Do You Have "Athlete’s Heart"?


Do you have “athlete’s heart”?

If you’re a well-trained endurance athlete, you probably do. And don’t even know it. But that’s okay, because “athlete’s heart” is generally a good thing. Here’s why….

We’ve known for more than a century that there are a variety of cardiac changes that are associated with exercise. As long ago as 1899, S. E. Henshen at the University of Uppsala Sweden published a report entitled, “A Study in Sports Medicine; Skiing and Competitive Skiing,” recognizing that skiers developed enlarged hearts that were a response to exercise. And we’ve learned a lot more during the past 100 years about the heart’s adaptation to exercise.

Today, we use the terms, “athlete’s heart” or “athlete’s heart syndrome” to refer to the entire collection of the heart’s physiological adaptations to exercise. Those adaptations come in 2 main forms: structural changes and electrical changes.

Structural changes

Over time, the well-trained athlete’s heart adapts in order to provide a high cardiac output (volume of blood pumped per unit of time) in the most efficient manner. Because of mechanical advantage (after all, the heart is only a pump), the heart adapts by increasing the volume of its chambers, decreasing its heart rate, and increasing the thickness of the heart’s muscular walls–particularly the ventricles (the pumping chambers).

Changes in the structure of the heart will not be the same for every athlete. These changes will be most pronounced for athletes who engage in the aerobic sports (running, swimming, cycling, rowing, etc.).

The thickness of the left ventricular wall is usually less than 1.3 cm in thickness, with many individuals having a thickness of 1.0 cm or so. Well-trained athletes may have a left ventricular wall thickness of up to 1.5 cm, again an adaptation that helps with the generation of additional cardiac output during exercise.

Electrical changes

Athletes can have a variety of electrical changes that show up on an ECG. The most common finding is a slow heart rate (that we call “bradycardia” when the heart rate is less than 60 beats per minute). You’ll know that you and your athletic friends may have a resting heart rate that is much less than even 60 beats per minute. Yet the medical profession arbitrarily calls 60 to 100 beats per minute “normal”….for most individuals. For the well-trained athlete, though, a heart rate less than 60 beats per minute is typical and simply reflects the efficiency that the heart has developed over time due to exercise.

There are many other findings that can be present on the athlete’s ECG, including sinus arrhythmia, wandering atrial pacemaker, first- and second-degree heart block, junctional rhythm, and various types of repolarization abnormalities. These terms will only be meaningful to a medical professional, but suffice it to say that, when we add up the frequencies of all of these findings, an athlete’s ECG is very often “abnormal.”

Physical examination

In addition to the structural and electrical changes, there can be changes in the physical examination, as well. Athletes are more likely than non-athletes to have murmurs or other heart sounds (heard by stethoscope) that are simply a manifestation of the structural and electrical changes mentioned above.

Why is this important?

I’ve said that all of these changes, or adpations, are a good thing. And they are! But here’s the problem….

Imagine this scenario. And it’s pretty typical. A 42-year-old man, an avid triathlete, crashes while cycling, fractures his clavicle, and requires operation for repair of the clavicle fracture. He gets an ECG before the operation to screen for any unrecognized heart problems….and behold, he has an abnormal ECG. His physicians overlook the fact that the “abnormal” ECG may be very “normal” for an endurance athlete….and they order a variety of (possibly unneeded) additional heart tests to look for any specific heart disease. And, in the end, they don’t find anything wrong.

It’s important for you and your physicians to remember that you’re an athlete and that you may have features of the “athlete’s heart syndrome.” The next time you’re at the doctor’s office and he or she is listening to your heart with a stethoscope, you might ask the doctor if there was a murmur. Mention that you’ve learned something about athlete’s heart syndrome and ask if any murmur might be due to that. You’ll impress your doctor….and you’ll be helping your doctor remember that athlete’s are special.

This another area where you can be as knowledgable (or perhaps more knowledgable) than your doctor. Take charge.

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  1. says

    How long does athlete’s heart tend to go away? In other words, how long before I should get my next tests to see if it’s truly hcm or athlete’s heart.

    • Ralph O'Brien IV says

      I have read that due to the physiological changes to the heart that the “athlete’s heart” is permanent. I would suggest that this is true since for me at the age of 49 and have not exercised for years and I continue to not only have the heart murmur but also have an average heart rate of 44 when I wake and a daily resting heart rate of 52 throughout the day. When I do exert myself doing any stressful work my heart rate may climb to 110 but return to the low 60 within a minute or two and get down to the 50s within 5 minutes. I wear a fitbit to record these measurements.

    • Juliana says

      I am interested in this topic. Seven months ago I started running and have lost 10 lbs. My normal blood pressure has also dropped to a normal-low level (100/70 on average). I was running an average of 15 miles a week before winter and daylight savings set in. In January it was determined I neeed to have a biopsy (all is well). I met the surgeon who checked my heart and asked me about my heart murmur. Huh? So off I go to cardiology for an echo. I never did hear back from cardiology and had the surgery so I assumed it is innocent. The anesthesiologist also heard that murmur the morning of the surgery. Here I am post surgery wondering when i developed a heart murmur. In the last 7 months? Could it be since I started running? I’ve attributed mild dizziness upon rising from sitting too low blood pressure but now concerned that it might be due to the heart murmur too. Obviously, I need to contact my pcp but wondering if anyone else has experienced something like that. Itching to get back to running after surgery, but now a little cautious.

  2. says

    Good question, Brian.

    In elite athletes, it can take about 3 months of deconditioning to produce 2 to 5 mm of regression in the ventricular wall thickness. Any change of this magnitude would EXCLUDE the diagnosis of hypertrophic cardiomyopathy (HCM). It’s probably worthwhile to check an echocardiogram every 6 weeks or so to try to document a change.

    Hope that helps. And good luck!

  3. says

    Yes, Denis.

    The various squiggles of the ECG (that we label arbitrarily with P, Q, R, S, and T) all relate to very specific electrical events in the heart.

    For young, well-trained athletes, with no other indication of current or past heart disease, the T-waves can be unusually tall, or “spiked.” This is 1 of the most common ECG “abnormalities” in healthy athletes.

  4. says

    I recently had a EKG, promptly followed by a call from my doctor. Apparently the results were abnormal and have prompted a stress test. Thank you for the reference material, I will certainly share your resourceful athlete’s heart insigth with the cardioligist!

  5. says


    Good luck with with your stress test. I’ll hope that the stress test is normal….and that will put your mind at ease. It sounds like you have a thoughtful doctor.

    Perhaps you could give us some follow-up when your evaluation is complete.

  6. says

    Many thanks for the info Dr. At the moment I am sitting in a hospital bed with AF (In Lanzarote) atatched to a holter? machine. I have been running + cycling for a couple of years and recently stepped it up a lot to take part in IM Lanzarote next year. I have been fine (swimming 4k, bike 150k, run 24k) until a couple of weeks ago when I notice my heart missing beats. In the last week it has been happening more and more for longer each time. An ECG of course raised alarm. Dr’s here fear of stroke etc etc which is worrying.

    I am 41, white, 5ft 11. 85kg. I run swim bike 6 days a week. I biked 152k last thurs, ran 10k fri, 10k yesturday, swam 1.5k yesturday. Last night I started Afib at 10pm then on and off until 4am then constant until 1pm today (in the hospital). It stopped when I started swinging my arms (as if free style swimming).

    I have been taking supplements like protien, power gels etc. The protein concerns me the most as it has many chemicals.

    Any ideas please, getting concerned.. Regds, Jason

  7. says


    Good to hear from you. Sorry that you’re in a hospital bed in Lanzarote.

    Atrial fibrillation (AF) is a very common problem among athletes. Many don’t even know they have the problem.

    Your doctors will be looking to see if you have any other heart disease and then make an assessment about whether or not to offer treatment. You’ll want your doctors to be very aware of your athletic aspirations if medications are prescribed….in particular, you won’t want your heart rate to be limited by medication. Your doctors will also need to make a judgement about whether or not some sort of blood thinning (aspirin or other blood thinners) is useful to reduce the chance of future stroke.

    The risk of stroke is small but accrues over the long term for people who have persistent or intermittent AF.

    Hope that helps. Good luck with your current hospital stay….and a very big good luck with your training and race at IM Lanzarote next summer.

  8. says

    Many thanks for your fast reply Lawrence, very much apprieciated. The Afibs only started around two weeks ago (the same time as I started with whey protein) In your opinion would the protein have anything to do with sparking AF? If you do, is the AF now always going to be a factor or will it go away when it is washed through? Any idea of time? here is the label for the protein notice “peptides” on the label which I have just read about.

    On other thing which i am not sure if it is conected is that I had a pain/discomfot in my neck upper chest a few weeks ago after swimming, maybe this is an internal strain to do with AF? Many thanks again for your help..

  9. says

    Hi Dr. Creswell,
    I was recently (4 months ago) diagnosed with an Athletic heart after going in for a routine test. My Echo showed an enlarged left ventricle. After a few other tests (gated nuclear stress-MRI-and follow up Echo, the final results showed a normal EF (59%) and mild dilation to the left atrium and ventricle (60mm). I am very active, working out 6 days a week for many years, about 3 miles per day of intense running and an intense workout immediatly after. If I slowed down, how long would it take to reduce the ventricle size? How can I completly rule out DCM? My cardiologist is a specialist at the Cleveland Clnic so I think I’m in pretty good hands. Great Blog!

    • Patrick says

      Just had an echo done and the heart Dr said there was mild dilation of RA and RV all valves and pressures in PA normal I’ve been running and lifting for over 30 years. The cardiologist scheduled a TEE with contrast just to be certain he is not missing something. Anything to be concerned about.
      Thanks Pat

      • Larry Creswell, MD says

        I’m not sure I have much to add here.

        For the other readers, an echo with contrast uses an intravenous drug that enhances the quality of the ultrasound images, increasing the sensitivity for identifying abnormalities.

  10. says


    Busy day at work. Sorry for my delay in a reply.

    First, it sounds like you’ve taken good care of yourself by finding an excellent cardiologist at the Cleveland Clinic. Athletes with changes like you’ve described should work closely with their cardiologist to map out plans for continued exercise programs.

    The short answer to your question….as a rule of thumb (and I shared this with Brian above), it can take about 3 months for elite athletes to have enough deconditioning (after halting exercise) to have a reduction in the thickness of their left ventricle of a few millimeters (an amount that could be detected by echocardiogram or other imaging test). Any such regression would EXCLUDE the diagnosis of HCM, which simply persits despite changes in exercise pattern.

    Hope that helps!

  11. says

    Had a question in mind about this for a very long time. Think about an athlete with a low resting heart rate, He stops his training and retires. Will his heart rate still be lower than the average Joe or due to the fat gain and lack of exercise increase his heart rate?

    • Ian says

      I am almost 50 overweight and have been a competitive cyclist for many years. For the last 15 years I have had almost no notable excercise. My pulse at rest is now between 55 to 60 and tests have shown no heart problems. So athletic bradycardie does continue to some extent.
      Immediately after the removal of a kidney stone last year my pulse increased to 90 with the impression that my chest was going to explode. Of course the nurses on duty thought that I was a hypocondriac at the best and couldn’t relate to AHS.

  12. says

    Dr. Creswell,

    Thanks for your information of the article, it is very helpful. I worked out a lot and recently started endorence running to prepare join the military. During physical exam, doc heard murmur of my heart and need cardiology consult. I am a body builder and martial artist. take omega III fish oil and co-Q10. I was afraid of the coming cardiology until I read your article. Most website mention murmur in two types as innocent and damage valve, but your article is definately the 3rd kind of murmur they should mention in their site. One quick question, Your answers above said 3 months to desize the athlete heart. Then How long it takes to develop a athlete heart when start to exercise.

  13. says


    Congratulations on entering the military. I appreciate your service.

    Your question is a good one. There’s probably a lot of variability in the speed with which structural changes in the heart develop with exercise. By 3 months, you could probably expect to see some appreciable change, though. With echocardiography, even small changes can be measured pretty easily.

  14. says

    My concern is that my heart rate during excercise exceeds 85% if I do any type of high impact excercise (running or zumba). I want to know if having a heart rate in the 180s while exercising is dangerous.

  15. says

    Dr. Crewell,

    My son has been told by his pediatrician that he has a heart murmur and are scheduling more tests. My 10 year old son is very active in select baseball and football and is always playing tennis with his older brother. Is my son going to be ok?

    • says

      I am no doctor, but I had been a very physical child when I was younger. I played soccer, tennis, baseball, and a little bit of basketball. I went to see the doctor when I was 12 about sharp pain I was having in my chest. After many tests they took a look at it and told me I had a heart murmur. They told me it was nothing to worry about and I should be fine. Now I am 20 years old and saw the doctor last year. When I saw the doctor he told me I had a strong athletes heart and to him it sounded like my heart murmur went away with my growth. He should be fine, but that is my opinion. I am no doctor.

      Hope all goes well

  16. says

    If i am running 10 kms(each day) 6 days a week and not doing any other exercise other than that, would i be considered an athlete and do i have any chances of getting athlete heart syndrome.


  17. says


    For unconditioned individuals, the HR can easily exceed 85% of maximum with even low-intensity training. With conditioning (from continued exercise), the HR for any given level of exercise intensity should fall.


  18. says

    Dr Creswell

    Thanks for posting such wonderful information. My chiropractor discovered my enlarged heart this week, I’m headed to a cardiologist today. You’ve definately given me great info to start the conversation today, thanks!

    Do most with athlete’s heart hit their max heart rate often? I hit and even exceed my max frequently.

  19. says

    Nice article Doc, i had some questions. Can a doctor easily tell the difference between Athlete’s Heart and HCM? Also, can Athlete’s heart ever lead to HCM? Also, if you have Athlete’s heart and not HCM, with no family history of heart problems, what are the chances of that person EVER getting HCM? How often should one test for it? Thank you!

  20. says


    For most people, your doctor should be able to distinguish between HCM and athlete’s heart. Expert assistance can be obtained if there is uncertainty.

    Athlete’s heart does not lead to HCM.

    Your doctor should be able to exclude HCM now. Some individuals have a gene for the disease but no clinical manifestations. They need to be followed closely forever.

  21. says

    Is there a resting heart rate number that would indicate an athlete has “Athlete’s Heart Syndrome”? For example, if you’re an athlete and your resting heart rate is anywhere from 55 and below, can you assume you probably have AHS? Also, about the HCM gene you mentioned that some people people have, how do you test for that? If there is no family history of any heart problems whatsoever, is it safe to assume you don’t have the HCM gene?

  22. says


    Not necessarily a relationship between resting HR and likelihood of athlete’s heart syndrome. That said, most affected athletes will have a relatively low HR.

    A blood test can be used to test for the known genes associated with HCM. Because some individuals can have HCM and have no symptoms, it is possible for some individuals to carry the gene(s) despite a negative family history.


  23. says

    Great article.

    I recently got diagnosed with an enlarged heart across all four chambers (mild and symmetrical enlargement) by an MRI. I have no symptoms of heart disease (dyspnea, ascites, edema etc) and tolerate exercise well. I cycled for three hours at the weekend. I’ve done a stress test and pushed out 10 mets and exceeded my maximum heart rate with no ill effects in the 9 minutes. The test was negative.

    The EF was 60% in the left ventricle according to the MRI and the wall thickness was normal – LVPWT was 1.1cm. My true resting heart rate is consistently 60 or below when awake – probably lower when asleep? The Dr reviewing the MRI results reported that the enlargement was just outside normal range for my height and weight and would be even more so if I were an active athlete.

    I have occasional junctional rhythm, prominent sinus arrythymia, occasional skipped beats and occasional left bundle branch block but am otherwise healthy.

    I cycle for three hours at the weekend and cycle to and from work (15 mins each way) during the week. I used to lift heavy weights but stopped about 5 months ago and I used to do mixed martial arts about 4 times a week but stopped about a year ago – maybe more.

    My question is, my exercise regime has been cut back to a minmimum compared to what it used to be, but I seem to have symptoms of an athletic heart still and no symptoms of heart disease. Could I still have athletes heart despite having cut back on my exercise quite some time ago? Was it perhaps even bigger a year or so ago?

    I know all these things about my heart because my GP referred me to a cardiologist when I had middle back pain. The cardiologist dismissed athlete’s heart right out on the basis my resting heart rate was not low enough when I came to see him. It was 60bpm and I was a little anxious to be fair.


  24. says

    Hi Dr
    I’ve recently had an echo and it was found that I have a severely dilated left atrium.

    About 3 months ago, I embarked on a new exercise routine … Shaun T’s Insanity DVD’s. Sometimes I would work out morning and evening.

    I have read a few articles about Athlete’s Heart but I’m not sure whether I have it as all the articles mentioned an enlarged ventricle. My ventricles are normal and so are the walls.

    My EF is 61% and my resting heart rate is 60 bmp.

    I can’t get in to see my cardiologist until mid January 2012 and was hoping you could tell me whether or not a dilated left atrium could be caused by an athlete’s heart.

