Some students are worried about training with heart conditions, well all I can say is that I have one and most doctors would recommend some form of training. However, my advice is always check with your GP first and tell them what you intend to do and get their approval. Then inform your trainer.
Here is my story:
Some years ago I started to suffer from a condition called Atrial Fibrillation, or AF for short. It is a heart problem that gradually got worse and affected my life and training over the years, but is now being managed. In the early period of my condition I used to panic as the symptoms were unpleasant and scary to say the least, now when I get them I don’t panic as much but that are still scary! I have even trained and instructed when having an attack, which I would not recommend.
So what is AF and why am I writing this article. Well the answer is to inform our members about AF and how to deal with it.
AF is quite a common condition, especially in older people. Nearly 50,000 cases are diagnosed each year in the UK. It affects about 1% (1 in 100 people) of the UK and has no age boundaries. Although its prevalence increases with age, being unusual below 30, but affecting 1 in 20 people above the age of 65. I have been told that it is common amongst rowers and athletes that have worked their hearts strongly, but again I don’t know how true this is. There are some that don’t even know that they have AF.
Now before I go on to describe AF I would like to explain how the heart works. Any Human Biologists out there if I have it wrong then please feel free to correct me!
The heart is one of our strongest muscles and is constantly working, amazing when you think that other muscles get tired and need to rest – it’s a good job our hearts don’t!
It is composed of four chambers – two Atria (top) and two Ventricles (bottom). These chambers need to squeeze in order to pump our blood around our body. This needs to be done in the correct order to be efficient and of course to keep us alive. This squeezing mechanism is what gives us our heart beat that we can hear and a pulse that we feel.
The sequence is as follows:
- Right and Left Atrium contracts to pump blood from these chambers into the Right and Left Ventricle. Then the Ventricles contract to pump the blood out of the heart to your body (oxygen rich) via the Aorta from the left ventricle, and to your lungs via the Pulmonary Artery (oxygen deficient) from the right ventricle. This function is clinically known as Systole.
- In the second stage the heart relaxes and the heart fills up with blood again and the first stage above repeats. This function is clinically known as Diastole.
This contracting mechanism occurs by way of electrical impulses from bundles neurons and fibres, which are called the Sinoatrial Node (SA # 1 in diagram), Atrioventricular Node (AV # 2 in Diagram) and Atrioventricular Bundle (AV # 3 to 5).
The SA Node is like a built in timer as it fires off the electrical impulse at regular intervals of around 60 to 80 per minute when you are at rest and faster during exercise; controlling the heart rate. This impulse spreads across both top chambers as seen in the diagram above, causing the chambers to contract and pushing the blood through one way valves into the bottom chambers.
As the impulse reaches the AV Node at the lower right of the chamber (#2 in the diagram), there is a small delay and then it carries this impulse through the AV Bundles (#3 to 5 in diagram) causing them to contract.
The heart then relaxes during Diastole and the sequence starts over. Thus for a normal heartbeat the rate is between 60 to 80 beats per minute as cause by the SA Node.
What is Atrial Fibrillation (AF)
Basically this is a fast and erratic heartbeat and the force of the beat can vary in intensity. What happens is the controlling timer of the SA Node is overridden by random electrical impulses causing it to fibrillate. This effect causes the atria to only partially contract, but very rapidly up to 400 times per minute. Only some of the impulses get through to the AV Node causing haphazard contraction in the ventricles, usually between 140 and 180 times per minutes, producing irregularity in contractions and with varying force.
Therefore you can feel this affect in your chest and throat. If you take your pulse you may count up to 180 beats per minute and it feels erratic and varies in strength.
In the early stages it might only last a few minutes, however, as the condition develops it can go on for hours, days and weeks depending on the type of AF you suffer from. I know when mine runs into several hours once it returns to normal heartbeat function I feel like I’ve run a marathon and suffer with the after effects.
However, this is only the minor downside to this condition, the dangers of AF are an increase risk of a stroke due to blood clots, and less common are heart failure, cardiomyopathy (weakening the heart muscle) and angina.
