In March of 2008 I began treatment for a potentially fatal heart arrhythmia whose cause was unknown. I was fit and healthy, having spent a good part of my adult life as an elite cyclist, much of it racing in Europe.
After 5 years of fence-sitting on the part of my doctors, I have been given a diagnosis of ARVD/C (Arrhythmogenic Right Ventricular Dysplasia / Cardiomyopathy). I lack the known genetic markers for the disease as well as some of the structural changes that accompany ARVD/C, and my condition has shown no indication of being progressive (yet).
There is a growing population of current and former endurance athletes who end up with acquired arrhythmias, and a diagnosis of ARVD/C. But by placing these athletes in the ARVD/C patient population, we are potentially ignoring the very real likelihood of an acquired condition, similar, but different, from ARVD/C.
This blog is written as a resource for athletes with acquired arrhythmias, as well as anyone about to undergo endo or epi-cardial ablation, or the implantation of a ICD. It is also written to help generate some critical mass of interest in support of further research into acquired arrhythmias in endurance athletes and others. Feel free to contact me through the comments page if you have any questions or wish to make a written contribution to this blog.
Friday, April 25, 2008
So THAT's what's wrong...
Monday the 21st of April. University of Pennsylvania Hospital. I brought my running shoes, ready to pound the treadmll into submission. Now, bear in mind I haven't done anything other than climb some stairs in over one month. Upon check in I am on a perpetual cardiac monitor. Every move I make, my heart's reaction is recorded. Happily I find my low heart rate hasn't gone the way of my fitness. I'm getting gurneyed around the joint, all the while beating steadily in the mid-40's.
I step up to the treadmill. We go through the paces. There is a casually dressed intern, and a nurse, and we are talking bike racing -there always seems to be someone interested in bike racing. The doctor increases the resistance on the treadmill, I respond. I look over at the monitor and I am PVCing all over the place. Steady "sinus rhythm", the proper healthy heart beat, is muscled aside by wild, baroque lunges of the EKG's readout. I feel fine, though and my heart rate is now 120. The resistance goes up again, we are eight minutes into the test, and I'm starting to feel funny. I know from past VOMax testing that I shouldn't be happy with lasting anything shorter than 17-18 minutes. I press on. At 140bpm the EKG readout looks like the trace of a conductor's baton during a Wagner opera. I am in V-tach. My heart is thumping on my ribs at 300bpm trying to get out. I go pale and limp and they pull me off the treadmill and onto a table. There is a long period where they run around getting the defibrillator going. I start to get that receeding feeling, like the whole scene is moving away from me down a rabbit hole. Somewhere in the back of my mind I remember what my girfriend's brother told me. A trained paramedic, he knew of cases where a person can defibrillate (cardiovert is actually a better term) themselves by coughing hard or thumping their chest. As the doctor wheels in the defibrillator I give a hard cough. Five seconds later I resume sinus rhythm. There is a collective sigh of relief. I was in a 250 to 300bpm run of V-tach for over one minute. Now I know what this this is all about.
The V-tach was utterly wierd. It put alot of things in perspective. I realized that at least one of my previous episodes of passing out - three years earlier while riding my bike in France- was a run of V-tach. It felt just like that. But what I didn't understand was why this time, with just eight minutes of mild effort, it came so quickly and so strongly, after having no serious sustained manifestations for so long. Part of me feels that somehow being super fit and diligent about exercise actually helped supress the uglier symptoms of my condition. After all, why, after over one month of totally sedentary living, do I now have an extreme bout of V-tach? There is nothing that I have come across in my research that agrees with this, it is just a speculation.
There is also the possibility that I had myself looked at JUST IN TIME. If I had waited any longer, ignored it and tried to race, I'd be lying in some gutter on the side of the road dead of cardiac arrest.
The treadmill episode dramatically vindicated Dr. Marchlinski's opinion. It's strength and length suprised even him. From then on there were no more doubts.