    Thank you.


  25. says

    Dr Creswell,

    My boyfriend was just diagnosed with an enlarged heart. He is an Aviation Ordanance man in the Navy, which requires lots of heavy lifting. He usually works twelve hours with minimal food and water (if any). Lately he’s been having chest pains, bouts of confusions, lost consciousness twice, and had an anxiety attack. Is this all due to his heart?
    Any help or advice would be much appreciated.


  26. says


    Thanks for your comment and questions.

    There are many reasons to have an “enlarged heart.” Athlete’s heart is just 1 of many possibilities.

    Given your botfriend’s many symptoms, I’d urge him to visit with his doctor to work things through.


    • says

      How does an athlete actually “decondition” their heart. That sounds like a silly question but as an athlete I’m trying to determine what exercise I could do to still decondition and result in the best results? I am an avid triathlete and train extensively 7 days a week.

  27. says

    Hello Doctor… I have been active all my life I am 29. I have been working out in gym for over 10 years and biking and swimming. I am a huge tennis player medium vigorous as well. Last month I had an ablation for supraventicular tachycardia that went well..performed by Dr. Khan out of Illinois. He is one of the top EP’s in the country. HE said it was 90% successful…I had to wear a holter monitor last Weds…I received my results today, mind you I am a healthy medical history, eat very well, active, you name it. The nurse said I had a heart block while sleeping, lower heart rate..Athletes heart gets like that so is this fine? I mean it gets to the 40’s or 50’s when sleeping…She also told me I had some extra beats I think.that everyone gets she said..Everything else was good..What you think of this heart block for me? being such a big athletic person..thank you..

  28. says


    Deconditioning probably begins the moment you reduce your activity level. We sometimes need to “schedule” a period of relative inactivity to let us sort out between HCM and adaptive hypertrophy of the heart muscle with exercise. It takes a few weeks for the thickness of the heart walls to decrease appreciably so that the change can be detected by echocardiography.

    I’m not aware that there are relatively safe vs. unsafe approaches to deconditioning.


  29. says

    Organic Life,

    Congratulations on your successful ablation. It’s not unusual for these procedures to be 90% successful. In some cases additional treatment(s) may be needed at some point.

    It’s important to realize that Holter monitors capture an incredible amount of information about the heartbeat. It’s not unusual for athletes to have a slow heart rate or extra beats and potentially even some degree of heart block. Your cardiologist will be able to know if there’s any significance in your particular case.

    Heart block comes in many forms–some worrisome and others not. Perhaps you could report back after your doctor has weighed in.


  30. says

    The nurse told me that the heart block episode was nothing to worry about..and yes probably because I am young and do so much athletic things like tennis, biking, gym, you name it. 90% is good though from what I read… and my Dr. said he ablated a secondary pathway..

  31. says

    Hi Dr.,
    Thank you so much for this forum! I have been scouring the web for info. and the information here is fantastic! I have been trying to sort out my heart issues for 3 yrs. and there just seems to be so much gray area!!! I am a 42yr. old female in good shape. I play competitive doubles tennis 2x/wk and jog 3x/wk. I am no L. Armostrong by any means!! I started off with Tachycardia events 3yrs. ago and was put on a very low dose of toprol. This made me feel tired and while playing tennis seemed to trigger more symptoms. I went off the med. a yr. ago and gave up going to my 3 mo. dr. appt.s because I was fed up. Well, at the end of Jan. I started to exercise slightly more to get ready for a cruise at S. Break and shortly after that I became extremely tired, was cold all the time, when I woke had tingly hands like they had fallen asleep, some mental confusion etc. Just some random symptoms. I looked in the mirror at my white face and was thinking what the heck is wrong with me??? I then thought about taking my pulse. It was 46. I went back to the EP and was given a holter patch for 2 weeks. It came back as my low being 33 while sleeping and high was 170. I had PAC’s and PVC’s The Ep said that this was fine but want to check me in 3 months again??? My question is does that mean I have athletic heart? Is she saying that I am normal? I do like to exercise but like I said I’m not training for anything and usually on my 3 mile jog I have to walk some of it. I just think 33 seems awfully low. When I talk to my tennis friends about it they all seem shocked and alarmed. Should I get a second opinion or should I be happy that they said I’m fine. Sorry this is so long and drawn out I just feel so lost in all of this. If you could give me any of your thoughts on this I would really appreciate it. Thank you so much for your time. Have a great day!

  32. says

    I’m 61, female, run 5+ miles/3-4x week. Just had an EKG as part of pre-surgery eval. (I assume strictly because of my age, since I have no symptoms). Was told it was “abnormal” and need to get re-tested or further tests. Is that really necessary?

  33. says

    5th grade teacher,

    We often check an EKG in patients your age before surgery. The purpose is to identify any (perhaps unknown) heart conditions that increase the risk of operation.

    Oftentimes, patients with abnormal pre-op EKG’s need to have a visit to a cardiologist who can be expert at knowing the significance, if any, of the abnormal EKG findings, and determine if (and which) additional testing is needed.

    So….yes, probably necessary.


  34. says

    Thanks for the great blog. Looks like I will be spending some time going through your older posts.

    Do You Have “Athlete’s Heart”? brought me here. And I’m not sure if the answer is yes or no. I’m not a well-trained endurance athlete. I’m 51 years old and have never done much physical work and had never been involved in sports.

    A few years ago I decided to get serious as far as exercising. I now exercise most days. In the winter I walk on my treadmill for an hour (4mph @ 6.5% slope, hurts my back less than running) and from Spring to Fall I ride my bike to and from work (9 km each way). Is this enough to develop athlete’s heart? I check my bp/hr at work during the day and my heart rate is typically in the low 40s. A few times as low as 36 and last week once down to 35 bpm, but normally 42-44.

  35. says


    Thanks for sharing your story about embracing exercise. That’s great!

    Yes, I do believe that you’re exercising enough for there to be adaptive changes in the heart. A low heart rate is probably very healthy.


  36. says

    Dr Lawrence,
    Thank you for all the great info that you’ve provided.

    I’m a 24 year old intern doctor and I run 2-3 miles almost every day (in addition to cycling 4-5 times/week and other cardio exercises). I recently underwent a pre-employment medical checkup at the primary care center. The dr told me I needed an ECG after she auscultated my heart. My ECG returned back with a sinus Bradycardia (46 bpm). My blood pressure was low on 3 different occasions (around 90/52 mmHg).

    Would you suggest I see a specialized cardiologist? And do I need an Echo to measure left ventricular thickness?


  37. says

    Dr. Creswell,

    As a 61yr old middle distance swimmer for many years, I have been training 6 days a week 3000-3500 per day. My times are good in my age group. I have a previously documented RBBB, BP of 118/75, pulse 40-45. Starting a few months ago as I am laying in bed at night I hear a whushing sound with each heart beat. I don’t have any symptoms or discomfort but this sound bothers me. Any suggestions?

  38. says


    Sometimes patients can actually hear a heart murmur or the bruit (sound) of blood passing through narrowed carotid arteries (that carry bloodflow up the neck).

    A visit to the doctor for a stethoscope listen at the heart and carotid arteries would be the good starting point.


    • Henry Gasko says

      Hi Doctor,

      I have a question similar to Hunter’s. I am 65 years old but very healthy. I have always exercised a lot and still cycle about 70 kms per week as well as gym work and some running. Recently I have noticed that when I am going up a big hill and my heart beat is gets near 140, I can hear a slight whooshing which is think is coming from my heart and not my lungs. I usually slow down a bit and it stops. There is no pain and there is nothing at rest or at lower heart rates. Is this anything to be concerned about?

      Also, I do feel I am slowing down a bit when going up some of the bigger hills around here – I assume this is to be expected as I get older, although it is seems to be happening a bit more quickly than I expected. My resting heart beat is about 52 and my BP is normal (but I am on medication – Ramapril 5 mg). I was also wondering what a reasonable heart rate while exercising would be for myself. Some calculations say my max is 220 – age = about 155, so 90% of that would be about 140.


      Henry Gasko (Melbourne, Australia)

      • Larry Creswell, MD says

        Not sure what to make of the whooshing. Might be interesting to take a listen with the stethoscope.

        Sounds like me….slower cycling with increasing age.

        Cycling coaches would be better than me about offering advice about target heart rates to produce desired training effects. Your suggestion of using some %age of maximum HR is popular.

  39. says

    HI doctor,
    I have VSD ( I think that’s what it’s called. I have a hole in my heart). It is very, very small. I have had it since I was born. My cardiologist has said I am able to do anything. But I recently started Insanity. Even though he said I was able to do anything, should I talk to him before I do anything this rigorous? Thank you!

  40. says

    Hi Doctor- I am 42yr old female avid triathlete getting ready to compete in 3rd ironman in Nov. I train a lot, extremely fit and healthy (low hr, no problems, great exercise performance lately, etc). Last week I had echo and Doc said I had mild DCM (with ejection fraction reading of 40%). Is there a way to distinguish between athletes heart and DCM (I read if lv dilated as many endurance athletes are could have low ef reading due to calc)? Could results be off since 18hrs prior I had done a 4+hr hard training run and day before 6hr bike? I have a nuclear stress test this wk- can that distinguish between athletes heart and dcm? I want to keep training and competing in Nov ironman, but need to make sure my heart is OK. Thanks so much for your advice

  41. says


    We’ve had a chance to exchange emails.

    With athlete’s heart, the pumping function of the heart (measured as the ejection fraction) should be normal.

    If the ejection fraction is reduced, there should be a search for a cause. Coronary artery disease (that would be evaluated with a stress test) is just one possibility.


  42. says

    Hi Doctor
    I am a 40 year old male and run an between 25 and 35 miles a week. Normally this consists of running 7 days a week. I’ve been doing this for 2+ years and was an avid soccer player all my life (till I moved more into running) playing college soccer etc.

    I typically run all my mileage on hilly single track trails in the 6:30 to 6:40 mile pace and make a point of pushing during my runs pretty hard. Yesterday I went to the doctor because for the past three weeks I’ve been feeling as if my heart is skipping a beat (ie. beat, beat, pause followed by a big thumping beat). It typically happens most when I am relaxed and my heart rate is lowest. I have experienced these skipped beats on and off since college but as mentioned in the past three weeks it’s increased dramatically so much so I finally decided to go to the doctors about it.

    I’ve been checking my resting heard rate regularly since this started and it fluctuates between 39 and 55 beats…..when I am up moving around doing normal activity it obviously increases above that. My doc listened to my heart, said she heard a bit of a murmur and then said I might be experiencing ectopic heart beats. She then called for an EKG. The EKG read abnormal and she said she was concerned with me having an enlarged heart. One of the lines was larger than normal heading down on the EKG…that’s all I could glean from it. I go next week to get a 24 hour monitor and electrocardiogram to image my heart. She’s aware of my high volume of intense workouts — and I did explain that over the past two months I have increased my long runs — in the range of 10 to 15 miles with an occasional 20+ mile run — because I am hoping to run a 50 mile trail run this November. She mentioned I might have “exercise” heart. I assume this is the same thing as athletes heart.

    Beyond telling the cardiologist about my workout routine is there anything else I should ask for or push them to do to rule out any underlying issues that could be bad? I am hoping it’s just athletes heart, but want to make sure they make the distinction between something bad and a well trained heart.


  43. says


    Love the blog! A couple months ago, I had an echo and the cardioligist informed me that I have Athlete’s heart….Here is my concern: I have just finished up a physical with my general pract. Everything looked good and he wanted me to see the cardioligist for consultation (did not do blood work yet). So now I am sitting here worrying why a consultation? My GP says that my left ventricle is enlarged and he did not mention anything of Athlete’s heart, but the cardiologist did. He said that there is no such disease/disorder. They wouldn’t release me to exercise unless they saw something, right? The echo was done a couple months ago. Since then, I have ran, not as hard, but never really had a problem. He also told me not to run until I have the consultation. Am I worrying for no reason? I have a resting pulse between 42-55. Any insight is greatly appreciated. IS the GP doing this to ease my mind?

    Best wishes

  44. says


    Thanks for the kind comments about the blog. As you’ll see, there’s a lot of interest in this particular topic. More readers about this topic than any other except “athletes and high blood pressure.”

    I think it’s typical for GP’s to ask patients with an abnormal echocardiogram to see a cardiologist. A cardiologist will be in a better position to interpret the echocardiogram and determine if there’s any consequence for your athletic activities. Most cardiologists would prefer to actually SEE a patient before making recommendations about safety of sports participation. For those reasons, it would probably be best to see the cardiologist. If you had concerns about doing so, then you might just discuss the situation with your GP.

    The GP is probably trying to ease everybody’s minds.

  45. says

    A million thanks for this article, Dr Creswell.
    I notice many cardio athletes here (runners, swimmers, etc.) I’ve read that left ventricular changes apply to them, while vascular changes such as carotid artery intima media thickening often apply to resistance training athletes. Any comments?

  46. says

    Dr. Creswell,

    I am a 32 year old woman. I started running about 5 weeks ago. When I began I was walk/run 2-3 miles 3-4 times a week. I am now running the majority of 3-4 miles 3-4 times a week. This past Sunday I began having some extreme heart palpitations. I checked my pulse and it ranged 40-45 bpm all day. I was mildly nauseated and dizzy while the palpitations were occuring. I did not have any Monday or Tuesday and my pulse remained in the low 50’s. Today I began having them again and my pulse is back down to around 42 and the nausea and dizziness have come back. Is it soon enough for my heart rate to be this low as I only started exercising a few weeks ago or should I head to the dr? Also I for the past few nights when I wake up after sleeping all night , while still laying in the bed I am extremely dizzy and the room is spinning. When I get up it seems to go away almost instantously, but I am extremely weak and shaky for the first few minutes. Would this be related to the palpitations?


  47. says

    Hello Dr,

    I have been working out and never quit for the past 6 years. anyways, I was working out 2 months ago an I did some really heavy weight set. so, after that heavy set my heart rate did not slow down and I tried to relax but kept beating like it was going to explode. And that ignited a panic attack that I had to go to the ER. so I had an echo-cardiogram and my EF was 70% and heart size was a bit large and I had some murmurs and (tachycardia due to anxiety).

    Sometimes I feel like my heart is skipping beats and when I go to sleep I measure my heart beat and it always measures between 40 to 48 before going to sleep and it causes me anxiety. I now back into working out because believe me it is like an addiction even though it was really tough for me because I started having panic attacks when my heart rate goes high during exercise.

    My question is: is it dangerous for the heart to beat higher than 85% with frequent panic attacks?

    I can now control my panic attacks but they keep coming and I have to deal with them.

    Thank you,

  48. says

    You asked about the potential danger of the heart beating “too fast” during a panic attack.

    Within reason, the heart is quite capable of beating fast. At times, it’s absolutely necessary. Of course, it isn’t designed to have a constantly high heart rate indefinitely.

    Certainly, panic attack can result in a high heart rate. There are probably many causes….and many potential treatments for patients with panic attacks. I’d urge you to work with your doctor about those issues.

  49. says


    Glad to hear that you’ve taken up running.

    Intermittent high heart rate (out of proportion to the intensity of exercise) or palpitations might suggest some sort of an arrhythmia.

    Light-headedness always needs an explanation, even if it is an obvious one (like dehydration).

    I like the idea of taking up these problems with your doctor.

  50. says


    Sorry for a slow reply.

    Yes, the consequences of endurance or resistance training are different….including the ways that you mention.

    Ordinarily, we think of “athlete’s heart” in the context of long-term endurance training/exercise.

    • says

      Hi Dr. Creswell

      Wow, great timing with your update request. Just yesterday I went to what should be my last doctor’s appointment for at least a year and it was basically all good news. It’s taken a while to get to this point, but like you said, taking it one step at a time and gathering information is key.

      As for an update — I’ll give a bit of a summary in case your readers find it helpful —

      As you know from my first post back on September 22nd, I wrote to you saying I felt like I was experiencing skipped beats. This was most evident at periods of rest like when laying down or when working at my desk. I had experienced these skipped beats on and off back in college when I played soccer and was extremely active (40 years old now). They came on very strongly again this past September. September coincides with me having really increased my running volume drammatically over a 4 month period from say 20 miles a week to anywhere from 35 to 50. I was also concentrating a lot on long runs with lots of hill…so slower, longer periods of running.

      In a nut shell, I went to my doc and got an EKG that showed abnormal. The first concern was an enlarged heart which was ruled out by a good songram. I actually showed no increased heart size ventricles and all. After wearing my first 24 hour holter monitor I was diagnosed with 2nd Degree Atrioventricular Block Type 1 (wenckebach) which, as you know, is literally skipped beats. The signal from the atria gets more delayed with each beat till finally it does not pass to the ventrical and then I get my “skips.”

      While this was extremely alarming a few months ago, I’ve basically learned to live with it. I’ve worn a holter monitor a total of 3 times. Each time I show the “skipped beats” and a very low resting heart rate. Especially when sleeping. My heart rate can easily get down to very low 30’s at night. Typcially during the day when I am not up and about it’s in the 40’s.

