Cycling UK Forum

softlips wrote: ↑31 May 2023, 8:01pm

PeterJ wrote: ↑30 May 2023, 11:02pm Presumably you've come across this chap?

https://drsanjayguptacardiologist.com/

If not, it might be worth contacting him.

He doesn't do electrophysiology, he does imaging - unlike Richard Schilling previously mentioned (I've worked with both).

There are many excellent Electrophysiologists in Canada you can be referred to.

My suggestion was more in relation to the overall management of conditions like this. I'm not keen on the word, but Dr Gupta's approach could be described as 'holistic' and he may be helpful in offering a wider perspective.

However, re-reading the thread I'm not sure a wider perspective is what the original poster is looking for.

Depends on how serious this is, Ive yet to determine 100% for sure that it is AFIB, but even if I get to that stage I need to determine the severity of it and how dangerous it is, then I can decided if the dangers of a treatment out weight the dangers of just living with it.

aegisgfx wrote: ↑30 May 2023, 5:39pm

axel_knutt wrote: ↑30 May 2023, 5:34pmSo I sent all the ECGs to Professor Richard Schilling, one of the world's leading arrhythmia consultants, who confirmed it was indeed atrial flutter:

Im in Canada, would it cost a lot of money to get this guy to look at my results for a better opinion?

That report cost me £50 in 2016. I've been back to the same hospital (but not the same consultant) asking them to review test results on another matter, and they refused, saying "we don't do that sort of thing". In the light of what I posted above, my guess is that they've been warned off by the NHS. (He does work in the NHS, as well as private practice)

aegisgfx wrote: ↑30 May 2023, 5:50pm

axel_knutt wrote: ↑16 May 2023, 6:24pmIs it worth going on something like Diltiazem just to see if it helps?

I've stopped taking diltiazem because it's damaged my feet, I wouldn't be taking it voluntarily knowing what I know now. When you were discharged after the tests weren't you given any advice on what to do if it keeps happening?

I guess a better question is, are drugs a good idea at all considering this **only** happens when I do high levels of exertion/exercise, which Im doing a lot less of now than I did in the past. So if I only go out and bike 3 times a month now, is it worth taking drugs all the time for that?

Incidentally I have a severe form of central sleep apnea (diagnosed by so far untreated), and I can say the problems are very much worse when my sleep quality is poor.

Sleep apnoea is a documented cause of AF (see the list of risk factors above). AIUI, central sleep apnoea, unilke obstructive SA, is a form of autonomic dysfunction; AF and overtraining syndrome are both forms of dysautonomia too.

aegisgfx wrote: ↑30 May 2023, 6:17pmIs it really worth taking calcium blockers all the time for something that only happens when I do very high exertion, which I might do now a couple times a month or less?

Diltiazem is what's known as a rate control drug, that is, it limits your maximum HR. Other drugs such as flecainide are rhythm control drugs, which are designed to prevent the arrhythmia and keep you heart in normal sinus rhythm. Is I mentioned above, my main need for it was to act as a safety back up in case the flecainide causes atrial flutter that leads to a dangerous ventricular rate. Whether there's much merit to it as a standalone drug I wouldn't know.

The problem with it is that it causes pitting oedema: your feet and lower legs become swollen because of fluid retention in the cells. For nearly a decade I thought this was fairly trivial and under control, so I was more than willing to put up with it as an alternative to the fatigue caused by beta blockers.

The problem with chronic oedema is that it causes damage to both the nerves and blood vessels, and in my case I hadn't really noticed the damage creeping up on me until one day last summer. I went out for a gentle walk, nothing unusual, and came home with horrendous full depth blisters, and the nerve damage was such that I didn't even notice any pain from them until they got to that stage. The skin on my feet seems all but dead, and now falls off at the slightest provocation without sufficient sensation to warn me what's happening.

I assume I'm now on the first rung of the ladder which leads to chronic ulcers and amputation.

Jdsk wrote: ↑30 May 2023, 6:14pm Anxiety

This has been suggested and you've associated that with being inadequately investigated and your concerns being dismissed.

From what you've told us I can see why it's being considered as a possibility.

Jonathan

Is that likely when he's already been diagnosed with CSA?

Anxiety

This has been suggested and you've associated that with being inadequately investigated and your concerns being dismissed.

From what you've told us I can see why it's being considered as a possibility.

Jonathan

I dont think Anxiety would be the cause, Ive been doing endurance athletics for over 20 years including races that take me to to top of mountains, not really the type of this I would associate with someone who has anxiety problems.

This problem came on very suddenly at the beginning of 2017, start with severe chest pains in the upper left right after intervals. It continued to get worse for the next 6 months to where I was getting pain and wildly off the charts heart rates after training sessions and races. And in spite of being in the best training shape of my life, I was tired and dizzy and weak at various timers who seemed very out of place for the point I was at in my season.

