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Atrial fibrillation

Today, I'm having my heart shocked

Thu, Dec  1, 2011  - By Mike Muha

If you've been following my training log for the last couple months, you'll have noticed a conspicuous absence of training sessions. I feel lucky to get in one training session a week these days. Part of the problem has been that I've been busy at work, busy ramping up the NordicSkiRacer web site, getting the Frosty Freestyle and Krazy Klassic races organized, a week being sick, plus entertaining Mom for a week. But overall, I have had a distinct lack of motivation (bordering on depression?) toward training. The one thing that has kept be going have been the organized Team NordicSkiRacer workouts. Having friends to train with makes all the difference.

So what happened?

In a word: Espressos.

It all started on Saturday, October 8 when I had two double-espressos for breakfast. As soon as I finished that second one, I could feel my heart rev up and the beats feel inconsistent. My rollerski interval session that morning was terrible: part way through I just fell apart. My heart rate monitor was useless: it thought my heart rate was 103-109% of max, even while standing still. It was also on espresso.

The following Saturday, October 15, the same thing happened, although I completed the session.

I backed off coffee for while, had a great Nordic Fest race. Things went well until Tuesday October 25 when I had coffee in the morning again.

II then caught some bug from my wife that had me down for a bit. I went to my doctor for the bug I had. I downed a cup o'Joe before I left just to see if he'd find anything unusual...and he did. He listened to my heart and immediately put me on an EKG. The office knows I'm in great shape - I'm routinely on outlier in any health performance tests I might take (breathing tests, stress tests). The nurse did two EKGs because she didn't believe the first result. The doctor didn't believe them either, and had her take two more. To their shock, I was diagnosed with Atrial Fibrillation.

So what is Atrial Fibrillation?

I'm not a doctor, so I stole verbiage from the National Heart, Lung and Blood Institute:

Atrial fibrillation (AF) is the most common type of arrhythmia (when the heart can beat too fast, too slow, or with an irregular rhythm). In particular, AF occurs if rapid, disorganized electrical signals cause the heart's two upper chambers (the atria) to "fibrillate" (to contract very fast and irregularly).

In AF, blood pools in the atria. It isn't pumped completely into the heart's two lower chambers (the ventricles). As a result, the heart's upper and lower chambers don't work together as they should.

People who have AF may not feel symptoms. However, even when AF isn't noticed, it can increase the risk of stroke. In some people, AF can cause chest pain or heart failure, especially if the heart rhythm is very rapid.

AF may happen rarely or every now and then, or it may become an ongoing or long-term heart problem that lasts for years.

TThe great animation below shows how problems with the heart's electrical signal cause the atria to beat very fast and irregularly:

Highly recommended reading:  What Is Atrial Fibrillation? goes into much more (and very readable) detail.

Causes

The diagnosis was confirmed by a cardiac electrophysiologist - a cardiologist who specializes in heart electrical problems.

I now join the ranks of Ken Dawson, Peter Vackx and other skiers who have had the same problem.

Oddly enough, if you've read other articles on NordicSkiRacer about AF, you'll know that some researchers believe there is a link between long term endurance sports activity and AF. In fact, one article suggests that "endurance sport practice increases between 2 and 10 times the probability of suffering AF". How ironic! Here we are incredibly healthy athletes and the very activity that keeps us healthy is interfering with our heart! (Life's not fair...)

But it's not just exercise. Clearly caffeine has a big affect on me, and the literature suggests alcohol consumption is related as well. Both caffeine and alcohol (and exercise!) irritate the heart. The possible mechanisms that link these irritants to AF are not really known.

Treatments

For the past month I've been taking a single aspirin once a day. Yesterday, I started taking a blood thinner, used to prevent clots.

At 8:00am this morning, I'm in the hospital for an Transesophageal Echocardiography (TEE) and a Cardioversion procedure.

For the Transesophageal Echocardiography, I'll be consciously sedated (I'm still awake). The doctors will put a probe down my throat to my esophagus. Then he'll take images of my heart using sound waves. This is to check for any issues such as heart infection or disease, or problems with the heart's walls or valves. I except them to find nothing abnormal, except maybe the enlarged heart typical of an endurance athlete.

The Cardioversion procedure is, well, more shocking. Literally. I'm put to sleep, then low-energy shocks are given to my heart to trigger a normal rhythm. Stop visualizing ER: this is not defibrillation ("CLEAR!") where they give you high-energy shocks to restart the heart.

I should be done before noon and on my way home. (My wife Jill will drive).

The future

I figure I'll be a little out of it on Friday, but Saturday I should be good to exercise again, and I should be able to perform at a level normal for me. Unfortunately I'll be heading to a wedding in Cincinnati for the weekend, so it may not be until next week that I get to train again.

I'm guessing that this treatment is temporary and that I'll need an additional treatment later: ablation. A flexible tub is run up from the groin area (the ablation catheter) and a special machine sends energy through the ablation catheter to your heart. The energy destroys small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start.

But I'm not worrying about that now. I'm worrying about how I can get into shape for ski racing season!

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