      I’ve been told this low heart rate would be alarming if I could not raise the rate easily — which I can definitely do while exercising. I wear a heart monitor when running now and my HR can easily ramp up over 160 when exercising. The other positive for me is that I am not “symptomatic” meaning I am not passing out, feeling dizzy or suffering any real ill side effects like chest pain etc from the skipped beats.

      In addition to the Holter Monitors I’ve had a stress test with heart imaging. I actually was told by the doctor reading that test that I passed with flying colors. He basically said he’d use my test to show people what a heart at exercise should look like….that certainly helped ease my worries.

      In short, my doctors attribute my AV block to increased vagal tone which from my understanding can alter parasympathetic responses like heart beat. You’d be able to clear that part up for any readers better than I can. I was asked to decrease my mileage and cap it at 20-25 a week, which I have done. So far, I’d say it’s helped, but it’s hard to differentiate between a true casual relationship from cutting back or me just not noticing the skipped beats because I am not freaking out about them and Iam no longer constantly monitoring my heart. I feel great and feel as good as I did when I was 25 so the doctors cut me lose and said “keep doing what you’re doing and come back in a year.”

      Hope this helps!

      Chris Daw

      • Kelly says

        I recently have been diagnosed with AV block second degree type 1. My cardiologist did not explain much of anything to me except that I’m fine and don’t worry about it. I’d be lying if I said it didn’t worry me a bit though. I’ve done tons of reading on it. And I understand it has to do with increased vagus nerve. But should I try to decrease it? I mean it doesn’t seem good that our hearts are skipping beats. Do you know if this is likely or even possible to go into complete block? Have you fainted since posting this? Once you get this does it go away or do you have it for life? I’ve had it on and off for the last four years, but this last bout has lasted five minths. I grew up playing soccer very competitively, I’m now a runner. I’m just curious what to do to help my body regain balance and what to expect from here.
        Thanks, kelly

        • Larry Creswell, MD says

          This type of heart block is not ordinarily associated with more serious forms….and therefore doesn’t ordinarily require treatment.

          Yes, it may come and go.

  51. says

    Greetings Doc.

    I have recently passed out playing basketball in the gym after about 10 mins of relaxed play (not even long enough to put any true stress my body). This has happened once before in 2010. I spent a week in the hospital going through a multitude of tests (including an interesting surgery when they ran a device through my groin to my heart to send an electrical shock to monitor results). Before I left all they could tell me was that I had a heart murmor, was low in Vitamin B, and diagnosed the “Athletic Heart”. I haven’t done any intense training sense 2007. Their testing ruled out any major heart issues. After the recent episode happening the exact same way it did in 2010, I’m worried as to what the problem is. Any thoughts?

  52. says


    Blacking out while exercising is worrisome. Even if you were checked out in 2010, I’d recommend getting checked out again. Sometimes a cause can be difficult o identify.

    If you email me we additional details, I might be able to point you in the right direction about getting evaluated.


  53. says

    Hi Dr. Creswell,

    I am writing on behalf of my husband who is a 28 yo Firefighter/Paramedic in excellent shape. We are distance runners and a very active couple.

    When we were in college 8 years ago my husband was on the crew team and started experiencing occasional palpitations. He was doing intense work-outs when the palpitations started to occur. He was cleared by cardiologists at that time at Creighton University Medical Center and was told he just had a junctional rhythm but an extremely healthy heart.

    Fast forward to this past August 2011 my husband started training for a marathon and has since experienced palpitations 1 or 2x a day with no other symptoms other than slight dizziness occasionally which he attributes to not eating frequent enough.

    For his job as a fire fighter he underwent an echo at the time of hire which showed an EF of 55% in 2010. He was cleared medically to work. He just underwent another echo in dec since he started having palpitations that showed his EF dropped to 50%. 24 Holter monitor showed he brady’s down in the 30s and then up to 150s occasionally. Resting his heart rate is in the 40s-50s. with 2.5 sec pauses. His cardiologist is talking about needing a pacemaker pending his stress echo results which we will get on Wed. A pacemaker is a scary idea for him because of how active he is and he is unsure they will let him work as a firefighter.

    Do you have any experience with firefighters and pacemakers? Should we be looking for a second opinion based on his symptoms?

    One other thing to add is he had a syncopal episode while vomiting in Jan 2011. Doc’s said he most likely vaso-vagaled. He ended up with Asp PNA and was in the hospital for a few days. He was then sick for over 1.5 wks with fever, muscle aches and lethargy. Was wondering if he may have had some undiagnosed viral cardiomyopathy that has altered his cardiac muscle and decreased his EF to 50%.

    I am in the medical field as a PA student and would love any information you could provide.

    Thank you so very much.


  54. says


    Great to hear from a PA student! And always good to hear from a concerned spouse.

    You’ve raised a lot of issues. Send me a quick email at and we can work on the questions by email or phone.

    For the readers here, a few thoughts….

    1. Syncope–or blacking out–can be a serious problem. I have a couple blog posts here that go over the problem in detail. Often the cause is not serious, but syncope can be a warning sign of a serious heart problem. It should get checked out like the firefighter did.

    2. Heart rhythm problems can be complex. The firefighter has issues with both slow and fast heart rates….and has pauses as well. These sorts of problems need to be sorted out by a cardiologist, and often one who specializes in heart rhythm problems.

    3. Many athletes have permanent pacemakers. I’ve also written about this topic here at the blog.

  55. says

    Hi Dr. Creswell,

    Had a question for you regarding my heart. I got into serious interval training around 4 years ago (spin 3-4 times a week as well as running intervals and weightlifting). During this period I was in very good shape. My resting heart rate during this period would get down to 40 on occasion but was routinely around 45-50. About 2 years ago I started having serious palpiations every night (when lying down) and tightness in my chest, increased while exercising but also prevalent at rest. I had an ecg, echo and stress echo all were clear (my father has IHSS). It has been 2 years now and my fitness has never been able to return, now running a slow mile is hard. I’ve had another echo which they said was clear but my palpitations are worse than ever (can only sleep on right side) and my resting heart rate can still be seen in the low 40’s at times. Is it normal that despite how deconditioned I’ve become that my HR should still be in the low 40’s? Also any thoughts on the palpiations?

    Any additional steps that you think I should have done?

    Thanks in advance.

  56. says


    A couple questions there….

    1. With deconditioning, the resting HR usually returns to some baseline. For well-trained athletes, that can end up being quite an increase. There’s probably wide variability in the time course for the change….and probably depends on how active athletes are during the deconditioning period.

    2. Palpitations that are bothersome should get sorted out. You might review with your doctor any foods, meds, etc. that might be predisposing factors. Sometimes a Holter monitor (a tape recording of the EKG for 24+ hours) can be helpful for pinpointing the exact type of heart rhythm that’s responsible.


    • says

      Dr. Creswell-

      If I could ask a follow up, my palpitations are literally anytime I lay down. And they’ve had me do a holter and event monitor, and said it showed some PVC’s but nothing else. I do know from my multiple echos that they say I don’t really have any fat around my heart. I used to be under 10% BF but that was over 2 years ago and now am probably high tens low 20’s (I used to be 185lbs, very lean but now am more in the range of 210, so not a skinny person, built more like a linebacker). Another interesting tid bit is you can visually see and substantially feel my heartbeat in my left rib cage (slightly under the armpit) and also really visibile and strong in my neck (collarbone area but only on the right side). It’s all very weird stuff to me but the palpitations are killing me and everyone is sort of washing their hands of them (cardiologist just said your tests are fine and primary care doc told me to just not think about them, which is hard when everytime I lay down it feels like my body is jolting (not fast palps, just slow and hard).

      Any thoughts would be greatly appreciated and happy to take this offline to email if you’d like.

      thanks again,

  57. says

    I am a 68 year old runner that logs around 1200 miles per year. My last marathon was 12/12. I started having AF about 1 year ago. I have had all of the diagnostic tests which indicated I have no heart disease. I am currently taking a beta blocker and blood thinner. My BP stays in the normal range and my HDL and LDL numbers are good. My AF’s are infrequent. I now log 20 miles per week with the longest being 4 miles. This is a combination of running and walking. I really enjoy running and I have been running for about 30 years. I know the risks of running with AF but just wanted to know if there are similar runners out there with my condition and what they are doing. I would love to run another marathon this year but….

  58. says

    Hello Dr. Creswell
    I am a 42 yr old female who has returned to exercise in the past 5 months after a break of 5 yrs( having 4 kids!). Prior to my ‘break’ i would have always been reasonably fit and active, running, field hockey etc.
    ive started swimming now and although i find the going tough at times i am improving and think im getting fitter. I had my bp taken in my Docs office yestetday and she was concerned that my resting heart rate was 45bpm. I am experiencing nausea at the moment which she feels is sinus related but asked that i return today for an ecg, my hr today was clocked at 39. I had an ecg about 5 years ago for palpitations and had a holter test which thankfully was grand. My doc noted today that the outputs on both tests were similiar and was not unduly worried about my low heart rate.
    I have always has a resting hr in the 50’s through college but have not regularly tested since. Is 39 a very low heart rate for a person who isnt superfit? Many thanks in advane

  59. says

    Thanks for sharing your experience, Upmunster.

    The normal heart rate is 60-100 beats per minute. So, yes, 39 is low and qualifies for the label of bradycardia.

    A couple issues:

    Can it be explained? It sounds like your doctor is working on putting this into context with the tests, both now and previous.

    And should anything be done about it? Ordinarily we don’t treat patients if they have sinus bradycardia and no symptoms from it (like lightheadedness or passing out).

    It’s encouraging that, after considering things, your doctor wasn’t concerned.

    • says

      Thanks for your reply Dr. Creswell, i have a 500m open water swim this weekend, my first! I’d imagine my heart rate will be considerably higher than 39!! Thanks again 🙂

  60. janie says

    Dr. creswell,
    I am a 60 year old female, long distance cyclist and have been on and off since my teens. In my twenties i trained long, fast and hard. Currently, i do as much or more cross-training/weight training as cycling? I have an “athletic shaped heart”, thickened left venticle, flattened t- waves in an ekg. Echocardiogram, normal; nuclear stress test normal; however i get light headed during intense wt. training. Due to this my cardiologist has me coming in for stress test yearly and ekg every 4 to 6 months. This all seems like overkill and he has never mentioned athletic heart as a possiblity. Is my age an increased danger with my heart shape, etc.?

    • Larry Creswell, MD says


      Thanks for sharing your story and questions.

      First, I can’t be your doctor from afar. I’d encourage you to continue to work with your doctor regarding the limits of safe exercise and any periodic testing that might help shed light.

      A couple general thoughts….

      Individuals of any age can have athlete’s heart. No age-discrimination! And athlete’s heart is not generally thought dangerous–it’s simply a physiologic adaptation to exercise. Finally, I’d say that it’s easy to under-estimate the significance of light-headedness during exercise. It’s best to search for and identify a cause.


  61. Tia says

    Hello, my son just got a physical today for football. He was told he had a abnormal EKG and a heart murmur. He has never had issues in the past and actually 4 years ago he was part of a program that tested young athletes hearts and had a major heat work up with a ultra sound prior to playing a season of ball. My son has played football since the age of six. He has never taken a season off and for the last 4 years he has played year round only taking 8 weeks off. He is 18 and received a full scholarship to play football. We just found this all out today and of course I am horribly worried. Just minutes before arriving at the doctors today he had to run from school then from across the parking lot at the doctors do to no parking and was stressed about being late because I was yelling at him of course because he was late yesterday and missed the appointment. Could his running prior cause the murmur sound and abnormal EKG? They also mentioned his bloom pressure was a little high. Are these all normal things for him being a football player? Worried mom here.

    • Larry Creswell, MD says


      Can’t really comment on your son’s particular situation since I’m not privy to all of the details.

      A couple general comments related to your questions….

      There are many reasons to have a heart murmur–some worrisome, most not. Your son’s doctor(s) should be able to sort that out. Sometimes an echocardiogram is needed to help sort things out.

      Exercise, even mild, can make a murmur louder or more pronounced. Exercise also raises the blood pressure.

  62. Bradley says

    I didn’t read through all the comments, so perhaps this was addressed already, but I have grown increasingly aware of the “presence” of my heart within me since becoming an endurance runner several years ago. I am 38, 5’10 and 140 lbs. and I run about 50-60 miles per week, mostly slow, but I incorporate speed work and hill work once or twice a week as well. When at rest, I notice my heart beat, slow and powerful, it seems, but also annoyingly “there.” I am quite thin, so perhaps this is just the fact that my heart is now bigger and stronger (and I am thinner) and so its presence is felt much easier. It’s also sensitive to changes more often (like big meals – postprandial hypoglycemia?) or climbing stairs, etc., again where I feel it more than I used to. I’m guessing my heart has probably always responded this way, but now the response is “exaggerated” due to size and pumping efficiency.

    • Larry Creswell, MD says


      I bet you’re right with your conjecture. First time, though, for somebody to write in with this issue.

      In my work, I have many, many patients who become hyper-aware of their heartbeat after heart surgery….most often in a quiet room when they’re alone. I’ve always been fascinated.

      Perhaps so do other reader will chime in.


      • Bradley says

        Thank you sir! I appreciate the feedback. On a somewhat related note, I am also aware that as I grow warmer (especially in the summer) my blood volume increases, my veins bulge, and I feel my pulse throughout my body (arms, feet, hands, ears sometimes, heart of course). My blood pressure during these times is always normal, but I wonder if this increase in volume puts more stress on the cardiovascular system and also why the increase happens.

  63. dave says

    Hello there
    I am 43 , I have been very fit in the past (about ten years ago) cycling around 160 km per week and doing regular 20-30 km mountain runs most weekends due to business commitments etc I failed to maintain my training and I let my condition slip away quite badly.
    I had to have a knee reconstruction 18 months ago (following a bad fall while hunting) during the prep for the operation I was advised by the surgeon that I was 35kg overweight (which I kinda knew ) and had very high blood pressure – he referred me back to my Gp who prescribed me cilizapril to get the blood pressure under control mumbled something about a resting pulse of 55 being way too low and recommended exercise and diet to drop the weight.
    I don’t recall him really listening to my heart ( and to be fair I don’t really recall any MD checking this in any depth as I have rarely required medical attention)..
    I brought another bike and hit the road ,over the last year I have gradually built my fitness back up to near where I was a decade ago and lost over 20 kg I am (was) cycling around 180 km per week and last week went to see the doc as I was getting dizzy spells in the mornings when getting up off the floor (I am a Mechanic) I suspected that my blood pressure was getting a bit low with increased fitness and may no longer require the prescription. after checking me out I was told I have a low resting pulse (55 bpm – I had just run half a mile to make the appointment on time its usually around 48-50 ) and my blood pressure was a “little low” but the big problem was a Heart murmur which they were “very concerned” about ,this obviously came as a big surprise to me..
    An ECG came back perfectly normal , they are sending me for an ultrasound and a 24 hour ECG harness “sometime in the next few weeks”. but have told me not to exercise over 130 bpm and keep it under 30 minutes until the tests are done – other than the odd dizzy spell when getting up too quick (which has only occurred in the mornings since the cilazapril and has been getting worse over time ) I feel great and had not noticed any lack of performance or undue stress during any of my rides I seem to peak at around 160 bpm but feel quite comfortable sustaining an average of 140-150 for up to 2 hrs (during a race)or so ,on longer rides I would sit at around 125-135 indefinitely ,
    I did try to explain that I have been training hard and getting very fit they were somewhat skeptical of the amount of weight I have lost (my normal MD has moved away) and seemed to brush over the amount of time I spend training like this could not be relevant to the situation , There was considerable alarm expressed when I mentioned sitting at over 140 bpm for over an hour (heart attacks and other nasties were mentioned).
    Is it possible that a high level of exercise over a year cause a Murmur (or damage to the heart) do I continue training at the extremely low levels they suggest or simply carry on.

    • Larry Creswell, MD says

      Maybe we could focus on the general issue of heart murmurs. They’re simply sounds that are caused by turbulent blood flow in the heart. This can be due to narrowing or leakage of the heart valves, for example. The echocardiogram is used to study the structure of the heart and will be used to see if there is a specific cause for the murmur. Light-headedness can sometimes be due to a heart valve problem.

      You ask about the possibility of exercise causing harm that produces a murmur. I suppose that’s possible. You’ll get more information from the echocardiogram and then you can make plans with your doctor(s).

      I do like the idea of following your doctor’s advice about exercise until everything is sorted out.

