This Valentine's Weekend really has been all about affairs of the heart for me, but actually my story probably dates back a few weeks.....
A lot of runners are aware of their resting heartrate (and indeed, many know specific heart rate bands that they train in - though I'm not one of those!) and check it periodically, eg for early illness warning signs, or to check for overtraining. As people get fitter, their resting heart rate tends to get lower, and I know that mine is usually around 48-50bpm. This may be higher than that of many other runners (which may be another reason why I never have any confidence in my fitness) but it's normal for me, and so if I check it and it's in the mid-high 50's, I know that I should look for a reason why.
I've already described feeling lacklustre about my running this year, but add to that some extra lethargy, constantly feeling cold and out of sorts with some weight gain, and I decided to check my pulse at work. 46.....a bit lower than usual, so I rechecked it the next day.....44....and then 42. I know I have sloth-like tendencies but that was a significant drop.
Maybe my pulse oximeter was faulty.....that must be the answer....but then when I checked the pulse of a patient with 'flu, it was up at 118, so it seemed to be reading OK. Next step for a paranoid medic.......ECG and BP.
My ECG showed a rate of 38 (and that was after coffee and cake!!)and my BP was 96/56.
Bouncing these results off a colleague (as the bradycardia protocol suggests giving medication and admitting to hospital urgently if a pulse rate is <40), he commented that he'd never seen such a slow ECG in anyone who wasn't seriously unwell.....obviously said partly in jest, but still, "there's always truth in a joke"!!
I didn't think I had suddenly become much fitter overnight, so I started to think about any other symptoms.
I had gone for a run one afternoon and had to stop as I saw black spots in my visual fields at the end and thought I was going to faint. I had put it down to hypoglycaemia, but with hindsight it couldn't have been as I'd had lunch before going out (and wasn't out that long). I also had a few episodes of feeling dizzy when I got up to go from the living room to the kitchen, but had just blamed myself for lazing on the sofa for too long (my favourite habitat!).
Now I knew that my pulse and BP were lower than usual (for me), I started to feel weak and wobbly from time to time, so although I knew those were just psychological symptoms, I decided it was time to put my mind at rest and so took myself off to my own GP. Blood tests were OK (underactive thyroids run in the family so we checked for that), but then I got a call that the cardiologist wanted to see me...........eeeeeekkkk!!
Next up - 4 appointments at the hospital in a week (anymore and I'd need my own parking bay):
1. To be rigged up to a "24hr tape". This is to monitor your heart rate/ecg for 24 hours, so becomes your faithful friend. I wasn't keen to exercise anyway, but it was great to have a good excuse for being lazy (the stickers from the 3 electrodes might have come unstuck, and I couldn't shower for 24hrs). The box and it's wires become your faithful friend, so it becomes a challenge to find clothing that hides them hanging down/the bulk on your waistband - and you have to ensure that you don't keep turning over in the same direction in bed or you end up wrapping yourself up in the leads!!! There is a button to press to record "when you feel symptoms", which is great for those with palpitations, but not so useful for me and my "feeling cold and tired".
2. To remove the 24hr tape - officially less of an issue as you disconnect it yourself and return it (along with your symptom diary). It was sooooooo nice to remove the sticky electrodes, as they aren't half itchy!
A lot of runners are aware of their resting heartrate (and indeed, many know specific heart rate bands that they train in - though I'm not one of those!) and check it periodically, eg for early illness warning signs, or to check for overtraining. As people get fitter, their resting heart rate tends to get lower, and I know that mine is usually around 48-50bpm. This may be higher than that of many other runners (which may be another reason why I never have any confidence in my fitness) but it's normal for me, and so if I check it and it's in the mid-high 50's, I know that I should look for a reason why.
I've already described feeling lacklustre about my running this year, but add to that some extra lethargy, constantly feeling cold and out of sorts with some weight gain, and I decided to check my pulse at work. 46.....a bit lower than usual, so I rechecked it the next day.....44....and then 42. I know I have sloth-like tendencies but that was a significant drop.
 |
| My ECG |
My ECG showed a rate of 38 (and that was after coffee and cake!!)and my BP was 96/56.