I've stopped taking diltiazem because it's damaged my feet, I wouldn't be taking it voluntarily knowing what I know now. When you were discharged after the tests weren't you given any advice on what to do if it keeps happening?
[/quote]

Do you know if anyone who uses the "pill in pocket" approach to controlling periodic Afib with Flecainide? (i.e. you only take it when you actually have an episode, not all the time) Would that work in high level athletes?

axel_knutt wrote: ↑16 May 2023, 6:24pm I've stopped taking diltiazem because it's damaged my feet, I wouldn't be taking it voluntarily knowing what I know now. When you were discharged after the tests weren't you given any advice on what to do if it keeps happening?

Do you know of anyone who uses the "pill in pocket" approach to controlling periodic Afib with Flecainide? (i.e. you only take it when you actually have an episode, not all the time) Would that work in high level athletes?

aegisgfx wrote: ↑2 Jun 2023, 10:32pm

axel_knutt wrote: ↑16 May 2023, 6:24pm I've stopped taking diltiazem because it's damaged my feet, I wouldn't be taking it voluntarily knowing what I know now. When you were discharged after the tests weren't you given any advice on what to do if it keeps happening?

Do you know of anyone who uses the "pill in pocket" approach to controlling periodic Afib with Flecainide? (i.e. you only take it when you actually have an episode, not all the time) Would that work in high level athletes?

There are some on the AF forum, but if you don't have a doctor who takes this seriously, where are you going to get prescription-only meds from anyway? If you're thinking of buying them online, I wouldn't, flecainide can cause cardiac arrest in patients who are susceptible.

axel_knutt wrote: ↑3 Jun 2023, 12:00am

aegisgfx wrote: ↑2 Jun 2023, 10:32pm

axel_knutt wrote: ↑16 May 2023, 6:24pm I've stopped taking diltiazem because it's damaged my feet, I wouldn't be taking it voluntarily knowing what I know now. When you were discharged after the tests weren't you given any advice on what to do if it keeps happening?

Do you know of anyone who uses the "pill in pocket" approach to controlling periodic Afib with Flecainide? (i.e. you only take it when you actually have an episode, not all the time) Would that work in high level athletes?

There are some on the AF forum, but if you don't have a doctor who takes this seriously, where are you going to get prescription-only meds from anyway? If you're thinking of buying them online, I wouldn't, flecainide can cause cardiac arrest in patients who are susceptible.

Well Im currently working with a portable ECG unit and I'm hoping to catch them myself the next time they happen so I can prove this to my doc. Problem is when I get these issues my hands shake pretty bad so Im not sure if I'll be able to hold the unit stead enough to get a good reading. But thats the plan Ive got at the moment.

Your obviously concerned here.Your local GP will be overworked and not have the specialist experience.Go on the internet and look up specialist sports doctor practices.They cater for pro's and enthusiasts.Book a session.

Ya I did that, I went to a cardiologist who works in a physiotherapy office.. he said it sounds like an arrhythmia to him, but then told me its something I have to take up with my GP. I get nothing but the run around here, its been 7 years now and no progress.

Sainsbury's trial of supermarket trolleys fitted with ECG sensors to detect AF.

https://www.theguardian.com/society/202 ... l-research

The results don't seem that promising as yet. Although I wonder if Sainsbury's have an interest collecting the data from shoppers heart rates as they walk around the store ?

re_cycler wrote: ↑24 Jun 2023, 7:05am Sainsbury's trial of supermarket trolleys fitted with ECG sensors to detect AF.

https://www.theguardian.com/society/202 ... l-research

The results don't seem that promising as yet. Although I wonder if Sainsbury's have an interest collecting the data from shoppers heart rates as they walk around the store ?

The press release from the conference:

"Supermarket trolleys set to help diagnose common heart rhythm disorder and prevent stroke":
https://www.escardio.org/The-ESC/Press- ... ent-stroke

With a crucial last sentence:

"A crucial aspect is providing immediate access to a health professional who can explain the findings and refer patients on for confirmatory tests and medication if needed.”

The technology may well get ahead of our knowledge of what to do with the answers... is the risk for people diagnosed this way the same as for other groups with AF, what's the responsibility of a practitioner presented with these findings, who should store the results, should the machines be subject to regulation... ?

... and at the cost-effectiveness layer should we investigate patients discovered this way rather than spend the resources on something else?

That's all the same as with Apple Watches etc.

Jonathan

Sep Vanmarke retires with heart problems

"Sep Vanmarcke has retired immediately from professional cycling after a cardiac scan revealed scar tissue on his heart which could lead to further complications.

The Belgian had an abnormally high heart rate detected while riding and a subsequent MRI confirmed the presence of scar tissue. Further racing could risk heart failure, forcing the Belgian to abruptly end his career."

https://www.cyclingnews.com/news/sep-va ... te-effect/

Any idea what caused him to get scar tissue on his heart? Overtraining?