      • Dave says

        Hi Doctor Creswell

        Just a follow up on a previous post I made on here back in March our healthcare system here in New Zealand is publicly funded and a bit slow – you have to wait until a specialist and/or time slots for tests become available (unless its an emergency) .We finally got there in the end .
        Well many months later I have had multiple ekg’s .a halter test and also worn the halter during a 60km “hard” ride (at my Cardiologists orders – who incidentally is another very keen cyclist) as well as an echo cardiogram and stress tests all of which have come back with no observed issues other than an audible murmur …. and low blood pressure which has been remedied by ceasing to take the cilazipril (which possibly was never needed to begin with- I now have another doctor) .
        I have now been given the all clear to continue training as before and have been enjoying getting out and cranking up the hills again Its been a bit of a scare but also its been well worth it to have a degree of reassurance that there is a very low probability of my heart giving me a nasty surprise .
        I did follow the advise of my doctor and after an initial consult with the cardiologist ,I switched my training regimen to base training – essentially going for long easy rides keeping my heart rate under 130bpm and stopping every 3o minutes or so to let my heart rate return to below 80 bpm before continuing on (which only takes about a minute or so) .
        Interestingly now that I have returned to my prior training regimen and my regular bunch rides (after three months of base) I am finding that I have more power and stamina on the hills and I can ride faster for longer .

        many thanks

  64. Sam says

    Hello, a few days ago I had an EKG done that said I had a resting Heart Rate of 51 bpm. I am a junior in High School and run 30-35 miles a week for track, and during cross country season I run anywhere from 40-50 miles per week. I’ve also had an eating disorder 2 years ago and was hospitalized for my resting heart rate being in the low 20’s (not good at that time) and a significant drop in weight. I stopped running at that point for a few months until I became weight restored and my heart improved.

    Now I am back to running for track and my weight has been pretty stable for a while now. My question for you though is: Is a resting heart rate of 51 bpm serious and does it require medical attention even though I run 30-35 miles a week. My doc had me stop running in track for a week and I am just curious as to if this is necessary or not. It 2 years later and I haven’t had any signs of dizziness or faintness, I feel fine. I don’t have a problem with food intake now and I’m eating enough to fuel my body for sports.

    • Larry Creswell, MD says

      Thanks for sharing your story. I hope that you’re doing better now.

      In healthy adult endurance athletes, a low resting heart rate is very common.

  65. Ian Young says

    Dear Dr Creswell, Very much appreciate the service you are providing to athlete’s with heart problems. I’m a 62 year old male, resident in Adelaide, Australia. I am a competitive Masters swimmer and last year achieved 10 FINA World Top 10 Ten rankings in my age group. Over the past 6 years I have suffered from occasional episodes ( average 3/year) of AF/A-Flutter and SVT, always post –race. Initially I reverted spontaneously within a few hours but in the last couple of years have required intervention (flecanide). I have had ablations for A-Flutter (successful), SVT (unsuccessful) and last December had a successful peri-mitral flutter ablation (though with component of left atrium myopathy detected). (Unfortunately I also had a complication –embolism in my renal artery a week after the procedure). Some further details: Resting HR= 45-55 BPM; Conductivity abnormalities (first detected in my 20s)=First degree AV Block, complete RBBB, LA hemi-block; Medication: Micardis (AC inhibitor) & Xeralto (blood thinner, since December); Echocardiogram –normal except for mild dilation of LA (like most athletes).
    Although I have not had an AF episode since the December ablation (the good news) I have been experiencing troublesome epsiodes of junctional rhythm (mid 30s HR, regular to irregular) over the past 3 months, starting 6 weeks after the procedure. They have been occurring on average once /week, most commonly the day after a training session or competition and last the whole day from mid-morning to late evening. A couple of episodes started during training. I experience common symptoms –conscious of slow HR (uncomfortable), slight breathlessness, some fatigue but no syncope (yet). I need to have further tests to determine the source of the problem but was wondering if my history is something you may have seen with your (athlete) patients? Could the junctional rhythm have been caused by the ablation (with the resulting change to the electrical patterns in my heart) or is it most likely related to a progression of my conductance disease? If the problem persists at the current rate is a pacemaker the only likely solution and if so can it be programmed so I can still compete at a high level? Sorry for the long note but would value your comments.
    Regards, Ian

    • Larry Creswell, MD says

      Yes, either of your explanations for the junctional rhythm is possible. Perhaps no way to know for sure.
      And yes, if a pacemaker is the solution you settle on, the settings can be made to accomodate your interest in training and competing in swimming. It sometimes takes some trial-and-error to get the setttings to be ideal.


  66. Marty says

    Hi Dr,

    I find this article very interesting. I have had an athletic heart having been a professional sports person.

    Question, is it common to have a sensation in the neck (pulse) that feels like a stronger beat or even as though you have missed a beat? I ask as I run regularly and feel great – my heart rests at 60-65 and recovers around 100-105.

    I wondered if this sensation was anything to be concerned about or was a common symptom that occurs from time to time?

    Thank you in advance.


    • Larry Creswell, MD says

      Good question, Marty.

      We can feel palpitations in various ways. Like you mention, you can become aware when there is an extra beat, then a pause, then a stronger=than-usual beat. I’m not surprised that you’re able to appreciate the feeling in the neck. Others might appreciate the feeling in the chest, or elsewhere.

      • Marty says

        Thanks for your quick reply, so this a completely normal sensation with active runners/athletes and the like?

  67. Shana says

    I am 25 years old. My dad died 6 months ago from Sudden Cardiac Death. I ran CrossCountry in College and still run about 3 miles 5-6 days a week…along with intense weight lifting. I have recently been noticing skipped beats and palpitations. These occur every 5 minutes or so……everyday….all day and night. I have an appointment w a cardiologist in two days, but I am VERY scared. I don’t like feeling the palpitations and am very squeamish about the feeling. I am wondering if it is Athlete’s Heart? and I can simply decondition some??? I almost want the cardiologist to find something….just so that I can have a REASON for why I’m feeling these palps so often!….(since my dad dying was so scary and traumatic). If it is Athlete’s Heart….what are you supposed to do about the palpitations/arrhythmia?…just live with it? ( I really don’t like the idea of them not going away!)….If anyone knows…..I would appreciate any informative response! Thanks so much

    • Larry Creswell, MD says


      I hope your cardiologist visit went well.

      Very often, when there is an episode of sudden cardiac death, it is valuable for family members to get screened. As you probably know, there are several inherited conditions that predispose individuals to sudden cardiac death. It’s worth knowing if such an inherited condition is present in you….or your family tree. Sometimes clues from the victim can point your doctor(s) in a particular direction.

      Regarding palpitations, there are many possibilities. First, they can be due to a handful of different arrhythmias. Second, there are sometimes factors that promote the palpitations (eg, coffee, caffeine, etc.). Work with your doctor to sort through the possibilities. It’s usually possible to put peoples’ minds at ease.

      • Shana says

        Thank you so much!
        My visit at the cardiologist went well I think. The doctor just listened to my heart and did another EKG. She thinks everything is ok and she said it’s normal for people to skip beats…even every few minutes or so. Or it could be an arrhythmia…but non-problematic. I still feel slightly concerned (maybe I’m just hyper-aware because of everything with my dad)…but, she said if I ever feel lightheaded along with the skipped/added beats or like it’s fluttering for over an hour back to back….that I should definitely come back.
        And also…maybe I was wrong about my dad dying of Sudden Cardiac Death. What actually happened was he was informed (after a stress test that morning) that he had had a large heart attack….and so, he needed to come back in in two hours to see a cardiologist. On his way to the cardiologist, he died. Is that still considered sudden cardiac death? (because it was related to a cardiologist? or no?)

        Anyway, I will DEFINITELY go back in if the palpitations get worse or seem WAY more frequent or anything. For now I guess it’s just an irritating part of life that I will have to get used to. Considering the fact that it could be Athlete’s Heart, I am seriously going easy on the cardio for the next few months to see if anything changes. I’m still doing weight-lifting and walking…but NO hardcore runs or long cardio sessions.

        Thank you again!

        • Shana says

          Is that still considered sudden cardiac death? (because it was related to a HEART ATTACK?or no?) hahah. oops!

  68. Chris says

    Dr. Creswell,

    I am 32 and run between 40-50 miles per week, I recently saw my doctor and he referred me to an electrocariologist because my heart rate was 43 bpm at his office(2 different readings).

    After wearing a halter monitor for 24 hours I went to the electrocariologist to have him interpret the results. He told me that I was showing all the signs of athletes heart, but did not diagnose me at that time with athlete’s heart. He specifically discussed the dangers of the vegal(sp) rate being too high for a prolonged period of time.

    He suggested that I cut my mileage in half running 20 miles a week instead of the 40-50, saying that maintaining the frequency and intensity of my workouts would continue to contribute to my low heart rate. He warned me that the possibility existed that I could be in need of a pacemaker at around 50 years old if I continued to train at the current pace.

    How serious of threat is maintaining my current training regimen? Are there further diagnosis that could paint a clearer picture for my future?

    I only ask because running is a huge part of my identity, it is something that I love, it is something I use to relieve stress. I want to be healthy and strong for my children, is it selfish to continue to train in this manner?

    • Larry Creswell, MD says


      Not sure I have enough information there to be completely helpful. A few thoughts….

      A low heart rate is common in endurance athletes. And, as you note, this is due to ramped up activity of the parasympathetic nervous system that acts on the heart through the vagal nerves. Ordinarily, we think of this situation as just a healthy adaptation to exercise.

      Not sure what to make of the suggestion that less running somehow changes the situation. I would think that for somebody like you, your heart rate would be very much the same (at rest, and at exercise) if you halved the mileage.

      I don’t want to interfere with your current relationships with your doctor(s), but sometimes a 2nd opinion can be valuable. This is particularly true when you’re making “big” decisions about your activities. Often, your doctor could suggest an option in your area for a 2nd opinion.

  69. Michelle says

    I have found this very interesting but hsve a question also. My 14yr old son visited the Dr last December with a chest strain due to a rough tackle during rugby they did an ecg which was abnormal, this was followed up with an echo which showed a thickness of 1.7, we have since been referred to inherited cardiac conditions. He had a mri which showed a mild thickening of the septum, we have had holter monitoring, signal average monitoring, and an excercise stress test plus another echo which are all normal, showing a thickness now of 1.2. He was training/playing rugby 3 times a week, actively cycling and doing 3/4 sessions of PE at school before all this, this was reduced dramatically and a period of 5 months has passed. His cardiologist says however that they still cant rule out hcm, and wants to stop him playing rugby. He has NO symptoms. Family members have been screened also and so far are uou have any thoughts?

    • Larry Creswell, MD says


      Thanks for sharing your story. I’ve certainly heard of similar stories where the establishment–or exclusion–of a diagnosis of HCM can be very challenging. It sounds like that’s bee n your experience.

      From afar, I don’t have much to offer in helping to sort things out. Please understand that, aside from your brief paragraph, I don’t have any of the details. One thought…. In cases where the diagnosis of HCM remains unsettled, you might inquire about referral to one of the several groups in the U.S. with the most expertise in this condition. It would obviously be great if you could decide if HCM is present or not….and sometimes a “most expert” opinion can be very helpful. You might talk with your doctor(s) about that possibility.

  70. Laura says

    Hi Dr Cresswell,

    My Dad is developing a new type of ECG monitor for his work, and after testing it out on the family it has shown that my ECG is different to everybody else’s, in that the QRS complex is inverted in lead I (ie. it goes down instead of going up). I was wondering if you would be able to give some insight into what this usually means? The reason I mention this on this blog is that I was a middle distance runner when I was a teenager (competitively for about 8 years) and now at 21 I just run to keep fit, but not as often. Do you think it is possible that my exercise when younger has caused athlete’s heart, and therefore an abnormal ECG, considering I no longer do as much exercise? Or could there be another underlying problem? It does not worry me as I am otherwise fit and healthy but it would be good to know!

    Thank you!

    • Larry Creswell, MD says

      Have you made a 12-lead EKG? Or do you only know about some of the leads?

      How does thee ice work (if you can share the details)?

      I’m sure there’s an explanation for your observation.

  71. Daniel says

    Hi Doctor,

    Love the website, it’s been a comfort after the visit to my gp today. I went in to get checked out for my annual physical. I’ve been training since October to prepare for a 30 mile obstacle course run in September that takes some people 14 hours to do, so I wanted to make sure I could physically attempt it. Over the past 6 monte, I’ve started ramping up my training intensity with about 5 workout days / week that range from 60 minutes (cross fit (body)weight routine followed by running) to 3.5 hours. About 4 months ago I was fine at the Dr.’s office (he listened to my heart then). Today, he noticed a “pronounced murmur”, found an abnormality on an EKG and is shipping me off to a cardiologist for an echo.

    He did a test with one BP cuff on each arm and I think ruled out a hole in my heart, but he said he was concerned that if I pushed my body hard I could have a heart attack and die. At 37, that’s not what I expected to hear – especially since I feel like I’m in the best shape of my life.

    Am I overly optimistic to think I might have a harmless case of “runners” heart after reading this? Just trying to frame expectations. Any guidance would be most appreciated, but the blog has be a great help all by itself.

    • Larry Creswell, MD says

      Thanks for sharing your experience, Daniel.

      We often use an echocardiogram to sort out why patients have a heart murmur. Remember that a heart murmur occurs because of turbulent blood flow somewhere in the heart. The echocardiogram images show the structure of the heart in great detail and can often determine the cause.

      Good luck with your cardiologist visit. That would be the perfect opportunity to discuss any potential heart risks of your sports participation.

  72. Lawrence says

    Thanks for this site. I had an echo stress test today and this site kept me calm leading up to today. Been running 4 years and came up with an abnormal EKG two weeks ago. Test today revealed athletic heart syndrome. I knew it during the test by the looks they were giving me and I kept asking to turn up the pace and grade of the TM. Thank you.

    • Larry Creswell, MD says

      Appreciate the kind comment, Lawrence. Glad that things turned out okay with your evaluation. I know that it’s hard to wait sometimes while an evaluation is completed.

  73. cristian says

    Hi this is cristian, I recently had an EKG and it came out abnormal and heart rate was about 56 beats per minute. The Dr said it might be hypertrophy or athletes hearts. I run a lot about 50 to 60 miles per week. I’m 17 and in great shape. Last week I had a stress test and it came out good but he still wants me to get an MRI. Why does he want me to get an MRI if I did great on my stress test? And if it is athletes heart will I be able to run still?

  74. YoungAthleteParent says

    Dear Doctor,


    I have a 10 year old son who plays tennis from last three years. He has picked up the sport well. His coache recommended us to put him under some physical fitness training along with his regular tennis classes. From last one year or so he has been doing endurance and agility exercises which are tennis related under the supervision of certified coaches, so I am assuming he is not over exerting as per his age.

    A few days back , he was with this general physician for some regular checks and while on stethoscope physician looked at me and said he can hear a murmur and recommended me to go and see a pediatric cardiologist but said it’s not serious. We will be going to the pediatric cardiologist soon.

    I read this blog about “Athlete’s Heart” and my question is – can this syndrome also develop in young athletes ? My son’s routine is quite professional one – where he does endurance/agility in mornings and tennis coaching/tournaments over weekends.

    Thanks for this great blog.

    A curious father.

    • Larry Creswell, MD says

      We generally think of “athlete’s heart” and older athletes. But there is no age cut-off per se. Even the young heart can adapt to exercise and cause the collection of findings we label as “athlete’s heart.”

      Heart murmurs are common. For a young athlete, evaluation by a pediatric cardiologist would be appropriate to determine the significance of the murmur and see if any additional investigation is needed.

      • YoungAthleteParent says

        Dear Doctor,

        Thanks for your prompt reply. Appreciate it.

        We will certainly ask our pediatric cardiologist about what this all means. However, in your opinion and experience, does the following makes sense –

        (1) If it is a young athlete’s murmur , would the doctor realize that ? I mean how different it could be from “innocent murmur” . Would structural changes in heart would reveal that difference ?
        (2) If the above point # 1 can be established with confidence then I am assuming we will be able to continue his organized playing schedule but if not, then do we need to slow down or completely stop ?

        The challenge is , not all the pediatric cardiologists might be aware of “Athlete’s heart syndrome” and our fear is that considering them as “innocent murmurs” they might advise for slowing down or stop. In the US , in some schools , if kids are found to have murmurs they are at times not enrolled for organized sports !

        Thanks again and would love to know your point of view. It would help us a lot.


  75. Tom says

    My son is a 15-year-old distance/track runner. He has been running regularly for two years. At the end of spring season, when the meets are coming frequently, he said that occasionally, when at rest at home or in school, his heart rate would speed up a bit (“speed up” = max 80 BPM). Once the season was over, and he returned to normal distance training, those episodes ceased.

    The pediatric cardiologist gave him an EKG and an echo. He saw some extra beats on the EKG, but said that it isn’t unusual for a runner. Nothing noteworthy on the echo. He suggested a stress test to see what happens when running. The stress test showed the extra beats while running, nothing at rest. The doctor said that he is 99 percent sure that there is no problem — but wants us to go to Philadelphia to the children’s hospital to have a heart MRI. And he advised “no running.”