Types of AF
There are three types of AF and these are:
- Paroxysmal AF.
This is recurring sudden episodes that come and go and will stop without treatment within seven days (usually two). The heartbeat stops as sudden as it had started going back to its normal rate and rhythm. The occurrence between each attack can vary greatly and even occurs when you’re sleeping; it has woken me many times in the night. Although it does go back without treatment, if you have suffered with this for more than 1 hour you are glad to get it under control with treatment. Also remember that while the heart is undergoing its AF you are at risk with the dangers mentioned above!
- Persistent AF.
This means that AF lasts longer than seven days and is unlikely to revert back to a normal rhythm. People that suffer with permanent AF are treated to bring down their heart rates, but the rhythm remains irregular.
Cause of Atrial Fibrillation (AF)
There are various conditions that will bring about AF. One of the most common is high blood pressure as it puts strain on the heart muscle. Other are also associated with the heart such as atherosclerosis, the blocking of arteries by fatty substances, such as cholesterol. Other heart problems are associated with the heart valve and congenital heart disease at birth, cardiomyopathy (the wasting of the heart muscle), and perocarditis (inflammation of the hearts lining).
Other medical conditions associated with AF are: hyperthroidism (over active thyroid gland), pneumonia, asthma, chronic obstructive pulmonary disease, lung cancer, diabetes, pulmonary embolism (blockage in a vessel in the lungs) and carbon monoxide poisoning.
These all sound frightening but not everyone with AF falls into one of the above groups. Some people with AF have no other conditions, and no cause can be found. This is known as Lone Atrial Fibrillation. For example, it can affect extremely athletic people.
Triggers of Atrial Fibrillation (AF)
There are various triggers that set the heart away to fibrillate, and I assume they will be different for each person. Some of these are:
- drinking excessive amounts of alcohol, particularly binge drinking.
- being overweight
- drinking lots of caffeine, such as tea, coffee or energy drinks
- taking illegal drugs, particularly amphetamines or cocaine
I’m glad to say that I don’t have problems with 1, 3, 4 and 5 above. Also I was not overweight when my condition started. However, I do suffer with stress in my job. I have also noticed that certain foods set off an AF attack, especially cheese, which I love but don’t eat so much now. So for me the main trigger is definitely stress, which can come in various forms. Sometimes I don’t even notice that I’m under stress until my AF flares. Apart from the obvious work related stress, it could be worrying about missing an appointment, or trying to get the bike back on the road.
Symptoms of Atrial Fibrillation (AF)
Talking to other people that suffer with AF, I’m quite lucky as their AF tend to go on for days. It’s bad enough that my worst case has been about 12 hours. It knocks you off your feet, and the after effects once it settles down don’t help. Some of my symptoms are:
- Fast heart rate and irregularity in rhythm and force. I first become aware of this in my throat; it feels like I have a lump there. I can then feel it in my chest and sometime can hear it in my head.
- Dizziness. Because the oxygenated blood is not getting to my head as it should I become dizzy and can’t stand.
- Breathlessness. If I have a bad attack I become very breathless, even to walk a short distance. It feels like you have just run a marathon.
- Chest Discomfort. This is a minor discomfort for me, but can be worrying as it is associated with angina as the heart is beating too fast and becomes less efficient.
- After Effects. Once the heart reverts back to normal, I then suffer with headache, lethargic and tiredness. All I want to do is rest and sleep.
I think all this has to do with the fact that the heart is not performing as it should and the oxygen is not getting to the various parts of the body in the correct way. Because of the poor performance of the blood flow there are serious complications that could occur.
Possible Complications of Atrial Fibrillation (AF)
Because of the turbulent blood flow in the heart during AF and that it does not get pumped out as it should it causes the blood to pool. This could then lead to small blood clots forming. These cots then travel around the body until they get stuck in small blood vessels, such as in the brain leading to a stroke. This risk of this varies and depends upon various factors. These factors are calculated by your doctor who then decides what treatment to provide such as Warfarin or Aspirin to help prevent clotting. Other complications have already been discussed such as Heart Failure, Cardiomyopathy and Angina.
