Long Q Interval Any swimmer's out there who have this?

Bob, I was diagnosed with some sort of cardiac abnormality, and I couldn't remember the name. I looked up yours, which seems to be technically known as Long QT syndrome. It turns out this is not what I have. I have first degree heart block, which (knock on wood) doesn't seem to have too many serious repercussions most of the time. The Long QT Syndrome, on the other hand, seems a bit more worrisome according to stuff I found on the Internet. Obviously, you should go to a good cardiologist, preferably one with a background in sports. Your history of marathoning and now swimming suggests to me that the standard cardiologist who spends his or her time treating the standard overweight sedentary American patient might be inclined to "better safe than sorry" namby pambyism, and try to sideline you from overly vigorous exercise. Anyhow, here is a quote I found from the Mayo Clinic website, which usually presents health info in an easy to understand but quite nuanced fashion: You may want to seek a second opinion if your doctor diagnoses you with long QT syndrome. Treatments for long QT syndrome can be life altering, such as avoiding strenuous exercise, taking powerful medications or having surgery. In addition, evidence suggests that misdiagnoses related to this condition are not uncommon — including diagnosing long QT syndrome when it's not actually present, and overlooking the condition when it is. Best of luck, dear Bobinator! If you haven't had symptoms, like fainting during vigorous workouts, I personally would be inclined to continue working out--but maybe make sure there is a defibrillator handy, and somebody who knows how to use it. Perhaps one of our learned forumite physicians--Drs. Dixon, Jaegermeister, and Gull--could opine from a more reputable perspective than this layman!

Hi jImby. Thanks for your advice! According to my electrophysicist he is the person who trained most of the people at Mayo and has written books about such problems. He was very adamant about that! I really felt like he was trying to tell me I could go ahead and proceed as I was currently doing but that he had to advise me to do the other things because that was the standard of care. I guess I could be reading him wrong but I don't think so. At this point I think I'm just going to swim workouts with generous intervals and not push it maximally. I think ow is a bad idea but I hate to think I'll never swim in another meet :( He also mentioned swimming seem to be the activity that is the most problematic for Long Q. He told me I did not had a syndrome because I was symptom free. I don't know if that's something to be happy about or not. I'm feeling very conflicted :(

So the worry is that really maximal exercise might somehow trip your heart into v-fib, which is fatal unless it gets shocked back into normal beating via a defibrillator? I can see why open water swimming might be problematic, but what about pool meets? Most facilities have AEDs now, and if you told the meet director about your condition, then they could be ready to snap into action if you needed it, right? You are more of a distance swimmer than a sprinter, right? I have a friend with a-fib who had to stop sprinting but was able to continue racing longer events. His heart rate would pick up, but not to the jack rabbity levels of a drop dead sprint. Anyhow, I wonder if you could talk to the doc again and explain how important exercise is to your life and see if he can provide "off the record" (i.e., you won't sue!) parameters for how much you can do, and what kinds of events, if any, you can compete in? Seems to me you might be able to still compete in 500s, 1000s, 1650s, hour swims, etc. One other note: what I read was that there are a variety of genes that can cause this. I think your insurance company should pay because it's possible your kids could have the same thing. And if it turns out you don't have any genetic markers, maybe it was a false positive test after all? The result of some medicine or electrolyte imbalance or too much chard following a dehydrating workout?

Bob--did you know that Worlds Gold Medalist, Dana Vollmer, was thought to have this? Fascinating article: www.sportsinjurybulletin.com/.../arrhythmias.html Sample quote: Management of the athlete with cardiac disease is equally problematic. The clinician is always tempted to play it safe in such instances, discouraging participation in competitive sports and endurance training, and instituting prophylactic treatment whenever there is a perception of increased risk. Athletes are understandably reluctant to relinquish the aspirations and investment of a lifetime. The stakes are even higher for professional sportspeople, in whom a cardiac diagnosis will threaten career and livelihood.

Thanks, Jim. And congratulations on your PB in the 800. Very impressive swim. I am not aware of any data to suggest that your level of conditioning affects your risk of sudden death in long QT syndrome. It is known that exercise can pose more of a risk in certain genetic subtypes than others. And which genetic sub-type is more at risk? I'm guessing it's women?

BTW, I was put on a low dose Beta Blocker (Metoprolol) while my genetic testing results weren't known. The doctor seemed to be telling me he thought my QT issues wouldn't be affected by the Beta Blocker but to take it anyway. He had me start with half a 25mg pill--and I just stayed on that. It did feel odd at first (though it's hard to say how much of that was me just being a little freaked out). I thought it would really affect me but I got used to it pretty quick. Didn't really seem to affect my swimming all that much--but maybe because I was on such a low dose. The doctor ended up taking me off the meds once my test results were back. Good luck at the doctor this morning :) Hi Amy! My Dr. put me on the same med at the same dose. I told him I was starting by just taking half, he laughed and said that was fine but a very small dose. I forgot I took it but I could feel it kick in right before the echo test. It really makes me feel relaxed. I'm afraid a whole 25 mg. may put me to sleep. I think I'll go halves a couple days before trying a whole. I have never taken much medication and I seem to be fairly sensitive to it. Oh, the Dr. told me to have all 3 my offspring get ekg's! All 3 were swimmers till age 13. The oldest swam through high school, the middle is currently a pro skateboarder, and the youngest ended up going the cross-country and track route. None of them ever had a fainting or heart issue. Dr. still said they should do it so we will.