    We’re not sure what to do. Should my son sit home for four weeks waiting for the appointment? Can he run? My son feels fine, at rest or while running, and he’s wondering why he can’t run at all. Obviously we don’t want to do anything to endanger him, but the doctor’s comments about being “99 percent sure” have us all confused.

    • Larry Creswell, MD says

      You ask a common question, Tom: what to do while a potential heart problem gets sorted out. Obviously, the prudent course is to follow the doctor’s recommendation and refrain. There must be some uncertainty in the diagnosis to warrant the trip to Philadelphia for additional testing. I know it’s frustrating for young athletes to stand down, but you don’t want to find yourselves in the 1% with a serious problem having ignored the advice.

      • Tom says

        Thank you so much for the reply. What can be seen with an MRI that isn’t seen with an echo? Could it pinpoint the cause of extra beats, or might it still remain a mystery?

  76. Richard Walker says

    I went to the cardiologist with chest pains (Last year I had missing beats and had a heart block-jargon bit deep for me) and after a full workup, treadmill ecg, echo and blood tests she said it could be an old back injury triggering a nerve remotely.
    But she did find a RHR of 43 and recommends that I decondition to take my RHR up otherwise I’d run the risk of a pacemaker in my 50s.

    I read up and found that I could have ‘athlete’s heart’ I live in Kenya, East Africa where most runners are leaf thin (I need to lose 30lb) world beaters. They don’t usually see a cardiologist, sports medicine is in it’s infancy as well.

    I use my running to cut the weight and would like to know what degree of deconditioning I should follow… 10mi/wk? weight training/no cardio? fully sedentary?

    I run 25-30 mi/wk and I’m 42 years old.

    Would appreciate any insights. In the meantime I want get checked by another doc.

    • Larry Creswell, MD says

      Good idea to seek another opinion whenever you’re concerned about a first opinion.

      I’m not aware of evidence to suggest that a low heart rate because of conditioning leads to an increased chance of needing a pacemaker later in life.

  77. worried mom says

    Hello Doctor.. my daughter is an amazing 17 yr old XC and track athlete. She is approaching her senior year and conditioning now for her XC season to begin. She recently had a couple episodes of a racing heart.. 41 beats per 15 secs. Seemed very fatiqued. This happened after returning from Australia 2 weeks ago where she was recruited to run in the Down Under Games Track n Field Meet. We went to the doctor today and her EKG showed a slight abnormality. 1st degree AV heart block. The doctor called this eve to tell us results. She had just ran a fast 2 miles prior to the call and felt fine. We are headed to get more test tomorrow as my brother in law is a heart surgeon. Should we be worried or like your previous posts state is this normal for a high endurance runner? Will she be able to continue with her training? She needs to get thru about 9 weeks of running then she will be off for the winter. And starts back up in the spring for her track season. Can they put her on medicine to get her thru XC season? And since she is so young can this reverse itself?

    • Larry Creswell, MD says

      Thanks for sharing the story about your daughter.

      Heart block is an unusual problem in athletes, but can certainly occur. The “racing heart” may or May not be related. Obviously, you’d want to get this sorted out. It sounds like you’re getting further evaluation.

      We don’t really have medications to treat (and improve) heart block. Severe cases may sometimes warrant a pacemaker. And be aware, too, that medications may sometimes actually cause heart block; and heart block may improve if they are stopped.

      • worried mom says

        She just underwent a new EKG and a Echocardiogram which both showed completely normal. So now we are a bit perplexed. Blood work isn’t back yet so will know more next Monday. They are having her wear a halter monitor for a few weeks while running and have cleared her to run/train for season. Hoping this was just a one time issue for her. Thanks for your reply.

      • worried mom says

        Hello! Thanks for replying. Since posting my original questions, Emily’s blood work came back. She tested positive for Mono. A surprise to us all since she has hsd no symptoms. No fever, no sore throat, no aches.. just tired. Looking back now the only symptom she had was sore arm pits.. which is a good sign. We ignored that 3 weeks ago. So all the fatigue makes sense. They still ran tests on her heart to rule that completely out. So this worried mama is relieved somewhat but saddened for her XC senior year. She is feeling better everyday and refuses to NOT practice. Where as her team may run 5.. she may only go 2 miles. Sitting out for a good 4 weeks to try and recover and hopefully have a few decent races torward end of season. It is what it is for now. She doesn’t play a winter sport so can catch up on some needed down time and gear up for hopefully a good track season. Thanks!

  78. Nordlys says

    Ijust started last month. My rest hearet rate is, unfortunately above 80. This does means that my rest heart rate will never slow down, not even with regular exercixes.
    Reading experiences of other people, I’ve noticed that when heart rate is high, they don’t take much benefits from sport.

    • Larry Creswell, MD says

      Most often, an individual’s heart rate will decrease when they move from sedentary to regular exerciser.

      I’m not sure about your notion about the heart rate and benefits from exercise.

  79. says

    I am so thankfuli stumbled across this blog! currently I am wearing a 30 day holter event moniter,(on my 4th day)and am curious as to what the results will be. I am a 34yr old female and have been an athlete pretty much my entire life. I ran crsscountry/track and swam competitively all through middle school.high school and college. I also am a professional figure athlete, with 3 pro cards under my belt. my workout routines are quite rigorous when im training for competitions, and when iam in an “off season” with competeing,i still run around 60-80 mile a week and shift my focus to competitive distance running. having said this, my training slowed down this time last year. I went from highly conditioned last summer (training for competitions and half marathons-ie 80+mmiles a week,6x a week heavy lifting,2-3x a week HIIT with running,etc) to just conditioned over the fall (still running 60+miles and lifting 5x a week) to hardly anything (20 miles a week)since February of this year. about 8months ago,i started having disturbing symptoms it started with a headache,then dizzy spells, increased heart rate,nausea,vomiting and feeling like I was about to pass out. I dismissed it as not enough sleep and foodfor the day. 3 weeks later I had another episode, and now have had one or two every month since. in may ,i decided to do a 5k,which I know I could still knock one out in at least 22-23minute without much effort. I felt odd before the race,fluttering n my chest almost like I was nervous (but I wasn’t) before the race I felt nauseated, but ran anyway. I felt yucky while running,but nothing going on with my heart until after the race….as soon as I crossed the line and started jogging back to the car, the flutters came back, my heartrate wouldn’t go down,i was dizzy, nauseated and felt like I was going to pass out.. thankfully my husband was there to drive me home. when I got home I started vomiting and i was going to pass out,was feeling that odd feeling with fluttering. my HR didn’t drop under 100 until about 3 hours after the race. I eventually felt better but now I have these episodes more frequently without the headaches,and without the running.i have “bad” episodes ie vomiting and dizzyspells about 1-2x per month, I can feel palpitations and flutters occasionally,but tend to get lightheaded more often.
    when I do run,its only about 3 miles and very slow. after exercise my HR is slow to get back to normal (normal for me is about 55-60bpm now-it used to be about 45-50) it stays about 100 for an hour after jogging and then gradually gets down again.
    my gp refered me to a cardiologist (she thinks I may have menstrual migrains,but wanted to check my heart out just to err on side of caution.
    blood work came back fine,cholesteral, hormones,thyroid,blood suagrs all within normal
    after the 30day monitoring I will do a stress test and have an echo done.
    I am very apprehensive even though there is no history of heart disease aside from my grandfathers.
    on one hand I am half hoping that something is found to explain how crappy ive been feeling-I want to get back into competitive racing again,and a half marathon is fast approaching, as with a pro figure competition. (November)
    does any of the symptoms I mentioned sound cardiac related??
    should I be concerned or have I just gotten myself really out of shape?(and a 10lb weight gain)
    since the cardiologist I saw only spoke with me 5 minutes,i didn’t have a chance to tell him about my athletic background. I did document my episodes for the past 3 months and gave him the handwritten documentation.
    I am hoping to get some answers soon,and would love to hear if you any input to my situation?
    Thanks in advance!

    • Larry Creswell, MD says

      Not sure that I have much to add from afar. Perhaps another reader will chime in.

      It sounds like you have a cardiac evaluation underway, with the Holter and other tests to follow. Hopefully those tests will be fruitful.

      It can sometimes be very difficult to track down the cause of the symptoms you describe.

  80. Debbie says

    My son is 13 years old and has been playing baseball since he was 5 and last year had been all around sports baseball, football, track, then he started strengthening and conditioning over the summer. This year he had a physical and everything was fine. They were offering a free sport EKG and I said what the heck it will make me feel better if he was clear of that. Well, it came back abnormal and they said he has Left Ventricular wall thickening. He has worked out very hard this past year with a LOT of activity in sports and I know they push pretty hard when it comes to football. My son will be devestated if he can’t play sports that is his life! He has an appt for an Echo, holter, stress test on Friday. How can they tell from an EKG? Can this be athletes heart?? Will he be able to play sports?

    • Larry Creswell, MD says

      Thanks for sharing your son’s story of EKG screening in conjunction with a sports pre-participation exam.

      The purpose of an EKG in that setting is to discover hidden heart problems–problems that might not (yet) have produced any symptoms but might place an athlete at risk. Thickening of the left ventricle (the heart’s main pumping chamber) is just one of many things the a EKG is looking for.

      Regarding thickening of the left ventricle, there are many potential causes. Some can be serious.

      Most often, athletes with an abnormal screening EKG will need to have consultation with a cardiologist and possibly additional testing to sort things out–and, in the end, make a determination if it’s safe to play sports.

      It sounds like you’ve already made progress toward further evaluation. Good luck with that.

  81. Mississippi runner says

    Hello Dr. Creswell,

    I am 35 years old and WAS an avid runner. I was increasing mileage and speed, training hard over the summer (and mississippi is hot in the summer!!!). One evening I felt my heart skipping and confirmed this by listening with my stethoscope. I am a veterinarian so I know just enough medicine to be dangerous when diagnosing myself! Ha! I believe I then had a panicking episode that lead to worrisome symptoms. Went to ER and was diagnosed with a 2nd degree type 1 av block. Have had an echo, stress test with nuclear imaging, holter monitoring, and even a cardiac CT to check for congenital abnormalities of coronary arteries. All was perfect (better than normal, my cardiologist and electro physiologist said). I have high vagal tone (fainted some as a child, faint when donating blood, etc.) exacerbated by the running. So I should be over it, right?

    Well, needless to say, this has devastated me. I have developed some health anxiety and constantly worry about every little thing being fatal! I have 2 small children and never in a million years would have guessed I would have a heart issue from exercising! I was running about 20-25 miles a week. Is this enough to cause changes? I love running and miss it terribly, but have no confidence in my heart and do not want to have any progression of disease. I have not done ANY exercising for 2 months. I am having some muscle twitching now (probably anxiety) and felt dizzy today after eating a large lunch. I was told this is also a vagal thing.

    I know high vagal tone is often a good thing. So my question is, what’s a girl to do. Will deconditioning lower my vagal tone? I also was a caffeine addict and had 4 diet sodas the day I had the ER visit. I still have bradycardia (50ish) at rest and still have the block at night. I have given up the caffeine completely, but shouldn’t that actually counter the high vagal tone? Also, I have some chest pain occasionally and a pounding heart at times. I have been told repeatedly my heart is FINE!! I have had a GI consult and no evidence of reflux.

    Any advice would be greatly appreciated! Should I run again to help with the anxiety? I’m sort of stuck…My family wants me to stop running for a while, but my doctors want me to get back to who I was before all this and go back to running. I am working on the anxiety issues, but would love your thoughts on the cardiac perspective.

  82. Seth says

    Hi my name is seth
    Im 14 and play
    Football,baseball,track,5ks ,wrestling ,weight lifting and play tournament paintball
    I went and got a physical
    For my football
    And doctor told me I had a
    Irregular heart beat / heart murmur
    Blood pressure was fine
    Every thing 56 beats a minute
    She said irregular because congestion or some thing when I take deep breaths
    And I had the mur mur
    So she sent me to get an EKG
    Came back
    Wasn’t perfect of course
    So now I’m getting an
    Echo this wensday
    I just want to know like what this all means
    Does it sound like an athletes heart
    Because like you can see I am a busy athletic person

    • Larry Creswell, MD says

      Thanks, Seth, for sharing your story about your physical and EKG. I don’t know enough about your circumstance to comment specifically from afar, but perhaps I can share some general comments that will be helpful to other readers.

      When there are abnormal physical findings or an abnormal EKG, it’s not surprising that the affected athlete would be anxious while he/she waits for additional testing. But Seth’s story is how cardiac screening for young athletes is supposed to work. Abnormalities discovered by history or physical exam (or screening EKG) should be followed up by a visit to a cardiologist and/or additional testing yo sort things out.

      Screening exams are sometimes falsely “positive,” where there is no serious underlying problem that explains the abnormal finding.

  83. Josh says

    Hello I have a question I would consider myself an athlete, or at least athletic. I usually cycle around 90 miles a week, swim and lift weights. In may i noticed a few skipped beats of my heart and panicked. I went to the geet hospital emergency room where a EKG, chest x-Ray and blood work was done. I had multiple skipped beat that day and the day I went into the hospital. The doctor sayed my EKG came back normal and blood work was fine. He did mention that my heart appeared to be enlarged. I had another skipped beat that he witnessed and said that I was fine and these were well within the range of normal. He also suggested that I probably had AHS and that he said I should go on a long ride immediately after being discharged. I realize he was probably trying to limit anxiety, which I have had a huge amount if as of late. I have set up an appointment with a cardiologist to look into this further. I have low blood pressure(90/60) and low resting heart beat (~46bpm). I am still getting these skips sometimes once a day or multiple times a day should I worry about this? Thank you for any input.

    • Larry Creswell, MD says

      From afar, I don’t know what to make of low blood pressure or low heart rate. Sometimes, these are not problems at all. Certainly topics for discussion during your upcoming cardiologist visit.

  84. Charles says

    I was wondering if a professional cardiolost could reply to my questions:

    I am 42 years old and don’t drink, smoke or take any drugs.

    Over the last 2 months I have been feeling really weird in my chest so I went to a cardiologist had a stress echo, 24 hour holster and dozens of ECGs all came back with no problem.

    I haven’t excersied for 6 months and put on 15kgs as I used to be very fit.

    Over the week I started to exercise again daily 30 mins on treadmill and 30 mins on bike and lots of walks.

    My normal resting heart rate is 60BPM but when I train it goes upto around 130BPM.

    My question is:

    Is it normal for my heart rate to take half a day to drop back to 70BPM as I’m not sure why it takes so long to recover?

    Is this normal or should I go see another doctor as I am concerned so if anyone that knows what there talking about can advise me I would be grateful.

    • Larry Creswell, MD says

      I can’t be your doctor from afar. I just don’t have all the necessary information.

      You ask about heart rate recovery. This can be a measure of cardiovascular fitness. The more fit, the quicker the heart rate returns to baseline.

  85. Cindy says

    Hi Dr. Creswell,
    I am 21 yrs old and am an extremely active person. My resting heart rate is around 48. Last year, I was having tons of skipped beats. This scared me. My grandfather used to be a diagnostician, so he pointed me in the direction of a well known cardiologist. He thought he heard a slight murmur, first I’d ever of that. He said even for his expert ears, it was very hard to hear. He wanted me to have an echocardiogram and an ekg just in case. The ekg was normal, but the echocardiogram showed an EF of 55% and some mild paradoxical septal motion. Could this be related to being so active? I’ve also had a stress test and a holter monitor, everything was normal except for a few skipped beats.

    • Larry Creswell, MD says

      Perhaps a typical evaluation for so embody with a newly-discovered heart murmur. It sounds like nothing worrisome was discovered in your evaluation. Did your doctor provide reassurance?

  86. Kyle says

    Hi. Im a 40 year old male. 6’3 215 pounds. Good overall health. I was an athlete (baseball) from age 16-22 which i ran everyday 5-7 days a week then got into weightlifting 5 days a week for roughly 15 years. I always had a low resting heart rate sometimes in the 40’s while sitting resting. I developed afib when i was 21 and have had it since. My cardioligist said line afib after doing an ecg. All normal. I recently this year went in for a followup ecg and all was normal. It has been 2 years since i have worked out at all yet my resting heartrate is still low. I notice it at 54-56 when lying down resting(not asleep). Does this sound.normal for.someone whos been out of training for.two years. Does the low heartrate stay with you forever? Thank you

    • Larry Creswell, MD says

      I would think that a healthy, well-trained athlete might continue to have a nice low HR even after not training for a while.

  87. M wilson says

    I posted a question a week ago and it was still saying awaiting moderation the. It disappeared, what happened?

    • Larry Creswell, MD says

      Not sure why your initial comment “disappeared,” but I’ve read your comment.

      You asked about the size, or voltage, of your EKG. That’s an interesting question.

      There’s a long list of possible causes: pericardial effusion (fluid around the heart); pleural effusion (fluid around the lungs); various heart conditions (eg, heart attack); lung disease.

      And alternatively, there could be some sort of technical glitch with recording the EKG.

      These possibilities will need to get sorted out with your doctor.