Bouncing these results off a colleague (as the bradycardia protocol suggests giving medication and admitting to hospital urgently if a pulse rate is <40), he commented that he'd never seen such a slow ECG in anyone who wasn't seriously unwell.....obviously said partly in jest, but still, "there's always truth in a joke"!!
I didn't think I had suddenly become much fitter overnight, so I started to think about any other symptoms.
I had gone for a run one afternoon and had to stop as I saw black spots in my visual fields at the end and thought I was going to faint. I had put it down to hypoglycaemia, but with hindsight it couldn't have been as I'd had lunch before going out (and wasn't out that long). I also had a few episodes of feeling dizzy when I got up to go from the living room to the kitchen, but had just blamed myself for lazing on the sofa for too long (my favourite habitat!).
Now I knew that my pulse and BP were lower than usual (for me), I started to feel weak and wobbly from time to time, so although I knew those were just psychological symptoms, I decided it was time to put my mind at rest and so took myself off to my own GP. Blood tests were OK (underactive thyroids run in the family so we checked for that), but then I got a call that the cardiologist wanted to see me...........eeeeeekkkk!!
Next up - 4 appointments at the hospital in a week (anymore and I'd need my own parking bay):
 |
| A better chest for viewing a 24hr monitor on |
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| My "Holter monitor" |
2. To remove the 24hr tape - officially less of an issue as you disconnect it yourself and return it (along with your symptom diary). It was sooooooo nice to remove the sticky electrodes, as they aren't half itchy!
3. An echocardiogram - which is basically an ultrasound to look at the structure of your heart. This is a simple painless procedure, though I have to say it is a trifle unsettling to be stripped to the waist while a colleague (that you see at meetings) performs the exam and talks you through the results as you watch it on screen. Mind you, when I say painless, I did get a sore neck craning round to see everything that he was pointing out on the screen as I had to lie on my left hand side and the screen was behind and to the right! It was fascinating to see the walls, chambers, valves etc of my heart and see the blood flow through it.
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| Diagrammatic representation of an ECHO (I'm not showing a pic of mine being done!!) |
3. An echocardiogram - which is basically an ultrasound to look at the structure of your heart. This is a simple painless procedure, though I have to say it is a trifle unsettling to be stripped to the waist while a colleague (that you see at meetings) performs the exam and talks you through the results as you watch it on screen. Mind you, when I say painless, I did get a sore neck craning round to see everything that he was pointing out on the screen as I had to lie on my left hand side and the screen was behind and to the right! It was fascinating to see the walls, chambers, valves etc of my heart and see the blood flow through it.
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| Another version of an ETT |
4. An Exercise Tolerance Test - I always knew that would be a fun-filled experience bearing in mind my general dislike of the "treadmill"! The test consists of 3 minute sections with each one being faster and steeper than the previous. I didn't think it could be too strenuous if little old ladies with angina are put onto it, but by the end of my test it was going at 5mph with an incline of 18%. To make it more fun, I had all sorts of wires attached to my chest (more than for a normal ECG as the 4 limb leads are also attached to the chest, as otherwise they don't read properly due to movement artefacts) and a BP cuff on my arm which kept inflating and deflating (and catching on the treadmill itself). Oh yes.....and I was still in my work trousers and shoes!! At least I got to watch the screen throughout the entire 15minutes of test and 5 minutes of recovery while chatting away to the technicians, unlike on a treadmill in a gym.
By the end of it, I feel like I've been totally through the mill (though now I feel that I can explain the procedures a lot more clearly to my patients when I refer them) and have come out as an "athletic sloth"! My heart is structurally normal - no structural, valve or flow problems, no hypertrophy or cardiomyopathy, and there were no great rhythm problems. My resting rate is back up to its "usual" now, so whatever it was that caused me to feel unwell, wasn't too significant and I'm not going to perish imminently!! You can all put away the black funeral garb and I can get back to furring my heart up with cake and chocolate...or dilating it with alcohol!!!!
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