Once I knew I had a problem my doctor sent me to hospital for various tests. They included electrocardiogram (ECG), which confirmed the condition, blood tests and echocardiogram to look for underlying causes, such as heart problems or overactive thyroid. Luckily I did not have any heart and thyroid problems. It appears my AF falls into the Paroxysmal AF condition, although my attacks are regular.
So how can this be treated?
Treatment for Atrial Fibrillation (AF)
There are mainly two ways, either by medication or by catheter ablation. Another way, but don’t necessarily prevent it from returning is cardioversion. This is where the heart gets shocked to revert it back to its normal rhythm. I have known a couple of people that have had this and it was not a cure as their symptoms returned within a week or so later. Most patients are on medication and some have had catheter ablation. I was offered ablation but so far have rejected this. The reason is as follows:
A thin wire is passed from the large blood vessel in the thigh up into the heart chamber and towards the pulmonary vein. Once there the ablation process starts by burning the tissue so that it is unable to conduct the abnormal electrical impulse that causes AF.
This treatment is only suitable in certain cases and does not always work, it is supposedly has an 80% success rate. However, I know of two suffers that have tried this on three occasions and in all cases their AF had returned. Furthermore, like any heart surgery there are associated risks, such as stroke, perforation of the heart, narrowing of the pulmonary vein and death. They are fortunately unusual, between 1 – 2% depending on your local area.
In my case I want to stay and try the medication route.
These are called anti-arrhythmics and can restore the heart to its normal rhythm and control the beats. However, it not as simple as prescribing some medicine as it depends on the type of AF, how well it responds to the treatment and side affects of the medicine. In addition to these are the medicines that help to prevent strokes, e.g. anticoagulants.
I have tried several beta-blockers that did not control my AF, but finally the one that worked was Flacanide Acetate. However, it is not completely under control and I still get attacks. When I do I have the opportunity to take an extra tablet hoping to bring it under control. Sometimes this does not work and I have to wait for it to go away by itself.
I also take Aspirin to help prevent blood clotting and reduce the risk of strokes. I know of other patients that take Warfarin which has more serious side affects than Aspirin, so I’m glad I’m not on that yet!
As with all medication there are side affects, and you’ll need to weigh these against the condition you are suffering from. The whole situation is a chance of risk, but one which needs to be taken.
I have been suffering with AF now for several years and my consultant said that there will be a time when the AF symptoms increase and I’ll have more attacks. I used to have an attack every week, then I started my medication and it went down to once every two weeks and then finally I noticed I was going for long periods without an attack, several weeks leading into months. Now all of a sudden I started getting daily attacks again, whereby I have to take the extra Flacanide tablet to bring them under control. I was getting quite concerned as I did not want to go for the surgery.
Then Mr. David Owen, one of our student’s parents had heard that I suffered and suggested vitamin treatment. He sent me information on Vitamin E, and Magnesium Chloride Oil, and just recently Vitamin B-100. This has been a big breakthrough for me because I’m back to normal again and have stopped taking the extra Flacanide tablet. In fact when my heart tries to go into arrhythmia it stops and goes back to normal, or I just put on more magnesium chloride oil.
As this treatment seems to work I thought I would inform people about it. The information that was sent to me by Mr. Owen will be put into another article, if that's of any help? Please let me know. I have also informed some of my friends about the benefits of vitamins E, B-100 and Magnesium Chloride and they too have started taking them.
In addition to this I went onto a low sugar diet and lost weight. I have now reduced my medication in-take and don't get as often AF attacks.
I hope this article has helped anyone who suffers with AF as it is very common, in fact more common that you think!
Useful Links for Further Information
British Heart Foundation
Greater London House, 180 Hampstead Road, London, NW1 7AW
Tel (Heart Help Line): 0300 330 3311 Web: http://www.bhf.org.uk/
Atrial Fibrillation Association
PO Box 1219, Chew Magna, Bristol BS40 8WB
Tel: 01789 451837 Web: http://www.afa.org.uk/
This is an international charity which provides information, support and access to established, new or innovative treatments for atrial fibrillation.