  88. Shazad says

    I had an echocardiogram done yesterday .. It showed a slight thickening in the septum.. Approx 1.5cm (the official results have not been given to me yet) .. The technician told me that its approx 1.5cm .. She said the other bits are normal .. Should I worry? 4 years ago the septum was 0.9cm

    Age: 39

    An update to the above:

    the cardiologist rang me and told me the following:

    I have very slight thickening consistent with an athlete’s heart (1.4cm).. It’s not HCM.

    He said its concentric symmetrical thickening.

    My ventricles are performing perfectly well

    He doesn’t have any concerns, I’m not at any risks, he has asked to go abit moderate with my weight training

    Do you agree?

  89. Nish says

    My son is 12 years old and very active. He has been playing basketball since the age of 7. He trains/plays seven days a week and in addition to that he is a runner. He had a 3km run at the school last friday and he said he was doing well until he came to the last 400m. There were flies everywhere and he felt sick. Dizziness and nausea are some of the things he experienced. He looked very pale when I picked him up from school. The same night he went for basketball training and on saturday morning he went to do his ahtletics. He had to do a 800m run but he said he is feeling tired. I asked him to rest. On sunday morning he had basketball training in the morning and evening. I noticed that he is not giving 100 percent. When I asked him he said he felt a bit tired. On monday he had fitness testing as part of basketball and he had to do a bee test. Last year he had a score of 12.1 and a couple of months ago in anohther fitness test (which I can’t rmember the name ) he scored 17. That was the 4th highest best score for his grade level. Anyway during the Beep test on monday I noticed he is getting tired and tired and he stopped when he reached 8. His eyes were very pale and he didn’t look alright.He was very tired and he had palipitation.The following day we took hism to a GP and he reffered him to a Paediatric Cardiologist since we were so concerened. We took him to the specialist yesterday and he said he can heara slight murmur. He wants my son to have a ECG, Stress test and an echocardiogram. He is going to do them in couple of weeks. Meanwhile he is to take it easy and not to do any strenuous exercises until he is given all clear. Do you think this is temperory? He hasn’t experienced anything like this before.

    • Larry Creswell, MD says

      Sounds like you’re headed in the right direction.

      Symptoms like unexplained fatigue and “being pale” ought to be investigated. Cardiac causes should be explored and excluded.

      Things that would cause temporary problems like you describe would be illnesses like a cold, etc.

  90. Scott says

    Hi Larry
    I am a 60 year old male masters runner. I have been running regulary for 16 years. I can still run 5km in under 18 minutes. I probably run about 50 km per week. I do not do many long runs and my favourite session is a 3 km warm up and then 6×1 km reps at around 3: 30 pace. I always run hard and enjoy 1500 meters on the track. Anyway, last Christmas my wife bought me a watch with a heart rate monitor. I started to notice that on cold mornings in particular, my heart rate would spike at the start of a run ( erratic up 185 bpm) . It would settled down after 1 to 2 km. After that it was fine and would stay within the range of 136 to 161 pbm. I have not really felt any odiscomfort. If I did not have a heart monitor, I do not think that I would be aware of any problem. My resting heart rate is 42pbm and after a hard 1km rep my heart rate drops to about 58bpm. Do you think the sympton sounds like typical AF that seems to occur in older runners? ( Have I been overdoing the intensity of my runs?). Should I be seeking medical advice?

    I really appreaciate your website and it has been very informative reading through the past blogs

    Kind regards

    • Larry Creswell, MD says

      Most athletes with paroxysmal (intermittent) AF report that the onset is unpredictable.

      The issue you describe, with higher than expected HR at a predictable time during your run, sounds more like a problem with HR detection by the monitor. You might want to take your pulse (manually) when the monitor says it’s high. If there’s a discrepancy, then no need to worry about an arrhythmia.

    • Adam says

      Spikes at the start of a training session are common with heart rate monitors because they need sufficient sweat to give an accurate reading. They can also give spikes because of the material in the t-shirt you are wearing. If you can get hold of some ultrasound gel, that will normally fix the problem.

      • Adam says

        Oh, spikes on heart rate monitors are especially common on cold mornings, since you take longer to start sweating. If it’s cold and dry it’s even worse because running around can create a build up of static electricity.

  91. Richard says

    I went to see a cardiologist mostly because I’m 66 years old and I was hoping to talk him into giving me a stress test. I told the doctor about a couple episodes of light headness where I needed to reach out to steady myself.

    So the doctor gave me an ECG there in the office and he was shocked to see my resting heart rate was 47 bpm. He has me wearing an event monitor for the next month.

    I tried to explain that I’ve been spending a lot of time on my treadmill during the past six months. He wasn’t convinced that I was a highly trained athlete. I didn’t think so either since I’ve been keeping my workouts to 70-80% of my hypothetical max heart rate. I want to lose weight rather than run races at my age.

    How so ever, back 10 or 14 years ago I was doing races and training seriously as an amateur. Back then, I did attempt to reach my max HR many times (at the end of a 5k !)

    So what are the chances that I regained that fitness and that athlete’s heart through modest (but dogged) efforts in my senior years?

    I do 2.5 to 3 hours a day at 3.5 mph and 5% grade on my modest home treadmill. One morning workout and one in the evening. I’ve lost a huge amount of weight!


    Now then, i

    • Larry Creswell, MD says

      Exercise over time usually does have an effect to lower the resting heart rate. That happens even with a modest amount of exercise.

      A slow heart rate and episodes of light-headedness can be serious. As we age, the heart rate mechanisms can deteriorate a bit. There might be nothing wrong with a resting heart rate of 47 at the doctor’s office, but it can be possible for the heart rate to go much lower (transiently) and be the cause of light-headedness. The monitoring test is designed to see if there are “spells” where the heart rate is slow or if the electrical activity in the upper and lower chambers become uncoordinated at times.

  92. connie hart says

    My son is 21, a distance runner who has been running for about 9 years, currently between 60-70 miles per week. He has had about 9 episodes of vasovagal syncope. The last episode landed him in the hospital for 3 days. The echocardiogram showed an EF of 60%. The report looks like everything normal but he has previously been diagnosed with Left Ventricular HYpertrophy. His primary care physician is very worried about the EF of 60. He is on Midodrine and florinef for the vasovagal syncope. He sees the cardiologist next week. Do you have any advice?

    • Larry Creswell, MD says

      No particular advice.

      Keep in mind that EF of 60% is normal. You might ask why your son’s doctor was concerned.

      Vasovagal syncope can be a challenging problem. It sounds like you’re working on it.

  93. Renato says

    I am a 55 year old male, non-smoker. Very fit. I lift weights five to six times a week and have done for over 20 years. I weigh 155 and my max bench is 250 lbs, just to give an idea of how heavy I go. I also run about 15 kms a week.. Recently, I saw a cardiologist because of palpitations and the 24 hour Holter came back showing 150 PVC and 20 PAC, and my doc said these were nothing to worry about. The palps seem to have come with a cold I got and and now that I am better, they are aomost entirely gone..

    My problem is I also had a stress test, which the cardio said was “excellent” and an echocardiogram. The echo results were all normal except for trace regurgitation in the Mitral, Tricuspid and Aortic valve. As I understand it, slight leakage is common, except in the aortic valve, which should not leak at all. The cardiologist said the leaks were mininal and only required periodic monitoring. He advised me not to lift so heavy.

    My question is could weightlifting have damaged the valves and will it get worse if I keep lifting? Also, could an cold or similar infection cause a (hopefully temporary) valve issue?

    Thank you for your kind attention.

    • Larry Creswell, MD says

      I suppose that all of the heart valves are “designed” to prevent any leakage. That said, small degrees of leakage are common, for any of the valves.

      Typical colds or other infections do not affect the heart valves. A more serious infection, called endocarditis, may occur when bacteria in the bloodstream set up shop on the heart valve(s) and can destroy them.

      Weightlifting produces increases in the BP that can put additional strain on the heart valves, producing an increase in leakage.

  94. Adam says

    I’m 37 and an avid cyclist. For example, last summer I cycled a total of over 5000 miles – which equates to about 10 hours per week. For years I’ve been aware of my heartbeat (more accurately my pulse in various parts of my torso) if I sit still or lie down. For a long time I just assumed that was a consequence of training so much – a more efficient heart pumps more blood with each stroke so you’re more likely to be able to feel it. I’m also a fairly thin guy (6 foot, 150 pounds) so I assumed feeling my heartbeat was just a sign of how fit I was. However, I recently started worrying it’s something more sinister since no-one else I’ve spoken with can feel their heart beating. Now I worry about it it won’t go away and it’s driving me crazy. I’m going to see a cardiologist in a couple of weeks, but I just wondered if my previous assumption sounded reasonable or if I am right to be worried? Can anyone else feel their heartbeat just by sitting still or lying down (and maybe thinking about it a little)?

    • Larry Creswell, MD says

      Maybe other readers can chime in with their experience.

      I think that lots of folks can feel their heartbeat like you describe.

      Good luck with your upcoming evaluation.

  95. robin says

    I just had ekg and echo. Had one last year and all was fine. I workout w ton but in novemeber started experiencing weird headaches and ringing in the ears. Everything came back normal from nuero. So went to carsiologist. Ekg was normal chest xray normal. I dis my echo and my doctor says left atrium slightly enlarged but nothing to worry about. Im 5″11
    160lbs female 32 years. I do heavy weights and running hiit workouts. He said he is not worried because im so tall. Im so freaked out. I have stress test friday and im nervous

    • Larry Creswell, MD says

      Good luck with your evaluation.

      The dimensions of the heart are generally larger for larger people (based on lean body weight, for example).

  96. Jeanette says

    I am obese and move a lot. We only eat once a day. I took two seasonal jobs this past October and was working sometimes up to 22 hours a day doing receiving which meant running product on u boats out to the floor for four hours and then restocking the shelves. I worked my butt off. Now it is February and business slowed down and after a couple of bad chest pains, I went to the doctor to be asked multiple times if I use cocaine. Apparently I have an enlarged heart. Could this be due to the strenuous work and long hours?

    • Larry Creswell, MD says

      There are many, many different reasons to have an “enlarged heart.” Certainly, enough physical activity can have that effect.

  97. vic beninate says

    I am a 67 year old, 47 year runner/ work out nut. Everything was great until about 2 years ago when i started having problems during races, ie felt like couldnt breath. Have been to cardiologist, treadmill stress tests, cardiac, ect.
    But, 2 weeks ago passed out when got up from chair quickly. had water glass i hand, broke cut hand, trip to emergency room, panic on their art, ect ect.
    pulde 35, bp 175/65

    visited my primary care md all ok. seeing the cardio md has seen in past

    this thursday see the cardio md. over past year my 5k times have varied from 21 minutes today’s all time worste , 26:23, could not breath.

    any thoughts?


    • Larry Creswell, MD says

      Breathing difficulties, particularly with exercise, need sorting out.

      Your plans to re-visit the cardiologist sound good.

  98. john says

    The first time used a Polar heart monitor to play squash it read 165 BPM so I stopped playing and went to a hospital and told a doctor, he ordered a stress test but stopped it at 135 BPM, I wanted it to go to maximum, anyway he approved continuing squash.

    Since then my monitor has read as high as 186 BPM after walking off the squash court,. Now I keep an eye on it and back off to keep it under 160
    When practicing on court alone I backed off because it went 151 BPM not because I was exhausted
    My RHR is usually 49 or 50 but first thing in the morning It has been as low as 46,
    Should I be worried about this unbelievable high heart rate.
    I’m a 74 year old male

    • Larry Creswell, MD says

      For athletes with a healthy heart, high heart rates with extreme exertion and low resting heart rates are “normal.”

      Whether or not to be concerned with a high heart rate might depend on one’s overall health generally and one’s heart health, specifically. Good question for your doctor.

      • John says

        Hi Dr Creswell

        Thanks for your reply,
        I already figured I wasn’t going to have a heart attack on court so I stopped wearing my heart monitor, it was making me a hypochondriac


  99. Marion says

    Hi dr creswell. My 17 yr old son plays a lot of football. recently he’s been complaining of heart palpations his EKG and echo was normal so the cardiologist suggested a 48 hr holter monitor. I got results today shows his heart rate is normal during the day but at intervals it drops to 30bpm when he’s sleeping. He has an appointment with cardiologist tomorrow to discuss his results and maybe do a stress test. I’m so scared to let him sleep tonight is a low sleeping heart rate dangerous. .. Help… Marion

    • Larry Creswell, MD says

      Good luck with your cardiologist visit. You’ll have the chance to review the findings from the Holter monitor. After reviewing the information from that test in further detail, your cardiologist will be in a better position to know if there’s any significance to the low heart rate in the evenings.

      • Marion says

        Thanks dr creswell. All went well with cardiologist today he said the low heart rate at night is very normal. He had a stress test also today which was normal too. Thankfully we can now sleep well at night. I live in ireland where we have a very high rate of sudden adult deaths especially among young active men many have died on the football field or soon after a game I wish our government could get their act together and roll out a screening programme for every young person involved in sports. Too many have lost loves one this way. Thanks again.

  100. Karol Wieczorek says

    I have been trying to find an answer to a question that had recently poped in my head. It is something like this:
    If a person lower it’s heart rate, due to exercise, from, lets say, 70 to 35 does it mean that it’s heart is twice as efficient in circulating blood in his body ?
    Does this mean that if this person engages now in a physical activity at the same intensity level as before the change, it will have half of the heart rate it had before ? Or it doesn’t work like that ? Can this increase in efficiency be somehow put in numbers? Or not really ?

    Man thanks for any reply as I cannot find anything online.

    Kind Regards

    • Larry Creswell, MD says

      The “trained” heart is indeed more efficient. At a given HR it will pump more blood per minute.

  101. Rachel says

    I’m a 44 year old female. Diagnosed with pheriphyl neuropathy 1.5 years ago and recently diagnosed through an Echocardiogram that I have a dialated left atrial.

    I started cycling in my teens up until I had kids. I didn’t have the hours and hours to ride like I use to. As they got older I went to get back into it but my feet started giving me problems not unlike the full blown neuropathy I have in my feet now. So I quit 🙁 just wasn’t enjoyable anymore. I have weight trained regularly in the past but the whole single parent thing limits my life and energy. I try to get in to the gym a couple times a week, I walk and dance a couple times a week. Over the last couple years I’ve noticed swelling in my legs but I thought I was getting fat 🙁 After getting the heart results back it all makes sense now.

    Here’s my symptoms: edema in legs and arms, out of breath climbing stairs (that one really puzzled me), migraines, frequent urination at night 5x+, extreme fatigue. I checked with my 79 year old aunt the other day on family history since her mom, my grandmother, died at 45. Some thought it was a blood clot, a stroke, or complications from a surgery she had for varicose veins. After speaking with her I believe she had a heart attack based on her symptoms right before she died.

    Since my diagnosis, I’ve been taking a mild diruitic and a baby aspirin a day just see if it helps. I feel so much better it’s unbelievable! I still get tired especially after working out. It was my neurologist that ordered the test and I’m scheduled to see a cardiologist as soon as the referral goes through next week. I’m going to back off on everything but walking until I get in.

    I think it’s important for athletes to do their due diligence on getting tested irregardless. Just because you’re a fit athlete doesn’t mean you’re excempt from serious heart problems. There’s been enough athletes that have died of a heart attack to stay aware of the possibilities beyond an “athletes heart.”

    • Rachel says

      *added symptom: heart palps (how could I have forgotten that one!?), this symptom seems to make me “think” the heart palps cause anxiety or the anxiety causes the heart palps. Geesh!

  102. Kathleen says

    Hi, I feel nervous about my son. We just went to a pediatric cardiologist and he said that he had an enlarged left ventricle, that it had increased in size from about 5.2cm to 6.5 cm over the past 2 years. However, the function is completely normal, as shown on an echo and there were no abnormalities on the EKG and he had no complaints of any kind. We went for a follow up since he had mono a few months ago and my husband has high blood pressure, so I just wanted him to be checked out. My son has been working out with weights, playing basketball 3 times a week and walking several miles a day at a brisk pace around college for about 6 weeks since he recovered from mono. Could any of this cause left ventricle myopathy? We are going for a cardiac mri, but cannot get a quick appointment and the doctor was not very helpful or reassuring and I am worried.

    • Larry Creswell, MD says

      There are many potential causes of left ventricular enlargement. From here, I don’t have enough info to help you understand the possibilities in your son’s case.

      It sounds like the MRI is planned to help sort things out.

      Once all of the results are at hand, your son’s doctors will be in a position to offer opinions about the cause and any implications.

  103. Bill says

    I’m turning 56 this week. I just found out last week that I might have Long QT after all these years of swimming (30 years) and sometimes competition in masters meets (though I’m far from great).

