Tag Archives: Cardiac dysrhythmia

Guest Blogger Adam Durnham – 5 Athletes that have Atrial Fibrillation

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Special thanks to writer Adam Durnham who has kindly sent me an article he wrote on atrial fibrillation and athletes – You are truly appreciated Adam!

 

5 Athletes that have Atrial Fibrillation

Atrial fibrillation (AF or AFib) is an irregular or quivering heartbeat that can lead to heart failure, blood clots, stroke, and other heart-related complications. According to the American Heart Association, approximately 2.7 million people in the United States live with AFib.

During AFib, instead of beating effectively to move blood into the hearts ventricles, the upper two chambers of the heart (the atria) beat irregularly and wildly. Some people experience no symptoms of this medical condition and become aware only during a physical examination. For those who do experience symptoms, they often include:

  • Heart palpitations
  • Shortness of breath
  • Weakness
  • Fatigue
  • Confusion
  • Lightheadedness
  • Chest Pain
  • Reduced ability to exercise
  • Dizziness
  • Sweating

Different Types of Atrial Fibrillation

Atrial fibrillation symptoms are typically the same; however, the underlying reasons and the duration of this medical condition help to classify the different types of AF problems. The different types include:

  • Occasional – With occasion AFib, symptoms may come and go and may last only a few minutes or hours and end on their own.
  • Persistent – With persistent AFib, the heart rhythm does not return to normal on its own. In order to restore normal heart rhythm, the patient will need treatment such as medications or electric shock.
  • Long-standing persistent – With long-standing persistent AFib, the condition is continuous and persists for more than twelve months.
  • Permanent – With permanent AFib, there are no further attempts to restore normal heart rhythm and the heart rate is often controlled by medications.

Atrial Fibrillation in Athletes

AFib is the most common arrhythmia seen in athletes. This is especially so for middle-aged athletes, although it can be seen in young athletes as well. Here are five athletes who have atrial fibrillation and how they handle the condition:

Larry Bird –  NBA legend, 12-time All-Star, three consecutive regular-season MVP awards, Boston Celtic Larry Bird suspected he had problems with his heart while still playing his beloved game but never told the team physician. It wasn’t until he retired in 1992 that he was diagnosed with atrial fibrillation. He claims his symptoms which included rapid heart rate, disorientation, and light-headedness, are now under control.

Jerry West – The 14-time NBA All-Star guard Jerry West who played for the Los Angeles Lakers from 1960 to 1971 was unaware he had symptoms of atrial fibrillation while he endured sleepless night, heavy breathing, and anxiety. West remembered breathing into paper bags during halftimes to help with his hyperventilation. He described these episodes as panic attacks. It wasn’t until his heart raced out of control after he became the coach and general manager of the Lakers that he was diagnosed with atrial fibrillation. To restore a normal heartbeat West was treated with cardioversion. Cardioversion is a procedure that utilizes a low-energy shock to the electrical system of the heart for the purpose of restoring normal heart rhythm. However, after this procedure, his AFib persisted and after 40 years with the NBA he retired.

Haimar Zubeldia – Spanish cyclist and Tour de France race Haimar Zubeldia, announced in 2012 that his AFib condition forced him onto the sidelines for a period of three months. Although his physicians explained to him that AFib could end his career, Zubeldia returned to the sport after treatment and weeks of rest. His was determined to remain competitive in the sport and finished sixth best overall that year in the Tour de France.

Karsten Madsen – Triathlete Karsten Madsen felt faint and short of breath in 2010 after a routine fitness test. He was diagnosed with atrial fibrillation at that time. He was informed by his doctors that he would need to undergo cardioversion to restore normal heart rhythm. Madsen’s doctors reassured him that he can continue to train, and he has his condition monitored closely.

Billie Jean King – In 2015, the legendary tennis champ Billie Jean King went into atrial fibrillation. After visiting a cardiologist, she was diagnosed with AFib and prescribed daily medication. In addition, she also underwent an ablation to destroy abnormal tissue that may cause arrhythmia. King has teamed up with Janssen Pharmaceuticals to raise awareness about atrial fibrillation and to educate those with AFib about their risk for afib-related stroke.

If you or someone you know has symptoms of atrial fibrillation, it is crucial to seek medical attention immediately to reduce the risk of complications.  If a person is a heavy drinker, it is important they get rehab services as this can affect their heart condition. Do not waste time if a loved one you know suffers from a-fib and drinks heavily.

What is the ACLS Approach to Atrial Fibrillation? (Advanced Cardiac Life Support)

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A week or so ago I re-certified in ACLS – Advanced Cardiac Life Support. ACLS is a set of emergency clinical interventions for cardiac arrest, stroke, respiratory arrest, etc., which is basically a step above BLS (Basic Life Support – formerly known as CPR). ACLS certification, in my case anyway, is done through the American Heart Association, and is only open to health care providers: doctors, nurses, dentists, advanced practice providers like PAs and nurse practitioners, EMTs, respiratory therapists, pharmacists, and so on.

I thought I’d write about it in this blog so people might know what to expect as far as the type of treatment they might experience if they have an unstable episode of atrial fibrillation.

