cycling at intensity ???

[Jas0n]

hi,

i posted a while back on the site and got some really amazing responces, so first off, i want to say thanks. a little background: i am a 21 year old competitive cyclist with a bicuspid aortic valve exhibiting moderate regurgitation with a moderate expansion of heart tissue (no surgery yet, but it is def. on the table when my docs - and i have seen many - decide it is necessary). when the regurgitation first became an issue, i was told to limit to the intensity at which i ride because there existed a possibility that i would pass out; above 175 bpm, my blood pressure would drop and i would begin to see stars. however, my max heart rate is around 218, and i spend most of my ride above 175bpm, and have simply gotten used to feeling the way i do when i ride (i always thought it was normally riding at this level). so i decided (with huge reservations, i even sold both my race bikes) to stop riding for a while b/c i know that i dont have the self control to ride at what my doctor deemed a "reasonable" pace; im 21 and way too aggresive a rider to sit in on group rides, i was always the hot shot grabbing sprints and attacking on climbs, even though it always hurt more than i thought it should (i usually had great form, but suffered so much more than others, but i found ways to deal with it). no ego here, just in case you didn't notice!!

so now, i want to get back into training. i want to ride again!! an echo done today confirms that the leakage is not as bad as it was 4 months ago (i still havent spoke to my cardiologist about the complete results/reccomendations, but i was told the leak was mild), but what are your experiences with training at a great intensity for a great time period (5+ hour rides/25 hours a week)??? am i doing damage to my heart my riding this hard?? am i making the leak worse?? long term issues?? is it better to be in "bad" shape than train the way i have, even if it means i have greater regurgitation??? i know these are questions for my doc, but he is on the conservative side and always advises me to limit myself (which is way too hard for me to do). so thats my rant, thanks for taking the time to read. thanks again.

 

[Gemma]

Hi Jason,

I'm afraid I may have more questions than answers here, but your post threw up a few queries I thought you may want to consider.

Firstly, your max heartrate sounds a bit high - the "textbook" max HR would be 220-your age (giving you 199), and the target workout HR is anywhere from 50-85% of that, depending on the intensity you want, so around 100 - 170 bpm. Seeing stars as you're riding along doesn't sound like the best experience ever .

Secondly, it's possible that your leakage has improved due to your decreased exercise. It's hard to know how big the change is without having actual figures though so maybe that's more a question for your cardio. It follows that if your valve isn't functioning properly, your heart has to beat much harder to get blood through it especially when you're riding at such a high intensity. My boyfriend Jim also used to carry on regardless of the pain he felt (although his tended to happen after he'd got off his bike, not during riding) and took a while to put two and two together. He also has a friend with another heart condition (don't know what) who was advised to cut back on the exercise as the intensity at which he was riding was causing problems. Sorry to seem so vague, but we only recently saw him again for the first time in years so I couldn't really start grilling him about the ins and outs!

I'm sure there are other members who'll have much better suggestions, but do you think your cardio could suggest a safe level of exercise that you'd be happy to stick to? I'd imagine some riding is better than none. Maybe do a stress test or something to figure out your safe limits??? Alternatively, if you'd prefer to be riding the way you want to, I guess you'll have to accept that valve replacement will be in the nearer future than if you don't do any exercise. And then there's the question of whether it's better to wait and get unhealthier (through not exercising), or stay fit and get it over with sooner...

OK, that's all from me for now. Sorry not to answer any of your questions, but maybe I've given you something to talk over with your cardio when you see him next.

Gemma.

 

[MarkU]

Just to share my experience:
I was an avid weightlifter/bodybuilder and did a lot of high intensity aerobic workouts prior to my AVR. In the year or so prior to my surgery I continued to push myself in my workouts to the point where the endorphins would kick in, giving me a false sense of well-being. Unfortunately, I was developing left ventricular hypertrophy (LVH), or enlargement of the left ventrical walls. The fact that I was in relatively good physical condition masked the seriousness of my condition. For a while my surgeon thought that I may have done irreversable damage to my heart muscle. Luckily, my AVR went smoothly and my LVH reversed itself within the first year post op. I was very lucky.
I guess my advice would be to be very careful about intense workouts causing damage to your heart due to the insufficiency of your valve. I would suggest a good heart-to-heart chat with your cardiologist might be in order.
Good luck.
Mark
PS- since my AVR I have started training for sprint triathlons, and not only reversed my LVH, but also reduced my resting heart rate into the mid 40's through low/moderate intensity aerobic training.