    I temporarily lost consciousness in March 2015 and was taken to ER. They found some irregularities in the EKG. CT scan okay, x-rays okay. I then got a cardiologist. He had me do a 24 hour holter monitor. The result (I got on voicemail) was “normal.” Then the stress test with ultrasound before and after – my doctor says my heart looks good, keep on swimming. Finally a tilt table test which measured some long QT intervals. I swam 4200 yards in a warm pool that morning with shorter intervals than usual for my eight reps of 400 yards. But felt good. I think I was dehydrated.

    I had elevated blood pressure (long story) for four years but was put on 5MG quinapril since 2011 to normalize it.

    Friday before the Long QT discovery I swam my usual 3600 yards. Must have been dehydrated for the test because they said not to drink water. I did not take my quinapril that day and my pulse in the evening was 55. The next morning my pulse was still in the 50s. Then I took my blood pressure medicine and did 56 minutes of moderate lifecycle at the gym. I got home and my blood pressure returned to normal but my pulse crept up in the 60s. And on Sunday my blood pressure was normal and pulse up to the 70s.

    My cardiologist said I do not need any pacemaker but he prescribed me a beta blocker, tropol, at 30mg. I did not take it yet because I am worried about driving on freeways with the medicine. And I want to have the doctor evaluate my blood pressure / pulse to see if the dosage is really too high or not. I want reassurance that I can drive to and from work with this new obligation to my life.

    Regardless, I continued swimming on Sunday and this morning with the dagger of a thought over my head. I was by myself in the pool this morning. The pool has “Warning, No Lifeguard on Duty” and I never much before worried about that. But then statiscally after thousands of miles of swimming behind me, I maybe would have had some symptom long ago.

    The doctor did say if my blood pressure gets too low he will take me off the quinapril.

    • Larry Creswell, MD says

      The same thoughts go through my head every time I see the “No Lifeguard on Duty” sign.

      It sounds like you’re being thoughtful about your evaluation and treatment.

      • Bill says

        Thanks Doctor,

        By the way, my cardiologist did say I have athlete’s heart. But I read that like any muscle, the heart grows larger with use. So I was not worried on that part.


  104. Anneke says

    Hello Dr. Creswell, I am a fitness instructor in my late 40’s. I consider myself to be very fit and healthy. I had a heart murmur detected when I was in my early 20’s and had it checked out. It was determined that it was due to the fact that I had a large healthy heart and that the force of blood through the valves made the “extra” sounds. I have had three pregnancy and don’t recall any doc noticing the murmur during that time. My resting heart rate is between 50 and 60 bpm. My mother had open heart surgery at 76 due to what was determined to be a aortic valve stenosis. She had no symptoms and felt well up to the surgery and felt no different after the surgery. However, she suffered a devastating stroke 4 months later. I believe the stroke was a result of the surgery, of course this has never been confirmed. Should I be concerned?
    Thanks very much,

    • Larry Creswell, MD says

      As you point out, there are several causes of a heart murmur. A heart murmur can be due to turbulent blood flow through a diseased heart valve, as in the case of your mother. A heart murmur can also be “physiologic,” due simply to increased blood flow through the heart.

  105. Maria says

    I just got diagnosed with sinus bradycardia … I have been playing soccer for the last 9 months , 3 times a week, is it possible that it could affect me,, @nd if so in what way?

    • Maria says

      I just got diagnosed with sinus _bradycardia
      do I need to stop playing soccer I play three times a week been playing for the last 9 months

      • Larry Creswell, MD says

        Many athletes have sinus bradycardia. That simply refers to a heart rate less than 60 beats per minute, with no other heart rhythm problems.

        Ask your doctor if there should be any concern in your case. Perhaps a phone call could put your mind at ease.

  106. Tyrell Ryan says

    Hello Dr.,

    About 3 weeks ago I went into the doctor for a routine physical. The doctor took an EKG and she said it was abnormal. There were high spikes and it showed my heart was enlarged. I was admitted to see a cardiologist, who ran an Echo-cardiogram and the results basically stated that my heart was enlarged. I then had to take an MRI last week, which I do not have the reults of yet. The cardiologist told me throughout the whole process that if I work out I need to take it extremely lightly. I have no family history of HCM, but I have not done a genetic test to see if I somehow carry the gene. I recently have been feeling fluttering in my heart area (I believe those are palpitations) and occasionally I do get very mild chest pain.

    I am an extremely active athlete. I do extensive training, as I am a college basketball player who has intentions of going professional. I actually do not know anyone who works as hard as I do. People tend to think I am ridiculous. I go to the gym 6 days a week and lift weights full-body for an hour and play basketball (train or play competitive games) for about 7 hours per day on average. So I could understand if my heart would be enlarged by how much I put it through.

    My main question is: Could I have athlete’s heart, despite recent palpitations and mild chest pain occasionally? Or is athlete’s heart only for people who have no symptoms? Like, should I assume, because now I have symptoms, that it is probably HCM or a related disease?

    Thank you for your time!

    • Larry Creswell, MD says

      Perhaps you’ve gotten the MRI results by now.

      Yes, athlete’s heart can be found in athletes with or without various symptoms. I’d bet most people learn of athlete’s heart when they have an echocardiogram that’s done because of some sort of symptom. A smaller group of asymptomatic people will learn of athlete’s heart when they have a screening echocardiogram.

      There are many reasons to have an enlarged heart. HCM, the inherited condition you mention, is characterized by abnormal thickening of the heart’s walls. In many cases, the diagnosis can be sorted out with echocardiogram and MRI. Not all patients with HCM have one of the known genetic defects.

      Good luck and consider posting back with an update.

  107. Tyrell Ryan says

    Hello Dr.,

    About 3 weeks ago I went into the doctor for a routine physical. The doctor took an EKG and she said it was abnormal. There were high spikes and it showed my heart was enlarged. I was admitted to see a cardiologist, who ran an Echo-cardiogram and the results basically stated that my heart was enlarged. I then had to take an MRI last week, which I do not have the reults of yet. The cardiologist told me throughout the whole process that if I work out I need to take it extremely lightly. I have no family history of HCM, but I have not done a genetic test to see if I somehow carry the gene. I recently have been feeling fluttering in my heart area (I believe those are palpitations) and occasionally I do get very mild chest pain.

    I am an extremely active athlete. I do extensive training, as I am a college basketball player who has intentions of going professional. I actually do not know anyone who works as hard as I do. People tend to think I am ridiculous. I go to the gym 6 days a week and lift weights full-body for an hour and play basketball (train or play competitive games) for about 7 hours per day on average. So I could understand if my heart would be enlarged by how much I put it through.

    My main question is: Could I have athlete’s heart, despite recent palpitations and mild chest pain occasionally? Or is athlete’s heart only for people who have no symptoms? Like, should I assume, because now I have symptoms, that it is probably HCM or a related disease?

    Thank you for your time!

  108. Amy says

    I have been sick for six weeks now and the doctors are now trying to diagnose what I have by process of elimination. My symptoms are similar to that of sinusitis but with more emphasis on the fatigue side of things. On bad days I struggle to get out of bed; even on good days, I am always tired; my muscles ache after really light exertion; I have trouble sleeping at night and I’ve developed issues with concentration. As I am an elite athlete, my resting heart rate is well under 60 and it has always been on the lower side of the normal spectrum.
    The doctors are now checking my heart rate when I first wake up. At the moment it is still pretty low (around 61-64) but it is slightly higher than what it would be normally. Also, when I get up and move around it jumps up to around 115-20. I haven’t really been training much- I lowered my training from around 20 hours a week to about 8 hours. Occasionally, my heart rate will return to normal (when I’m lying down not doing much).

    • Larry Creswell, MD says

      Thinking generally, sick athletes might well have a higher than normal resting heart rate….and have a higher than normal heart rate when they exercise or move from a sitting to standing position.

      Get your doctor’s help to sort out why you’re sick and hope that as you get better, your regular heart rate patterns will return to your normal.


  109. Hamid says

    Dear Dr. Larry,
    I am a 55-year-old healthy man. I do cycling 2 days per week, about 100km on each day. I alway choose a route with several hills (total 30-40) km. I push myself on the hills to my limit while my bike is on the big chain ring. Yesterday I was a subject model for a echocardiography test and they found that I had LVEF of 43%. They told be that was too low but they did not find any other findings. My heart rate at the time of echo was 54 bpm. I am much fitter than average people. I use my heaven mountain bike on the road but I am much faster than most riders with road bikes. My question: have I pushed my body way beyond my cardiovascular fitness that my LVEF has reduced? Should I reduce my intensity of my riding while hill training? Should I see a cardiologists?
    Thank you very much for your insightful feedback.

    • Larry Creswell, MD says

      A couple thoughts….
      First, it’s great that you were able to take advantage of the opportunity to be subject for the echocardiogram. I tell people to look for opportunities like that because you can sometimes get the test for free or at a discount.
      Second, yes…43% is lower than normal for the LVEF. There’s often some subjectivity to that estimate, though.

      A heart rate of 54 could be very typical for an avid cyclist.

      It would be unusual for recreational exercise to CAUSE a drop in the LVEF. A visit to the cardiologist would probably be helpful to sort out if there is truly a lower-than-normal LVEF and, if so, what might it’s cause be.


      • Hamid says

        Thank you very much for your comments Larry. I had a second echo at my local hospital today to confirm the finding of low LVEF. The new echo reported my LVEF at 60% which I am being told it is normal. Not sure what caused the low LVEF at 43% in the first scan? Have you seen such a variable results in LVEF within just a couple of weeks? How can I be sure that the echo results are accurate as both scans were performed by highly experienced registered cardiac sonographers?

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  111. MGW says

    My daughter is 23 and a long distance college runner. She suffers from Dysautonomia, small VSD, and slight mitral valve prolapse. This track season she has had 3 episodes of syncope during races. The last was the worst – in and out of consciousness for 40 minutes. After 20 minutes her heart rate was 160 and BP was 103/65. While in the ambulance she was given 2 bags of fluids and her BP dropped to 80/30. Her EKG in the ambulance showed left ventricular hyperophy. Once at the ER they ran blood work and was found to be severely dehydrated, even though she pre-hydrated for weeks and all during the race. Her diagnosis was acute renal failure and rhabdo. After 5 bags of fluid, and anti-nausea meds for vomitting she was released and told to followup with her GP. The next day she came down with her 5th case of Shingles. That was 4 weeks ago. Since then she has suffered from extreme fatigue and shortness of breath. She is used to running 90+ miles/week but has only ran 8 miles (2 trips) since the marathon.. Her GP ordered an echo yesterday and we have yet to hear the results; however, the tech did mention that her resting heart rate was never over 44 and that her mitral valve prolapse seemed more pronounced. Her GP is concerned about cardiomyopathy. She sees an eletrophysiologist on a regular basis and her EKG’s always show right bundle branch block.

    My questions: could this be cardiomyopathy? we have never caught her resting heart rate that low, could she have suffered heart damage? what should our next step be?

    thank you

  112. Bledi says

    Hi Dr. Larry! i have mitral valve prolaps. when i go to my doc and he make me an EKG and Echo and say that my heart structure is good and i have MVP sometime with MR. i say to him that i go to the GYM and training with weights. and he say thats ok your condition needs exercise. and exercise is good theraphy for MVP. i did and stress test and say excellent. my question is. why when i start workout my heart work to fast and i dont feel any pain just a little bit tired. my HR in rest is 50-60 BPM. should i workout without worry? and what i should know for my condition.
    thank you and God bless you

    • Larry Creswell, MD says

      According to the guidelines from the 36th Bethesda Conference, athletes with MVP but without significant mitral regurgitation can participate fully in their sports.

  113. Alex says

    Hello dr. Larry! So I’m 26 y old, playing american football now for 7 years. The thing is that I have resting heart rate through the day arround 55 and before bed 48-50. I’ve had a stress test with EKG and ultrasound of my heart. During my stress test I’ve reached a point where I was so exhausted (dizzines for about 1 min). Doctors opinion is that my heart is normal (ekg + ultrasound) but I don’t have proper fitness level. It doesn’t make sense! Having low heart rate but not in proper fitness level + heart is normal.

    My thoughts arround this: from August 2014 to February 2015 I’ve had really intense offseason (every day 2h of intense training in gym and field) then from March till June we’ve had season and I didn’t train, only played games and my fitness level dropped. Is it possible that low heart rate is still here from last years offseason?


    • Larry Creswell, MD says

      A low HR that is due to conditioning can take a long time to increase, even with complete cessation of exercise. Often, a low HR can be maintained by levels of exercise that are not extreme.

  114. Mary says

    I’m a 25 yr old female and I just moved from sea level to 7,000+ ft and have always been athletic. Before moving up to sea level I was running four miles a day almost, however, now it’s more like 1.5. Aside from the difficulty to adjusting to exercise at this altitude my new dr in town told me when listening to my heart that she heard a split sound. At first she thought it was just because my chest cavity wall is so thin, but now she’s wondering if this is something else and is recommending test just incase it causes me problems 25 years from now. I’ve been told in the past by my “sea-level” dr’s (whom I see yearly) that I have an athlete’s heart, and hardly have periods of inactive exercise. I do on occasion feel heart flutters, but never during exercise or enough to make me feel faint or dizzy. I’d assume it’s just from anxiety.

    Should I take her seriously? Is it possible that the altitude change is causing extra sounds as well, as I’ve only lived her now for 6 months. What do you recommend with what I’ve provided?


    • Larry Creswell, MD says

      First, it’s typical to have difficulty with exercise at altitude, even for well-trained athletes. It’s not unusual to have higher heart rates (with the same level of exertion) and breathlessness related to the oxygen content in the atmosphere.

      I’d always advise listening to your doctor and following his/her advice. I’m not certain how altitude alone might account for abnormal splitting of heart sounds, but perhaps an echocardiogram (ultrasound test of the heart) could be an easy way to evaluate the issue.

  115. Mary in Cleveland says

    Hi Dr. Larry,

    My boyfriend is 63 years old. He has a physical job (electrician) and is athletic. Last year and back through end of 2013, he was slowing down, being more tired, just felt like sitting around reading in his spare time. He thought he was just getting old. He’s been an avid soccer player his entire life but was not playing as much (thank God or he’d be dead I’m sure). In April of 2014, after “indigestion” problems were found to be blocked arteries (the widow maker arteries were blocked; stents were not going to work), he had quadruple by-pass surgery. Thankfully, he did not have a heart attack. Cardiologist says he has a strong heart. At 5′ 10″, prior to surgery he weighed 165#; he is 150# or less now. We are eating a near vegan diet (thank you “Forks Over Knives”).

    His recovery went well; he seems to be doing great. He’s been working since last September. Now that the weather is good he is playing soccer 2 times/week. He also bought a bike last year and rides 20 some miles at least 3 days/week (sometimes more and more often; he pushes himself). His heart rate was in the low 50s the day before his heart surgery and it runs low now.

    The other day, he’d been working extra hard and doing a lot of things and it was hot so he was tired, which is normal. He wanted to sleep way more than usual which kind of bothered me. Once he was up and sitting in a chair reading, I checked his pulse and BP. Pulse was 48 and BP was 95 over 60 some (I think). Shortly, his pulse went up to 51 and the BP went up a little too. After eating he felt better. I did not recheck any vitals at that point.

    The only meds he is on are Aspirin and 60mg of Pravastatin. Post surgery he was on 12.5mg Metoprolol daily but, even though it is a teeny dose, it (in my opinion) made his heart rate too slow, so MD cancelled it quite some time ago.

    My question is, how low of a heart rate is too low for someone like him, i.e. athletic, over 60, and 15 months post CABG surgery? I think it’s too low. When should I get concerned? What do you think?

    Thanks for your insight,

    • Larry Creswell, MD says

      We consider 60 – 100 beats per minute to be “normal.”

      Heart rates not too much slower than 60 can be acceptable so long as there are no symptoms or difficulties because of the slow heart rate.

      Older individuals can sometimes have difficulty with the heart rate being low generally….and VERY low at some times. Sometimes, these people need a permanent pacemaker to take over if the heart rate falls too low.

      Many athletic individuals, including older individuals, continue to exercise without difficulty with relatively low heart rates.

  116. Jim HOurihan says

    Dear Doc,
    I am a 51 year old, at 5′ 10″ ,160 lbs, who was diagnosed with 1st degree heart block 2 years ago. I recently completed my 2nd Ironman. Is there any risk in continuing endurance sports such as triathlons, marathons, swimming and trail runs? I would like to do another ironman in the future. I would like to try to qualify in my age group 50-55 for Kona.
    Am I risking heart damage over time? My primary care physician epressed concern that I could suffer down the road as I age. Any advice and insight would be appreciated.

    • Larry Creswell, MD says

      Very often, first degree heart block has little significance and shouldn’t prevent an athlete from participating in his/her sport.

      Consultation with a cardiologist–or a cardiologist who specializes in electrophysiology–can be helpful to make certain there are no other (electrical) issues that need to be considered.

  117. MGW says

    My 23 year old daughter has been a competitive distance runner for several years, until recently. In late May, she collapsed at the 25.5 mile marker of a marathon. Since then she has struggled to even run more than 5 miles at a time.
    She had an ECH which revealed preserved left ventricular function, slight mitral valve regurgitation and minimal tricuspid insufficiency.
    Lately, she has noticed that her resting heart rate is quite high, 90+. Her recovery HR is very slow and she has even caught her HR rising after finishing a 3-4 mile run.