I’m in permanent atrial fibrillation, so when I’m in one of these classes I’m glad I’m not hooked up to an EKG – I don’t feel like getting medicated or shocked!

ACLS deals with various problems using algorithms, so let’s look at the “Tachycardia with a Pulse Algorithm” which would generally apply to acute atrial fibrillation.

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So basically we start with a person with a fast heart rate. Tachycardia is, by definition, a pulse over 100 beats per minute, but for ACLS purposes it generally means a pulse over 150 bpm. Obviously not all tachycardia (fast heart rate) is atrial fibrillation.

For this article I am not discussing the other types of tachycardia, even though they are in the algorithm. I assume most people reading this blog are dealing with atrial fibrillation.

The first step is to assess the patient, identify and treat any underlying cause, make sure the patient is breathing effectively, assist if necessary, and give the patient some oxygen.

Now the next step is very important – is the patient stable? Five things: 1.) Is the blood pressure too low? 2.) Is there altered mental status (confusion)? 3.) Is the patient going into shock? 4.) Chest pain? 5.) Heart failure?

Even though I am in atrial fibrillation, all the time, I don’t have any of these symptoms. But if the patient is unstable and have tachycardia, basically, they are going to be getting some electricity! That means synchronized cardioversion, and in the case of atrial fibrillation (see “narrow irregular”) that means 120-200 joules – that’s a big shock!

Check out this video of cardioversion for atrial fibrillation – yikes!

Notice that it says “consider sedation.” Sedation can be considered, but not if it interferes with getting the unstable patient shocked as soon as possible. If you go into unstable atrial fibrillation at a race expect that the sedation will likely be skipped and get ready to be ZAPPED.

Photo by Ted Friedman.

Photo by Ted Friedman.

This is for unstable tachycardia – that means the patient is in some sort of crisis that may eventually be life threatening.

For an episode of stable atrial fibrillation expect vagal maneuvers and a referral to a cardiologist. Vagal maneuvers include firm carotid sinus massage, coughing, gagging, valsalva maneuver (holding your breath and “bearing down”), and placing your face in ice water (snow also works). A lot of people with intermittent atrial fibrillation already know how to do this.

For a great article about her episode of unstable atrial fib see Run, Smile, Drink Water and Don’t Die – A Guest Post by JoAnna Brogdon.

I’d be very interested in anybody else’s experience with unstable atrial fibrillation and what type of treatment was administered. Please comment below. Thanks.

Run, Smile, Drink Water and Don’t Die – A Guest Post by JoAnna Brogdon

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Once upon a time there was a girl that loved to run just for the fun of it. She woke up early one morning on a cold and rainy March morning, excited to run the Rock Creek River Gorge Trail Run at Prentice-Cooper State Forest, just outside Chattanooga, Tennessee. She had run this race before and was wowed by the gorgeous gorge views and challenging single track trails.

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She signed up for the 10.2 mile run but wasn’t feeling exactly right that morning. She couldn’t put her finger on it. She was just a little off but that wasn’t going to stop her! She bounced out of bed and decided to do the 6.5 mile option instead of the 10.2—a decision that turned out to be one of the best she ever made.

The start was a little fast. Everyone was ready to get moving on the chilly and very wet morning. Soon the 158 runners headed into the woods and formed a single line, slowing the pace which was a good thing. The trails were incredibly slippery with tons of thick mud after much rain that winter. One runner took a face plant when crossing the creek and came up with a big gash on his forehead and blood dripping down his face.

“Are you OK said the girl?”

“Yes, I am just happy to be out here,” he responded.

“Me, too!” she replied. There were smiles on everyone’s faces as they headed up steep hills and carefully focused on the each step.

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At the half way mark, she was feeling OK but a little more tired than usual. No problem she said to herself, just having an off day. It was time to focus on other things, talk to people, make some jokes and carry on. She found a guy wearing a shirt that said, “Idiot Runner’s Club – Run, Smile, Drink Water and Don’t Die.” This sounds like my kind of runner thought the girl! They chatted and laughed about how slow they were going but how happy they were to be there instead of sitting on a couch or still sleeping in bed. The mud was so thick that their shoes nearly got sucked off but happily they went up yet another hill.

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Even though she wasn’t moving very quickly, her heart was starting to race quite fast. She slowed down and was walking more than running. She put her hands in the air a few times feeling like it was getting a little hard to breathe. Just focus on the gorgeous trails and it will be over soon, she told herself.

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There is that Idiot Runner again. He caught up and they were passing each other back and forth. It was time for more chatting and laughter. Only a few more hills and it will be time to relax and enjoy the day. One final push, climbing up through the narrow Indian Rockhouse and the race is almost over.

It is only 6.5 miles, she thought why does this feel so hard? She had run 50Ks and didn’t feel this bad. There goes a female racer. She will have to see if she can catch her but just felt so tired and ready to stop. Then she heard the crowd and knew that the end was near. She pushed as hard as she could one final time to make it to the finish line—she did it! And then she decided to sit down for a minute, she really didn’t feel so good … and then there was darkness …

…what is that noise?

