serious effects of atrial fibrillation is the development of heart failure, a condition in which the heart becomes too weak to keep blood pumped efficiently to the muscles of the body. When you have heart failure, fatigue and shortness of breath become so severe that any physical activity becomes extremely difficult.
Heart failure can cause Afib; Afib can cause heart failure. The combination is particularly debilitating. And the best way of avoiding either condition is to keep the heart strong through regular exercise.
When atrial fibrillation is caused by a specific trigger such as excessive use of alcohol or caffeine, it will sometimes go away on its own when that trigger is removed. It can also be cured, although most attempts at cure carry risks that may be potentially more serious than the arrhythmia itself.
Evan was anxious to try anything to get back to running, even though his symptoms were not bothering him very much in any other way. Rather than going for catheter ablation, an effective but somewhat invasive treatment, his doctor advised him that he might be better off changing his exercise pattern and goals so that he can remain fit and healthy.
EDITED AND APPROVED BY Joshua C. Ranum, M.D. Internal Medicine FROM WEST RIVER HEALTH SERVICES
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01/21/2015
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