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    Tf01's Avatar
    Tf01 Posts: 1, Reputation: 1
    New Member

    Jul 10, 2012, 11:54 AM
    Weakness/Chest Discomfort after exercise
    I am 39. Over the last few years, I have had several episodes after exercise (typically following extreme exertion while hiking, squash, skiing, spinning) where I felt very weak afterwords for a period of hours or even days. The aftereffects were sometimes associated with the inability to exert myself without "feeling bad" and having pressure in my chest area or upper/middle abdomen.

    If I rest the symptoms go away but it may take hours or days. On a couple of these episodes I have also had accompanying symptoms that some doctors have described as vasovagal symptoms.

    In the last few years, I have visited the ER twice, my GP twice, and two different cardiologists. I have had a nuclear stress test, chest CT, basic echocardiogram, EKGs, many rounds of blood work, all showing nothing sinister. My general health and weight are normal. My BP and cholesterol have always been very, very good. No murmurs. I sleep well and 7-8 hrs per night. None of my doctors could find anything wrong with me and seemed puzzled.

    I generally stay fit and exercise. I was a college football player and after college ran for exercise consistently, and generally stayed very active, hiking, skiing, running triathlons, playing sports, etc. However, about four years ago, I started a new stressful job that required me to sit at my desk for 12+ hours a day. Also, my exercise habits have been more intermitted since then, in part because I quit running due to hip problems (acetabular cam impingement). In the last 5 years I mainly have been using the elliptical machine, swimming, and/or weight lifting, due to the hip problems. Also, my workouts have been at lower intensities due to anxiety about these episodes and more intermittent due to my new job.

    Another piece of information that may or may not be relevant, is that 7 years ago I had an episode of hyponatremia following a 6 hour half ironman triathlon in Florida. I felt weak and dizzy after the 6 hour race in +80F heat and the medical tent gave me two units of IV fluids which made my dizziness much, much worse. After a couple of hours I asked to go to the ER. The ER doctor resolved the problem pretty quickly with salt tablets. But he kept me in the hospital for 2 days due to exertional rabdomyalysis. He said my CK levels were rising and until they stopped rising they wouldn't let me out or I had a risk of kidney damage. He also mentioned that extreme races like that could damage your heart. Though he later told me my troponin levels were normal. Since then I have read online that extreme exercise very rarely leads to heart damage.

    When I showed my GP the medical records from my hospital stay he said he thought the hospital overreacted by admitting me because "of course my CK levels would be rising after an extreme event like a triathlon", and likely the hospital was trying to protect themselves by admitting me.

    I don't know what to do. I do not want to continue getting expensive tests, especially when doctors don't seem to have any good hypotheses about what might be wrong.

    During my last cardiology visit a month ago, my very experienced NYC cardiologist said I was an enigma and implied it was anxiety related (as have other docs). He asked me what I wanted to do and when I mentioned that I hadn't had a stress echo he referred me for one. Also, he mentioned an angiogram and potentially trying to rule out diagnoses by experimenting with a beta-blocker and/or CCB. I didn't like his plan.

    My latest theory is that I have these episodes when I exercise at or near my max heart rate for extended periods. So I am going to start wearing a heart monitor when I exercise and experiment with exercising at different heart rates. How I developed this theory: After having felt fine after consistent, moderate exercise in the last month, I stepped up my 30 min elliptical workout to near my max heart rate (the HR monitor on the machine read 200 at one point). The next day I felt mild symptoms as described above. After a couple of days of rest I was able to resume my moderate work outs without feeling bad.

    Any ideas of what might be causing this? I don't want to avoid hiking, skiing and sports where I heavily exert myself. But I am scared to resume these activities until I feel I understand this better.

    I suspect it is not atherosclerosis given my age, negative stress test, and otherwise good health and diet. I do have a family history or heart disease, but my health habits have been significantly better than those aflicted family members.

    I don't think it's a valve problem since I do not have a murmur and have a negative basic echo. I haven't done a stress echo though.

    I doubt it's arrhythmia related, since my EKGs during the stress test and during ER visits while experiencing symptoms were normal. Though I haven't done a holter monitor test.

    Again, any ideas?

    Could I just be more out of shape than I think due to my lower level of exercise in the last few years and thus over-exerting myself?

    That said, I have friends who are approaching middle age, are more out of shape than me, and do weekend warrior stuff without having these symptoms.

    Could I have damaged my heart during the half ironman triathlon? Wouldn't my troponin tests have indicated this?

