Getting to the Heart of the Matter; a precautionary tale

 I felt it was really important to write this blog post. Hopefully by the time you finish reading you will understand why I wanted to write it and why I wanted you to read it. 

I have a family history of Atrial Fibrillation (click the link for more information). My father has it and I have always been aware that this increased my risk of developing the condition at some point. I have other risk factors as well. Namely I am tall, I am (almost) a life-long endurance athlete and I have a naturally large heart. Needless to say I am well aware of my level of risk and have always had it in the back of my mind that one day the condition could become  a reality for me. 

One of the main symptoms of Atrial Fibrillation is tachycardia (sudden acceleration of heart rate well above established maximum).  The first time I raced bikes (from the ages of 16 - 25) I never experienced any tachycardia. Now in my second crack at bike racing (from the age of 39 to now at 47) I have had three isolated issues, until recently. I remember them very clearly. Two occasions in 2013 and another in 2016. Hardly anything to worry about and not a blip (no pun intended) for four years. That all changed a few weeks ago.

It was a very cold Sunday morning, nearing the end of a bunch ride on the online platform Zwift. I was climbing hard at about 168 beats per minute (bpm). My absolute maximum is close to 180 bpm. Without a single warning sign my heart rate accelerated up to 192 bpm and I could feel my heart nearly exploding in my chest. I immediately backed off and my heart rate dropped as fast as it went up. In a minute or two I felt like I had recovered and believed this was just a 'one-off' tachycardia event, similar to what I had experienced a few times in the past. A few minutes later it happened again. This time not quite as bad at 185 bpm, but the horrible sensation in my chest was the same. I backed right off, warmed down slowly and carefully and then stopped. You can see the two events as plain as day in the heart rate graph below.

In the days after, things just didn't feel right. I was experiencing minor flutter sensations in my chest, very heavy heart beats and some occasional mild vertigo. At the time, the three round Queensland Individual Time Trial Series was about to start. Three time trials over three consecutive weekends. I had barely raced all year due to the COVID situation so I was keen to pin a number on. I was hopeful that the symptoms would subside and I would be able to race well. This was a mistake, medical advice should have been sought at this point. Hindsight is a wonderful thing.

The other critical part of this tale is a situation that had occurred in my professional life. I can't go into a great deal of detail as I will breach my employer's confidentiality guidelines. What I can say is that a part of my job is managing a boarding school. I had two occasions over a six week period, where I was almost the first adult to respond to critical situations where I truly believed that the child in question could lose their lives. This was without question the most challenging period of my twenty-three career in education and the impact it had on me was significant. I had some time off work and counselling as a result. The second situation I dealt with was actually the night before round one of the time trial series in Purga. 

The Purga round went average at best. I was tired and distracted by the events of the night before. I had little ability to push myself and kind of muddled along to a very average time. People who I normally beat were faster than me. People who I normally beat by a lot, I beat by only a little. It didn't go well.

Leading into the second round of the series at Elimbah I had been experiencing the same heart sensations as previously. The big heart 'thumps', the flutters and that general feeling of something not being quite right. Again, I should have been receiving medical attention by now and I wasn't. On race day though, it actually went okay. I managed good power numbers and a course personal best time by five seconds. In terms of where I finished versus the other riders it looked like a return to normal. I was hoping this heart 'stuff' had vanished. That couldn't have been further from the truth. 

The third and final round of the series at North Arm also doubled as the Queensland Championships, which I had won in the 45-49 years category the year before. I was keen to defend my title. My heart had been playing up the same way all week. If anything it was actually getting worse. I realise I was self-negligent and naive to not seek any help at this point, but in my defence the symptoms were never major and they would always go away. A 'thump' here and flutter there, then nothing for hours. 

Race day came and it could not have gone much worse. The first few minutes were okay but then my heart rate was creeping up way higher than it should have for the effort I was putting out. I felt absolutely woeful and just suffered terribly for the entire race. I actually eased of off the pedals twice when I was cresting hills based on the sensations in my chest and my heart rate numbers. Yes Dean, you are an idiot and I should have just stopped. I ended up second in the results but in the end this is a race I would rather just forget.  For comparison:

• Round 2 Elimbah: 375 watts @ 162 bpm average.
• Round 3 North Arm: 352 watts @ 167 bpm average. 

Light years apart. That is the impact this issue had on me in terms of performance. 

The days after this race my symptoms worsened and I finally saw my GP. He was immediately concerned and very interested in the stress I had been experiencing in my professional life. He was equally as interested in my family history of Atrial Fibrillation. He arranged for me to wear an ECG Halter Monitor for 48 hours, which was a very annoying piece of kit to have on night and day let me tell you. A cardiologist would go through my data after that and then forward the results to my GP.

It was an anxious wait the next few days. It's amazing how quickly you stop caring about bike racing and start focusing on your long-term health and future when something like this happens. My symptoms were very frequent when I was wearing the monitor, but things actually started to improve in the days after that. Even before my results came back I was starting to feel a little relief that things seemed to be getting better. The results would prove to be 'best case scenario' with no indication of Atrial Fibrillation, which was an incredible relief. That diagnosis would have had life changing implications. The diagnosis was in fact Stress Induced Tachycardia. Something that can and will improve with  appropriate rest and stress reduction. It still amazes me that significant workplace stress can have such an impact on an extremely healthy cardiovascular system, but it is entirely possible and in my case very real.

I feel like this was in many ways a lucky escape. I am still worried that Atrial Fibrillation is in my future. My long-term risk of developing this condition still remains. I am now kicking myself for my ignorance at continuing in a race series when these underlying health issues were at play. Again, in my defence, it honestly didn't dawn on me how serious this could have been. 'She'll be right mate!' 

So please, dear readers, especially those of you who are my vintage or older, play nicely with your heart. You only get one so look after it. Seek medical help early if you have issues. It's just not worth the risk. It's only bike racing and in the end meaningless when compared to the ability to live a long life as a husband, wife, brother, sister, mother, dad and friend. Stay well people....