I have been in permanent atrial fibrillation for a couple of years now, but only been taking an anticoagulant (Pradaxa). But things have changed and for the past month I have been on a beta blocker, carvedilol.
Prior to starting the carvedilol, while in permanent atrial fibrillation, I had been able to run two marathons and one ultramarathon (50K) without any more trouble than the normal marathon type suffering, but over the past six months I have noticed things have been changing. I’ve slowed down, even for me, and distances are getting harder. My last half marathon was a joke and I was at the end of the pack within the first two miles. After a run or mountain bike ride of an hour or more I would have problems afterwards – my blood pressure would drop and my pulse would stay high. After a long run, especially if it was a hot day (which they all are, recently) I would get so light-headed after standing up I sometimes had to grip onto something to remain standing.
A visit to the cardiologist, and a subsequent echocardiogram, revealed that my heart rate was increasing and my ejection fraction was decreasing, and for that reason the cardiologist wanted me to start on a beta blocker.
A beta blocker, in this case carvedilol, is a drug that reduces stress on the heart by slowing the heart rate, decreasing the force with which the heart beats, and reduces the tone of the arteries throughout the body. The end result is that blood pressure is reduced, as is heart rate. The heart needn’t work so hard.
Some non-endurance athletes actually use beta blockers as performance enhancing drugs – it is said that it calms a person, reduces performance anxiety, and is commonly used in less endurance specific sports such as golf, target shooting, archery, and even in music performance.
Clearly these drugs are performance diminishing for endurance sports like distance running and mountain biking. We like to stress the heart, raise the heart rate, and we don’t have very much stress – we’re long distance runners after all – the mellowest people around.
I generally am in at least half marathon shape year round. Even if I’m not training for anything my weekend long run is going to be between nine and twelve trail miles. Prior to starting the beta blocker I had signed up for the 15K at the SOB Trail Run at Mount Ashland (Oregon) – one of my favorite races. This relatively high altitude run is basically all up and down trails and fire roads (zero flat sections) and I have done it at least six times in the past, including completing it twice in atrial fibrillation. I was curious to see how being on the beta blocker would affect my race.
The answer was I DNFed (did not finish) and dropped out fairly early in the race. That was terrible – most of my friends were running the 50K or the 50 mile and I DNFed the little 15K???
The course at the SOB is brilliant, really. A lot of trail races start out right away on singletrack, but the SOB has about a mile(?) of fire road at the start so everybody has plenty of time to figure out whether they are going to be running with the fast people or the slow people before they hit narrow Pacific Crest Trail. I ended up at the very back of the group that was running, but I was still in front of the few people who were walking the 15K.
I found that as soon as the course headed up hill I was unable to run. My chest felt funny – not chest pain, just felt weak, not right, and my legs felt dead. I wasn’t short of breath, I was just unable to do it. I decided, in my typical OCD mode, to continue running for five more songs on my iPod shuffle, and then turn around and drop out, thinking that I should at least get a little bit of a work out in, and that I could justify keeping the T-shirt I had paid extra for. I knew I could have walked the course, but that is not what I went there to do.
I was delighted that the fifth song on my iPod turned out to be an oldie from my high school days: Yours is No Disgrace by Yes. Not actually I song I still like very much, but in this context it seemed like a cosmic pat on the back.
A Cosmic Pat on the Back
On the way back I met a woman who was also DNFing (sprained ankle) and we walked the last section of the race together, commiserated, and removed our numbers so they wouldn’t mistake us for the top finishers. At the finish line we informed the race officials that we had dropped out so they didn’t need to send a search and rescue team to find us.
DNFing and commiserating together as we remove our race numbers
So this article is, basically, my first impression of being on a beta blocker, in addition to the atrial fibrillation, and trying to remain an endurance athlete.
So far I feel that the beta blocker is more of a hindrance to my running and cycling than the atrial fibrillation alone had been – but then again, because of the atrial fibrillation my heart function is gradually diminishing.
I should say, on a positive note, that the beta blocker is working, and is doing what it is supposed to do. I check my heart rate and blood pressure at least once per day and since I started the carvedilol I am right where the cardiologist wants me to be. And I can understand why people who aren’t trying to be athletes might like the med – it seems to have a mild calming effect. Furthermore I no longer feel like my heart is a fish flopping around in my chest, and my post work out blood pressure and heart rate has stabilized.
I am optimistic that the carvedilol will be worthwhile and will help me preserve and regain my ejection fraction. But really, what choice do I have?
So here is how things have changed so far (compared to just permanent a fib without the beta blocker):
1.) As far as mountain and road biking is concerned I have been able to ride all the hills that I used to be able to ride, although I am much slower. My wife now has to wait for me at the top of a climb, and that’s fine. I am delighted I can still ride and don’t have to get off and walk my bike.
