Post-Exercise Heart Rate Variability and Concerns

Slow and irregular heart rate after exercise?

Hello, I would like to ask: I have a regular running habit, but a little over a month ago, I felt my heart rate was too slow (40-60 bpm) during the night, accompanied by a strong heartbeat and missed beats.
Although I did not feel unwell, I went to the emergency room.
The doctor in the ER administered a dose of atropine, and I was discharged in normal condition, with a recommendation to see a cardiologist for further evaluation.
The cardiologist interpreted the ECG from that day as complete heart block and scheduled an echocardiogram and a 24-hour Holter monitor a week later.
During that time, I did not experience any discomfort.
Later, the doctor informed me that all test results were normal and that it was likely an occasional symptom that should not be a cause for concern.
However, recently, after resuming my usual running practice, I have been experiencing a feeling of tightness and pain in the lower left chest, with an unstable heart rate at rest, fluctuating between the 30s and 60s bpm, along with missed beats.
These symptoms can last for more than a day, but I do not have any other discomfort.
I am a bit worried and am unsure if I should undergo further testing.
Thank you.

Mr. Zheng, 30~39 year old female. Ask Date: 2013/03/24

Dr. He Dongjin reply Cardiology

Hello, it is recommended that you go to a major hospital to undergo another 24-hour Holter monitor test and perform the running exercise again.
This will help assess your heart rate condition when you feel unwell.
Please bring along your previous hospital records, including the ECG from the emergency department, for a comprehensive evaluation.
Changhua Hospital is concerned about your well-being.

Reply Date: 2013/03/24

More Info

Understanding post-exercise heart rate variability and the concerns surrounding it is crucial for anyone who engages in regular physical activity, especially if they have experienced previous cardiac symptoms. Based on your description, it seems you have a history of bradycardia (slow heart rate) and occasional skipped beats, which can understandably cause anxiety, particularly after experiencing a significant event like a complete heart block.

Firstly, it's important to recognize that heart rate variability (HRV) is a normal physiological phenomenon. After exercise, the heart rate typically increases to meet the body's demand for oxygen and nutrients. Once the exercise ceases, the heart rate should gradually return to its resting state. However, the rate of this recovery can vary significantly from person to person, influenced by factors such as fitness level, hydration, stress, and overall cardiovascular health.

In your case, the episodes of bradycardia you experienced, particularly the heart rate dropping to 30-60 beats per minute, are concerning, especially when accompanied by symptoms like skipped beats and chest discomfort. The fact that you were treated with atropine in the emergency department suggests that your heart rate was critically low at that time, warranting immediate intervention. The subsequent diagnosis of complete heart block indicates a serious condition where the electrical signals in the heart are disrupted, leading to a failure in the heart's ability to maintain a normal rhythm.

However, the follow-up tests, including the echocardiogram and 24-hour Holter monitor, returned normal results, which is reassuring. This suggests that the episodes you experienced may have been transient and not indicative of a chronic condition. The heart can sometimes exhibit abnormal rhythms in response to stress, dehydration, or even certain medications, which might explain the variability you are observing now during your running sessions.

The left-sided chest discomfort you are feeling could be related to several factors. It might be musculoskeletal, especially if you have recently increased your running intensity or duration. Alternatively, it could be related to anxiety, particularly given your history of panic and concern about your heart health. Anxiety can manifest physically, leading to sensations of tightness or discomfort in the chest area.

Given your ongoing symptoms, it would be prudent to consult with your cardiologist again. They may recommend further monitoring or testing to ensure that there are no underlying issues that need to be addressed. It’s also essential to discuss your exercise routine with them. While regular physical activity is beneficial for cardiovascular health, it’s crucial to ensure that your body is responding well to the intensity of your workouts.

In the meantime, consider incorporating a gradual warm-up and cool-down into your exercise routine. This can help your heart rate transition more smoothly between resting and active states. Additionally, focus on hydration and nutrition, as these can significantly impact heart function and overall performance.

Lastly, it’s vital to listen to your body. If you experience any new or worsening symptoms, such as increased chest pain, significant changes in heart rate, or feelings of dizziness, seek medical attention promptly. Your health and safety should always come first, and it’s better to err on the side of caution when it comes to cardiac symptoms.

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