 

[Jas0n]

thanks for the replies. here are a couple of additions: i had a stress test when the issue first surfaced. i was able to finish the whole test (23 minutes on this particular machine) with a heart rate of just 211. my max heart rate is very high, but that is just the nature of my heart's function; my cardiologist likened it to a race car being able to rev to 18k rpm while your standard car will only rev to 7.2k (im a car guy as well). the stress test also lent the intution that suggests the reason i see stars is because of a drop in my blood pressure above 175 bpm. however, my heart rate is always above this "limit" when ride. also, interestingly, despite the shape i was in, my resting heart rate was higher than expected at 68 beats per minute. obviously, this all semms to point to a very high restriction upon flow which causes my heart to both pump at a higher pace and with greater force (or so i understand it to be the case. that is, my hear beats quicker because there is effectively a limitiation placed on blood flow and as a resulte, the heart tissue expands to be able to pump more blood with more force). are all these assumptions true?? as for other activities, i rock climb every day (indoors as well as outdoors) and have started to get into motorcar racing, but i still love riding. still waiting on the call my doc, so im keeping my fingers crossed, but i think i know what the answers are.

 

[ChristineBP]

Hey Jason - If your doctors question what you are doing, do what I started doing. Tell them that if they are so worried about your well being during a race they should come out and join you. Or they can strap on a heart rate monitor - I've had that done.

It's hard for doctors to understand younger more active adults and the fact that it is hard to give up an active lifestyle.

My doctors have told me they just aren't sure what I can do and what I should not do. They know that if it were up to me I would run until my legs fell off. But we work together. Right now it's 5 miles.

I'm finding that hard to follow, so I'm working on trying to make it 10 miles. I'm hoping you stay healthy and strong. Best of luck with all you do and I hope your happy with your doctors and I hope they work with you and you get where your going in GOOD Health.

 

[BillCobit]

Hi Jason

Couple of thoughts:

Echocardiograms (and their interpretation, which is somewhat subjective) are good tools but you can't necessarily treat a more favourable interpretation as an indicator that your condition has gotten better. You can get some "points off the curve," so to speak. So take the results w/ a grain of salt.

Your heart does make some adaptations to regurgitation that have short-term functional benefit - like heart enlargement - but these ultimately have a negative effect on the condition of your heart (e.g., heart failure).

You may be interested to read:

Cardiac Surgery in the Adult - Pathophysiology of Aortic Valve Disease

http://cardiacsurgery.ctsnetbooks.org/cgi/content/full/2/2003/791

for a description of physiological adaptations and functional effect on the heart muscle.

 

[stormrev]

Intensity up to a point!

Intensity up to a point!

Hi Jason

I'm a little older than you (49 next month!) but was very active right up untill my AVR surgery March 2004. When I was your age I was beginning to run marathons etc and had no idea I had a bicuspid AV until it was detected at age 36.

At that stage I was a competitive triathlete who, like you had no idea my companions weren't suffering as much as I was ( at least that's my theory!!!) and I loved to run hills and go hard on the bike. It appears that all the intensity of aerobic exercise had little bearing on the timing of my surgery and that the mild leak stayed mild for a long time. My Dad had to have his bicuspid replaced at age 65, my youngest brother at 34.

I have a theory (and it's difficult to find any definitive research on athletes with bicuspid valves) is that there is a great deal of individual variation amongst us and the progress or deteriation of the valve is hard to predict. I know my brother played rugby (as did I) but he did a lot more weight work than I ever did - maybe the isometric pressures from heavy weights is a contributing factor?

The advice I was given ten years ago when a mild leak was discovered was that it shouldn't preclude me from any physical activity - so I continued to run and compete with no obvious diminishing of capacity.

However 5-6 years later my body began to tell me that something wasn't right and sure enough the leak and stenosis had progressed but it was very gradual. I attended yearly checkups and had scans and so they were able to monitor what was happening and in the end the pressure gradients were a clear indicator when surgery was required.

Now I'm back exercising but at a much reduced level - I guess I feel that I no longer have to prove anything but enjoy the privilege of being able to run, swim or cycle once more.

This saturday I'm heading to Lorne to swim the 1.2 km Pier to Pub sea swim down the coast - me and 5000 others!

All the best

Grant

 

[Paul]

Hi Jason,
I have the understanding that my leaky aortic valve made my heart work much harder and so my heart accomodated by growing my left ventrical both thicker (stronger muscle) and larger, to accomodate the thicker tissue. I am still trying to reduce the size of my chamber with medication. I was able to compensate quite well but my heart was working extra hard. With the enlargement, it does not squeeze all the blood out efficently and that, along with the regurgitation, reduces your capacity.

So my level of training (10hrs/wk riding) i was keeping healty but my left ventrical was taking the hit.

I raced quite well, but not my best, till the 2004 season. That year i had a hard time going out for a 90" ride. I had lots of other reasons for this fatigue but when the valve was diagnosed i my surgery in a month. So it had likely degraged fast.

In your case they are prsumably watching your chambers for enlargement and keeping an eye on the pressure gradient.

I would be interested to know why he wants you to take it easy if these factors (and indicators i am un aware of) are not degrading??

I LOVE to go fast too, so hope you can get back to it. However I wonder if you have or will loose some self confidence in your bodies ablity to handle the extreem efforts?