2.) Running is more negatively influenced. My previous slow pace is even worse, and hills are quite difficult. Not surprisingly I do not like this one bit. A slow jog feels like a 5K effort. But I am still able to run – Yay!
3.) Long runs in heat are not possible. I am just not able to do a long run in heat, and lately every day has been warm. Understand that I am a big red-faced Irish-American who considers anything over sixty degrees to be hot running weather; plus I live in a very sunny place, a high desert climate without a lot of shade. It is not surprising that this is happening. A normal person running in heat will have a higher heart rate for a given pace, and will need to slow down. If you are on a beta blocker that reduces the maximum heart rate by a significant amount, well: “game over.”
My goal is to continue running and mountain biking on trails like this: Brown Mountain Trail
4.) I suspect that the beta blocker might be making me lazy. I don’t know if that is the right word, but I had a full day off in the middle of the week a while ago and I had planned on, among other things, writing this article and going for a trail run, and next thing I knew it was late afternoon and I hadn’t done a thing. What? By that time there was a thunderstorm so I was not going out for a run – but the article still hadn’t been started. I hope this is not going to be the case from now on. Being lazy and depressed is far from my idea of fun.
I am going to wait until I have had more experience with the beta blocker and write a better informed article. I’m going to sign up for a relatively flat (downhill, actually) trail half marathon and try to redeem myself.
In the meantime I would love hear about other people’s experiences with the dreaded beta blockers. Please post a comment below.
I’m sorry to hear the the beta blockers have not been great for running. I can’t really comment as I went straight from no drugs at all to ablation, which I thoroughly recommend – it’s stopped my AFib completely. I hope you manage to find your way through this maze.
Michael, take it from someone that has been dealing with it for 25+ years, Arrhythmia’s SUCK. I have 4 different arrhythmia’s (A-fib, atrial flutter, atrial tachycardia and PVC’s).
I have been on numerous betablockers over the years, currently on Toprol XL and Tikosyn (which as my primary calls it “the big boy medicine” and it’s a drug that my cardiologist cant prescribe. I have to get it from my Electrophysiologist). Anyway, like you I am 6’3″ and a little under 200. I have ran off and on for years, but have done marathons, and a 50 miler. However unlike you, I am not in constant A-fib, mine come whenever and they only way out is via Cardioversion (not fun).
I have not experienced any issues with speed in regards to taking the betablockers. I live in Massachusetts so I dont have mountains to deal with and dont Mountain Bike at all, but from my standpoint/experience I dont think it is a betablocker issue. I am lucky to be near Boston, where my EP doc is, as he is one of the top 3 in the world, and actually developed and/or fine tuned most of the procedures done today for arrhythmia’s including ablations.
I guess my recommendation would be to find the best EP doc you can and see what they can do. Perhaps that can try to ablate what you have.
Because of the way my heart is, with severe left atrial enlargement, I have been told that ablation would be unlikely to help, so I have to work with what I’ve been dealt. I’d be interested in hearing about your experiences with arrhythmias and running. Would you be interested in writing an article as a guest blogger?
Oh and on a side note, when my ejection fraction dropped i was put on Lisonpril. It’s a High blood pressure med, which I dont have, but one of the side effects is that it helps with increasing heart strength/function. May be worth asking about
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Hi Michael – glad to have found your blog. Really good to see you’re not letting it stop you being active. I was diagnosed with afib about 7 years ago at the ripe age of 36. Was in it persistently for a couple of years. About 10 cardioversions and one ablation later I was afib free until about 3 weeks ago when it came back. Another electric shock and I seem okay. Training for the Brighton half marathon in Feb now in the UK. Waiting to see cardiologist to see what to do next, if anything.
A quick word about training on beta blockers. I’m not on them all the time, just when I feel the need. But I have found that I can run and cycle just as far on them as not. I might not have that extra bit of grunt for a sprint finish but other than that it hasn’t made any difference. Mine are Bisolporol and I have also found them invaluable when speaking in public. I find I get massive adrenalin rushes when giving presentations etc since afib started. Couldn’t do them now without them.
I did do the Brighton half a few years back when I was in afib and not on betas. Bit silly really. Got into trouble about 3 miles in and left arm started feeling strange. Like an idiot I dragged myself round and nearly collapsed on the line in 2.25 (not very fleet of foot.) I think on betas I would’ve fared better. I really shouldn’t have been there at all.
Since the incident 3 weeks ago I’ve started my own embryonic blog at atrialfibrillationuk.blogspot.com
It’s all a bit random at the mo but you’ve given me the enthusiasm to keep it going.