Some beta blockers, like Bystolic, are tolerated much better than others. If you do in fact have long QT syndrome, I'm not sure that anyone will "clear" you to compete. So at the end of the day you will just have to decide for yourself if you are willing to take the risk. Do you think I should keep my heart rate under a certain level during workouts? I just feel so good when I swim. I wonder why they haven't given me a exercise stress test to see what that does to the rhythm. In the echo test I had to "bear down", sniff, and hold my breath in and out. I hope it comes out okay:badday:

Bob--did you know that Worlds Gold Medalist, Dana Vollmer, was thought to have this? Fascinating article: www.sportsinjurybulletin.com/.../arrhythmias.html Sample quote: Management of the athlete with cardiac disease is equally problematic. The clinician is always tempted to play it safe in such instances, discouraging participation in competitive sports and endurance training, and instituting prophylactic treatment whenever there is a perception of increased risk. Athletes are understandably reluctant to relinquish the aspirations and investment of a lifetime. The stakes are even higher for professional sportspeople, in whom a cardiac diagnosis will threaten career and livelihood. Wow, amazing article! Especially after watching her win the 100 fly in a WR! I'm not sure I have many similarities with Dana except her love of the water. At her level I can see why she might choose to continue on, I am just amazed that it doesn't effect her performance on a subconscious level. She must be tougher than nails!

Hi Amy! My Dr. put me on the same med at the same dose. I told him I was starting by just taking half, he laughed and said that was fine but a very small dose. I forgot I took it but I could feel it kick in right before the echo test. It really makes me feel relaxed. I'm afraid a whole 25 mg. may put me to sleep. I think I'll go halves a couple days before trying a whole. I have never taken much medication and I seem to be fairly sensitive to it. Oh, the Dr. told me to have all 3 my offspring get ekg's! All 3 were swimmers till age 13. The oldest swam through high school, the middle is currently a pro skateboarder, and the youngest ended up going the cross-country and track route. None of them ever had a fainting or heart issue. Dr. still said they should do it so we will. Funny that you say the Beta Blocker makes you feel relaxed. I actually kind of liked the feeling at night. I tend to be a little hyper so, besides making me a little more tired, I didn't mind the half-pill dose. I will say that I felt funny swimming at first on it--like I couldn't get my heart rate up. That didn't last. But I never went up to the full dose. Interesting that your doctor wants your kids to have EKG's before you have your genetic testing results back. Especially considering you haven't had any fainting spells or family history of any kind. And, considering EKG's can't always pick up long QT issues. My doctor didn't say anything about having my kids tested and I was hesitant for fear it would scare them. My kids are all under 14 and not as heavily athletically involved as yours, though. Hope all the tests come out great. Until then, remember you've been fine all these years and that nobody is guaranteed another day on this planet whether they have a heart condition or not. Enjoy being here :applaud:

Hi Bobinator-- First off, I'm so sorry you are having to go through this. This is one of the creepiest experiences I've ever had. To go from extremely active and healthy to being told you may have a potentially fatal heart condition really, really stinks. I had an EKG last Spring in preparation for a routine OB surgical procedure and the OB sent me to the cardiologist because of my QT interval. I went from the cardiologist (who had decided I was ok based on a great stress-test result) to the electrophysiologist (just to be safe). The electrophysiologist didn't like the looks of my resting QT interval and had me do genetic testing. I think he was sure I had type 3 LQTS (where I'd end up needing a defibrillator). He never told me I had to stop exercising outright but that may be because I was so adamant that I've made it 45 years with no problems. I didn't compete this summer and took a small dose of Beta Blockers while trying to be careful training. This all started in March and I finally got my genetic testing results back in the middle of July (took 5 weeks after they got my blood sample). I do not have any of the three genetic markers for LQTS. I have an abnormality but it's not known to have any specific effects. So, I've been cleared to resume my normal life (though I need to avoid any drugs that lengthen QT intervals and to make sure I keep my electrolyte levels normal). Does your doctor recommend genetic testing? It's not cheap--even with insurance it's pricey. However, for peace of mind and the ability to inform your relatives of any potential issues, I think it's worth doing. I probably know exactly how you are feeling right now. Irritated, a little freaked out and confused at how you could possibly have something so serious and have lived so actively with no problems thus far. Please PM me if you want to chat some more.