She was waking up and heard a loud noise – it was her heart pounding at an incredible rate and a bright light in the distance. Someone was saying something to her, if she could only get to the light. She woke and found herself inside the medic tent with two physicians by her side. Her legs were cramping with the worst pain she had ever felt. Where was she? What had just happened? What was her name? Which hospital did she want to go to? So many questions…

She was being placed in an ambulance and sent to the local hospital. She was in rapid rate Atrial Fibrillation and needed a Cardizem drip to get her rate down. They admitted her to the hospital and the nurse came by to explain what A Fib meant. She drew a nice picture for the girl.

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She learned that A fib occurs when one or both of the upper chambers of the heart – called the atria – don’t beat the way they should. This can cause blood to pool in the left atrium, where a blood clot can form. If that clot breaks away, it can travel to the brain, where it can cause a type of stroke called an ischemic stroke.

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Two and half days in the hospital she waited for the meds to convert her heart back to normal sinus rhythm. They placed a band on her wrist that said “fall risk” – they had no idea.

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The doctor decided the only way to get her heart back to normal rhythm was to cardioconvert using an electric shock. She was wheeled down to the operating area and what a surprise– she saw the two doctors that were at the race. One was a cardiologist and the other was an anesthesiologist for cardiology. They were chatting and laughing and encouraging her that it was all going to be OK. Her cardiologist was running late and it delayed the procedure. He was known for this as he always took time with his patients. Right as the doctor arrived; the nurse looked at the monitor and said wait—she converted on her own! We don’t need to shock her heart. The girl was happy and believed that it was actually going to be OK— maybe not happily ever after but OK. She smiled as she remembered the new friend she had just met on the trail…

“Run, Smile, Drink Water and Don’t Die.” Now those were words to live by.

The End.

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JoAnna Brogdon, forty-three years old, went into a fib several times since the race and was hospitalized twice. She has no underlying chronic conditions and the doctors are unable to tell her why she has had a fib. She believes the worst part of the condition was the emotional stress and not being able to exercise as she had in the past. She underwent a cardiac ablation recently and her heart has been beating normally since. She is hopeful that she has put a fib behind her at least for now and looks forward to running, traveling and feeling normal again. JoAnna wants to support those that struggle with a fib and may be contacted at joannabrogdon@hotmail.com.

Persistent and Intermittent Atrial Fibrillation

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There are different types of atrial fibrillation. They’re all the same arrhythmia, the main difference is duration. Some people have intermittent (or paroxysmal) atrial fibrillation. This means that the individual goes into atrial fibrillation for a short period of time – maybe a couple minutes, maybe twenty-four hours, but less than one week. Most of the descriptions of atrial fibrillation I have found on the web describe paroxysmal atrial fibrillation.

Atrial fibrillation that lasts for longer than seven days is called persistent atrial fibrillation, and atrial fibrillation that lasts for over one year is referred to as long-standing persistent atrial fibrillation or permanent atrial fibrillation.

Regrettably that is the type of atrial fibrillation that I have. I have just “celebrated” my one year anniversary of persistent atrial fibrillation. I miss sinus rhythm.

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The Best Mile Marker

People who are in sinus rhythm most of the time and go into atrial fibrillation only occasionally are fortunate because they get to be in sinus rhythm most of the time, which is basically the hot set up for any type of endurance sports. The disadvantage is that when these individuals to go into atrial fibrillation the effects are pretty devastating, and more often than not they find themselves on their hands and knees wondering what happened. The other bad news for people with intermittent atrial fibrillation is that it may very well progress into a persistent type atrial fibrillation, and of course there is a risk of having a stroke. So it is important to discuss this and formulate an appropriate treatment plan with your healthcare provider.

The disadvantage of being in persistent, but relatively asymptomatic, atrial fibrillation is that you have a performance penalty all the time; but the advantage is that you stabilize, at least I have, and are able to participate in your sport, albeit at a slower pace. It never gets much worse or much better.

Maybe there are some athletes out there who are in persistent atrial fibrillation who are unable to continue to participate in running, mountain biking, etc. if so I would encourage you to share your stories in the comments section.

All unable to discuss at this point in time is my own personal experience.

finish line

Bizz Johnson Marathon – I think I’ve done this one five times

What Is Atrial Fibrillation?

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Atrial fibrillation is the most common heart arrhythmia in athletes. The best explanation of atrial fibrillation, in my opinion, is from the Athlete’s Heart Blog:

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Atrial Fibrillation in Athletes (In a Nutshell)

One simple way of looking at it is to realize that when you are in atrial fibrillation the atria (plural of atrium –  the top two chambers of the heart which help fill the ventricles) are beating so fast it is as if they are not being at all, so in other words an individual who is in atrial fibrillation has had the misfortune of going from a four chamber heart to a two chamber heart. This reduces cardiac output to a certain extent, but does not necessarily exclude one from athletic activities. But it makes a runner who was previously a back of the pack runner into a runner who finishes right ahead of the people who are walking the race.

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Getting Ready to Run on the PCT