Hi, I was diagnosed with Afib 12 months ago and have had 2 episodes , 1st October 2013 ,2nd November 2014. I am 38 but was 37 at time of first diagnose , to be honest scared the hell out of me at start , still does , but seeing your blog amazes me . I am also from Dublin , Ireland . Seeing you jogging and biking with your Afib gives me hope and makes having Afib a little easier to deal with, thanks Micheal , Richard
Thanks for your kind words. Best of luck with your a fib struggle.
Good morning all. Just wondering if any of you have also been diagnosed with PVC”s (early beats) as well? I had been completely symptom free from A-fib and PVC’s since my 5th ablation in August. But the PVC’s showed back up last week and my running suffers (mostly the feeling of dead legs). Anyone else?
I think everybody has PVCs (premature ventricular contractions) from time to time. Ask your cardiologist if your PVCs are problematic or not. It depends on how frequent they occur and where (on the EKG) they occur. Prior to my atrial fibrillation I used to have a lot of PVCs when I started running, and they would resolve after a coupe of minutes when my heart rate got up to running rate. I was able to witness this on the monitor while doing a stress test. I can tell you anecdotally that after my cardioversion, when I was in “normal” sinus rhythm for 33 days before going back into atrial fibrillation I had a lot of PVCs which I found very annoying. Eventually I went back into a fib again. Does the appearance of a lot of PVCs at this point, after your ablation, suggest that you might go back into a fib? I have absolutely no idea – but you might ask your EP/cardiologist, he or she would be able to clear that up for you.
Also, are you sure you are having PVCs or is it some other arrhythmia, maybe even a fib??
Glad to find your blog. I have not been to my cardiologist yet, but have had a handful of episodes over the last few years, that I was hoping would go away. Had my most recent episodes during a 50 mile run this weekend. I finished fine, but had rapid beats at two point in the race that lasted about 30 seconds. I am hoping to get checked out in the coming weeks and will definitely follow up on this blog. Any advice would be great.
Thanks for your kind words. No advice here except definitely check it out with your cardiologist. It could be atrial fibrillation but there are others arrhythmias as well, such as supraventricular tachycardia, or who knows what else. You’re better off knowing what’s going on!
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Michael, I know this reply is looooong after your original post but if you haven’t already you may want to ask your cardiologist or EP if Tikosyn (dofetilide) is right for you. I have chronic AFib + flutter, ablations (two, so far) haven’t fixed me and neither conventional rhythm or rate control drugs did either. Beta blockers definitely slow me when running, though I think that eases a bit with time. Beta blockers are often required if you’re also taking certain rhythm control drugs, such as Rhythmol or Flecainide. But dofetilide does not, so something you may want to consider. It does take 3 days in the hospital to get started (they need to watch you for a very rare but serious side effect) but it may be the best drug for runners with AFib/flutter.
Thanks for your comment. I will bring that up with my cardiologist next time I see her.
I’ve been on Tikosyn for a few years now with remarkable results. I was taken off flecainide due to complications after being on it for a few years (something to do with extending a beat to a dangerous level – they actually stopped me mid-stress test). Anyway, I have had real good luck with it, coupled with Toprol XL to help control PVC’s
What is your problem to which a beta blocker is the solution? Seriously! “It makes my doctor happy” is not a good answer.
In 35 years as a software engineer “What is the problem to which this is the solution?” has probably been the most important question to ask, over and over and over again.
Short background: Although never any good at running (compared to triple jumping, basketball and downhill skiing) I ran 2:52 in the 1981 London Marathon. Was diagnosed with 100% 24×7 af in 2009 and had idiot doctors try and prescribe all sorts of rubbish for me. After much internet searching I decided to stick with daily mini-aspirin, cut alcohol down to one or two drinks a week and maintain my high curry and garlic diet (garlic is a natural blood-thinner). I jog (for me the running/jogging borderline is at about 8 minute miling) 2 to 4 times a week, mostly at between 10 and 11 minute miling. Like a boiled frog I thought I was running much, much faster until my af diagnosis and then the ubiquity of GPS chips in mobile phones disabused me.
Personally, from what I’ve seen in other people’s experience, beta blockers would ruin my life for no benefit whatsoever. Your blog post just seems to add to the negative evidence.
Yes, taking the beta blocker (carvedilol) has been rough; but one key point – the med is helping what it is supposed to help – prior to staring the beta blocker my ejection fraction was decreasing (meaning my heart was not pumping as much blood as it should) and this has been reversed by the medication.
Prescription medications, basically, are just poisons that have some beneficial side effects.