    Any suggestions would be appreciated.
    tystratton's Avatar
    tystratton Posts: 1, Reputation: 1
    New Member

    Jun 27, 2013, 08:52 AM
    I am also experiencing these symptoms with heavy exertion. I am 34, healthy with good BP, and eat healthy foods. The first time I experienced this was in 2008 when I began cycling with a group of guys that were very fit (22 - 28 mph for 30 - 50 mile rides). I had exerted myself pretty hard on one ride and my heart felt very weak. Eating seemed to help, but there was a sustained weakness that troubled me through the night... then, of couse, anxiety started to set in. I ignored it and chalked it up to "just a hard ride."

    Then in 2009 after I tried my first time trial the weakness in my heart came back. I had been cycling for a couple seasons, my fitness level was great, and the time trial was at the end of the 2009 season. The time trial only lasted about 30 minutes, but I was at my max heart rate for the entire time. That night my heart fealt weaker than my experience in 2008... again the anxiety set in and I had a rough night sleeping. This prompted me to go to my PCP. They ran an EKG and everything checked out fine, but my heart rate was at 39 bpm. They didn't believe the result, ran it again and it was at 41 bpm... fairly consistent result. It took a couple days for the weakness to wane. They scheduled me for a stress echo and everything checked out fine during that test. They wanted me to wear a heart monitor for 24 hours a day for a week... I only lasted the first day and could not stand that test. I figured since the weakness/fatigue in my heart went away, and the other 2 tests came back fine, I was fine.

    I've maintained decent fitness since then, but life threw a couple curveballs. I had a baby 2 years ago and arthroscopic knee surgery around the same time. It took me about a year to get into a good exercising rhythm again. The past year has been one if my better years for working out... swimming, cycling, crossfit type workouts in my garage, weights, and yoga. Last night I hooked up with an old cycling partner and rode with him for about an hour. He pushed me, but I've been on harder rides. I had the same weak feeling in my heart after the ride and am still feeling very fatigued with the weakness in my heart. I am sure it will go away, but it troubles me that I get this feeling in my heart.

    Like you, I don't want to get any more tests ran... my Drs. Seem to thing everything is fine. I found a little comfort in your story because none of my friends, family, or co-workers experience this feeling after heavy exertion and it has been worrying me. One Dr. told me that my muscles will give out before my heart does during exercise, but I'm not too sure about that one.

    After last night, I vowed to myself and my wife not to push that hard again. I am coming to the conclusion that I don't need to "red line" to get a good workout in... it's just hard for me not to do that. My mentallity has always been to "go hard" and when micro challenges present themselves during workouts, I have to step up to them. I think I have to shift my mentality and pace my body more, but this is just a guess and a road that I will try in the future.

    Any updates on your end this past year? I'm curious how the past year has treated you.
    tennisoregon's Avatar
    tennisoregon Posts: 1, Reputation: 1
    New Member

    Aug 1, 2013, 10:38 AM
    I'm not as fit as you guys, but I am 25 and do lead a physically active lifestyle with playing tennis, short bike rides, walking, and the occasional swim or jog. It could be very well anxiety related - I was actually diagnosed with panic disorder about 5 years ago. My anxiety started in class room situations -- and exercise was the only thing to help at the time. Within the last year though I get exhausted after excercise/overheated/anxiety ridden. It seems like heat really adds fuel to the fire though because I can exercise a decent amount and push myself hard enough in cooler weather. I am on Zoloft for anxiety, which raises your core temperature a little - so that may have to do with it.

    Unlike you guys, I was having palpitations in college and got an EKG, which came back irregular (as if I had a heart attack). So I had a stress test, a echo, and an ultra sound. They found out that I had mitral valve with moderate regurgitation and an enlarged aorta, but said I could continue to push myself with cardio. So, I did a follow up the following year and they found that my aorta was fine (upper end of healthy range) after all and they messed up on taking the first image at a bad angle. All of this is bad for a guy with anxiety. Anyway, the regurgitation also went from moderate to mild. So, my heart is generally healthy according to my cardiologist and he claims that its in my head. But, when a physical manifestation of absolute fatigue takes place its hard to ignore. I pushed myself hard at the gym one day and ever since then it seems to be hard to get the heart rate up really high without feeling like blahh. So, I can understand your guys' issues - it sucks. I figure just workout moderately and hopefully regain that tolerance over the long term.
    driftma's Avatar
    driftma Posts: 1, Reputation: 1
    New Member

    Sep 11, 2013, 04:29 AM
    Hey did any if you ever figure out what was happening? I'm 46 and have same issue, except at night after my harder runs my BP is also slightly elevated. Chest pain starts about 3-4 hours after exercise. Feel great during exercise. I had a worse about with this back in Jan 2013 after New Years Eve drinking and then taking an Imitrex which is a vasoconstrictor. My belief is that the coronary arteries are dilating during exercise and then restricting too much during recovery, resulting in angina like pain. No cardiologist has been able to confirm this... I've had stress tests, ECGs, and Echo's, and everything comes out normal. Doc won't do angiography because stress test looked fine.

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