    What is going on?

  118. Scott says

    I am a 40 y/o cyclist and I spend maybe 6-8 hours a week mountain biking and cycling. I race here an there but not often and I’m accustom to riding hard with a fast group at the Cat 1 level and have been doing so for about 5 years.. My preference is MTB on a single speed bike and I know my HR prob spikes more that typical riders of MTB’s as SSing could be considered more demanding. This year I haven’t raced at all but I’m one of those athletes that 80% of the time I ride, I ride hard. I just love competition and being in great shape.

    With all of that said, this weekend while relaxing in a chair I experience something I’ve never experienced before (syncope or bradycardia). I passed out and was out for a good 15-20 seconds I’m told. I fell over, hit my head and was taken away by ambulance (head was fine) . The cardiologist’s diagnosis was syncope / bradycardia btw. My resting HR is in the mid 40’s and they suspect that somehow my HR dropped and it was lights out for me.

    So now I’m puzzled. I’m hopefully getting an ECG or EKG asap to learn more about my heart. I guess my initial question is, I’ve only been riding a bike for 5 years or so. Is it possible that my heart has undergone changes? I’ve also been under the weather with gastro stuff for a month but prior to this incident but I’ve been feeling good for about a week. Just looking for a variety of thoughts on this so I can ultimately figure out what might be going on. Obviously I’ll be going to the docs soon but you know how it goes… it will likely be a long time until I am figured out. Any thoughts?

    • Larry Creswell, MD says

      Syncope can be due to a heart problem. Sometimes this can be serious. Careful evaluation can sort out this possibility.

      More often, though, syncope is due to one of many non-cardiac causes. It can sometimes be difficult to identify a cause.

      Yes, the heart will have various adaptations after several years of cycling.

  119. Richard Witt says

    Hi doc! First let me start by saying thank you for explaining everything so thoroughly. I have recently lost 70lbs and now I’m in the gym for 2 n a half hours 5 days a week. I do cardio twice during that span for over 30 minutes combined then lift and do abs the rest of the time. My resting heart rate is 50 and regurly dips to 45 when I’m super relaxed. I’m healthier than I’ve ever been but 2 days ago my hear fluttered n missed beats for a bit. I feel better now but still scared me. Sound like athletes heart? And how long does the feeling take to subside?

    • Larry Creswell, MD says

      Palpitations can be scary. Even if this is only an occasional proble, it’s probably best to mention to the doctor at the next visit.

  120. Joy melendez says

    My 16 year old daughter just had a routine physical because she takes Sertraline and buspoirine for anxiety and her dr wanted an ekg done. Her ekg was abnormal. 1 sinus bradycardia
    2 incomplete right bundle branch block
    3 st-the changes in the septal lead
    She plays club soccer and trains 4 days a week and plays 2- 90 min games a week. She is very fit, cardio appt isn’t for a month, should I be concerned? She is still training hard and it makes me nervous.

    • Larry Creswell, MD says

      Thanks for sharing your daughter’s story.

      From afar, I’m not in a position to offer advice here. I just don’t have enough information at hand.

      If you’re concerned about the situation, I’d suggest that you meet with your daughter and her doctors to discuss the findings and make certain that you understand if there is sent risk of activity.

  121. Matt says

    First, I just wanted to say thank you for this website. My doctor today during a physical noticed a murmur and have and Echo set for next Monday; I was worried upon hearing this and unfortunately my physician was very short and did not explain much. I have been feeling great and working out 6+ days of the week increasing my cardio on the treadmill and elliptical so I was surprised to hear this so this site eases my fear going into the test.

    I love working out and relieves much stress so hopefully I do not have to scale back, it is comforting to know others out there that are physically active encounter these same issues. Seems ironic that those that are so active have fears about their heart condition, hopefully I will get some clarity coming up. Cheers!

  122. Steve From Australia says

    Hey Doc, I just stumpled across this whilst searching Bradycardia on Google.

    Sorry for the long rundown but i’m just trying to fill you in as specifically and as accurately as I can without dragging it on to long.

    I am a 42yo Australian Male White, 5.10 in height, weight fluctuates between 98 & 102kg, Very Stocky Build, just a little chubby around the belly (slight pot to some), I’ve Never Smoked, I Very Rarely drink Alchohol (Can’t even remember the last time I did) I eat reasonably healthy, My Daily Fluid intake would consist of about Filtered water 90% of the time, about 8% juices Such as Organic Apple & Orange juice, 2% the odd can of coke or sugary drink, or a Flavoured milkshake, thick shake when i’m out with my kid’s etc etc.

    I used to go to he Gym regularly when I was younger and then had a long time layoff (10+yrs)….I eventually started again and have been going to the Gym now for about 2-3yrs, Most of the time I go about 3-4 days a week, and sometimes maybe 1-2 days a week depending on time, i’m not obsessed with it or a fitness freak or anything like that, I just go for a little physical exercise and stuff, Now, I don’t do a great deal of cardio at the Gym or ride bikes etc just mainly lifting moderate weight’s and sometime’s slightly Heavy.

    I’ve never been on any medication’s or anything, and I’ve never used Steroids or anything when younger etc, BUT occasionally I get some shock type feeling’s in my heart which I have had for quite some time. At a guess I would be estimating around 12 months, possibly longer that I’ve really takin notice. Sometimes I get them whilst sleeping which will wake me, then my heart with be racing but i’ll drift off to sleep again, I Told my Dr about this a few time’s and then he referred me to have a Sleep test.

    My results from that were that I had mid range sleep apnea, So I was referred to an ENT specialist and ended up having an operation about 3wks ago Which was a Septoplasty & Turbinectomy. After the operation my blood pressure was extremely high so much so they were going to give me something to open up my arteries, but it slowly settled down and they ended up keeping me overnight and discharged the following day.

    I slowly started to get on the mend but started having some bad dizziness to the point of stumbling a little, as in for example from lounge room to toilet in my home say, I was also having headaches in the back of my head, cold feet & hands and a bit of a pain in my side, So I called a home Dr and after an examination he said for some reason my blood pressure was high and heart rate low, So he called ambulance for me and I ended up in hospital again, Once there they took my blood, and done a lung xray just to checked I didn’t have a lung issue for the pain in my side etc. The Dr at the Hospital also told me my blood pressure is pretty high and my heart rate is very low, By saying low I mean it’s not uncommon for it to be below 50bpm, So they kept me overnight and released me the next day with a letter to follow up with my GP.

    I then Went to GP and he ordered I have 24hr blood pressure monitoring to take home, which I completed, and after he got the result’s from that now want’s to undergo further test’s as my blood pressure is still high’ish, and my pulse is still low, He has also referred me to see a Cardiologist who I have to see next week, Reason I started Googling and found this page is I noticed on the referral note he has given me, it is mentioned I have Mild Hypertension & Bradycardia, I have since bought a good quality blood pressure monitoring device for home, and have noticed my blood pressure is up still (160-170 over 80-90, & 46bpm), and have seen my pulse go as low as about 42bpm, I am still having the noticeable stumbling episode’s every now and again.

    My Dr asked did I want a mild blood pressure medication and I said I would rather wait and see what the Cardiologist has to say as I don’t like taking pill’s etc, I would rather something natural if possible to lower blood pressure…

    My main Question is, and again I apologise for taking so long to get to the point, BUT I Am No Athlete, I don’t play sport’s, I don’t cycle, or Play Tennis, Football etc etc, I don’t do half the things half the guy’s above have posted, At a guess I could probably jog for like 3-5mins top’s before I would have to stop for a rest, Would it be possibly from the amount of Gym I am doing I could have Athlete’s Heart ? Or could I have something more serious ?

    Just has me a bit on edge and concerned at the moment, as I’ve read that with Bradycardia a pacemaker is pretty much the only remedy for cure, and I don’t really want to have to have a pacemaker or anything like that.

    Is there any other natural way of boosting my heart rate via diet or more or less exercise, or am I having wishful thinking ??

    Hope to hear from you soon.


    • Larry Creswell, MD says

      By now, you’ve visited with the cardiologist. Perhaps all of your questions have been answered.

      Any update that might help the readers here?

      • Steve From Australia says

        Hi Doc,

        I went to the cardiologist, he checked and said my blood pressure is high but pulse is low, I think it was 54bpm and he asked me some question’s and ordered me to get a blood test I think to check for thyroid etc, I go back this coming Wednesday to find out results…

        He also wants me to do 24hr blood pressure monitoring and I think a heart stress test, I am not to sure if that will be on this visit or not I will have to keep you posted…


  123. kirsty boyce says


    My daughter who is nearly 12 is a keen swimmer and trains 8 hours a week as well as fitting in competitions. She has recently had chest pains and had an ECG and they said her heart rate was on the abnormal side as it was lower than a normal child’s resting heart rate. Is this due to her having a higher fitness level or should I be worried?

    Many thanks,


    • Larry Creswell, MD says


      Not sure what to make from this situation from afar.

      Best to review the ECG findings with your daughter’s doctor….and either put your mind at ease or settle on the need for some further investigation.


  124. Ike says

    Hey, came across you site looking up some info on heart health. I was diagnosed with a mild MR back in high school and after seeing a cardiologist to sign off that my condition wasn’t too serious I never really thought much of it again. I recently purchased a Fitbit and found that I have a resting heart rate of about 45-48 BPM. I’ve always been highly active and in good physical condition and I’m also pretty young. So if I am understanding your feedback to other questions correctly, my murmur may be a result of all the physical activity and my low BPM is indication of this? Thanks in advance

    • Larry Creswell, MD says

      Yes, there are “innocent” murmurs that merely reflect normal blood flow through the heart. And yes, a low heart rate can be the result of exercise.

  125. Christopher anzures says


    I’m 27. Run an Mma gym. I work or about 2 to 3 hours a day very high intensity preparing for competitions. I am having some wierd blood pressure readings so I went to the doc. She believes it to be anxiety and sleep apnea…but then we did an ekg. Well it was abnormal. She said I def have an enlarged heart…but that there was something indicating a possible abnormality in flow. When she pointed it in the ekg. It was a small peak in between the two big peaks that she explained indicated an enlarged heart. So she reccomend es an echo. I said well what does this truly mean. Best and worst case. She said worst case this could indicate you are at risk of heart attack and you will be told to never exercise strenuously again…best case it’s normal. Well….seeing as how martial arts are my life and I am only 27….I AM In SHOCK. Am I over thinking or over exaggerating? Should I be concerned?

    • Larry Creswell, MD says

      An echocardiogram is often useful for evaluating the structure of the heart to help explain some types of ECG abnormalities.

      Perhaps the best course is to gather all of the info before worrying about the what-if’s.

  126. Jack says

    Hello, great article. I’m a 55 yr old male who has recently begun aerobic exercise after many years of being sedentary. I’ve been doing about 200 minutes weekly of treadmill running with a heart rate monitor, for the most part keeping my heart rate under 132 BPM in order to maximize aerobic adaptations. I feel like I’m making progress, (slowly) and after 10 weeks, my resting heart rate has decreased from its initial 62 bpm to about 55 bpm. My 2 minute recovery heart rate, originally about 36 bpm, now is 49 bpm. I feel like I’m making progress. Here’s my concern. A few weeks ago, I decided to go all out and run a mile. I ran it at a 10min/mi rate, and my heart rate slowly climbed, reaching maximum near the end. Later when looking at the heart rate graph, I noticed a trough, 29 seconds near the very end of my run in which the heart rate dropped 6 points, (to 155 ppm) and stayed there, for a full 29 second, before jumping back up 6 ppm for a few seconds, at which point I ended my run. I noticed nothing unusual on that run, except that of course I was exhausted near the end. I showed a few people the graph, a few athletes, and they think the trough is simply an artifact. Thing is, although I’ve had complete drop outs before (which ended after a battery change) I’ve never seen a trough like this. Also, the graph doesn’t drop immediately to 155, as there is one second of an intermediate rate going into the trough, (157BPM,) and a two seconds of intermediate beats again on the way back up, 29 seconds later. The heart monitor is making recoding measurements every one second. I’ve examined the RAW FIT file that the Garmin monitor produces . It especially concerns me since the trough occurs near the maximum heart rate. Prior to this run, I’ve gotten my heart rate as high as 156,(on what seemed like less than maximal efforts) but never as high as on this run. I have no known heart disease. The battery in the monitor was brand new. Thanks in advance! You can take a look at the data here:

    • Larry Creswell, MD says

      Not sure what to make of this. Wasn’t able to access the data file. As you’ve mentioned, artifact is a possibility. It’s unusual to be bothered by an arrhythmia that has a lower HR than your exertional HR.

          • Jack says

            It’s only happened the one time. I’ve only had my heart rate over 150 bpm maybe six or seven times, and over 160 ppm twice, including the time in question. I’m using a chest band sensor together with a Garmin watch. I know the problem is not with the watch itself, because the sensor in the chest band stores data in its memory, and I downloaded the data separately to my iPhone to see if the trough is visible that way. Data has the same trough. The chest sensor itself could be creating an artifact I possibly. You can see the entire file here:
            It’s much longer duration, because the chest sensor was recording all the way on the drive to the track, as well as for a one mile walk I did prior to the run. You can also see the data after the run concluded, as I walked back to my car. The trough is at the 43 minute mark.

          • Larry Creswell, MD says

            Thanks for sharing the (larger) data file.

            Perhaps others can chime in with experiences with HR monitor artifact.

  127. Nathaniel says

    I’ve recently become an owner of a fitness watch that keeps track of the wearers heart rate. I’ve read your article and looking at the readings on my watch it would seem that I would have an athletes heart, but I am far from ‘well trained’ and the only exercise I really do is jam roller skating. I’m not sure if I should be worried that my regular BPM is around 55. Oh and it might be worth mentioning that large blood veins is common in my family. Is it possible to have ‘athletes heart’ without being a real ‘athleet’?

    • Larry Creswell, MD says

      It probably takes a moderate amount of exercise over a long time period to develop the changes associated with athlete’s heart.

  128. Thomas says

    Hello Doctor, i´m from brazil, and i´m a long distance runner, in the last 3 years i have consulting with a doctor about arrhythmia, but in this year he told me that the number of my TVNS is getting higher, so he advised to me a deconditioning. But the point is, he want that i stop with any physical activity, for 3-6 mounths, and i would know if i could do that, but no stop with all, so what i can or can´t do in this period.


  129. AT says


    Your information on athletes heart is great! Thank you!

    I’m 45 and have always been active and I feel great! I went in for a simple physical and found I have an enlarged heart. No other symptoms. BP is good. HR is high forties low fifties. I swim for simple workouts and did a lot of Brazilian jiu jitsu and lots of heavy weight training. Lots of walking and occasional hiking. According to the test results (echo and a CT scan), heart’s function is fine, no blockage, no calcium build up. Not exactly sure on the EF, but doc said it was fine.

    Since my dad died of a massive heart attack at 59, the doctors are rightfully concerned and have said my enlarged heart is hereditary. At autopsy, my dads heart was enlarged to 470 grams. My cardiologist put me in 5 mg of liprinisol (I’m sure it’s spelled wrong. It’s the ace inhibitors.).

    I don’t know what my take on this should be.

    What are your thoughts on this?

    Thank you!

    • Larry Creswell, MD says

      There are many causes of an “enlarged heart.” You point out several good things….good BP, normal heart function, no coronary artery blockages, no calcium build up. The echocardiogram is usually very useful for identifying the common inherited forms of cardiomyopathy (eg, hypertrophic cardiomyopathy [HCM]).

      It’s always wise to get advice from your doctor about safety of exercise.

      • AT says

        My echo results showed my left ventricle was enlarged to 7.2 cm, but all other chambers were normal. My EF is 55%. Again, I’m very active and have no symptoms at all. Do you think these two numbers can improve?

  130. AB from AK says

    Hi I would like to thank you for your blog. I am a 41 year old female and have been training 8-12 hours a week for past 10 years mostly triathlon. I’ve had a murmur since I was a child, and recently had an echo to check up on it. I have trivial aortic insufficiency, trace mitral regurgitation, trace to mild pulmonary insufficiency, trace tricuspid regurgitation and mild LA enlargement. I am seeking a sports cardiologist but the PA said I am going to have to moderate my training. He really couldn’t qualify that – he said only 1/2 marathons probably. I love to simply train and am willing to give up most racing if necessary…. My question is this: is it the intensity of the training that is dangerous for me or the volume/duration. I would like to do long mountain bike rides (don’t have to race long) and short races as I just got a new full suspension bike for Christmas but I am in this for health/longetivity. I train mostly using Maffetone method which is 130-140 hr for me. Thank you for your time.

    • Larry Creswell, MD says

      Exercise can be safe for many individuals who have only trivial or mild valvular heart disease.

      Like you mention, perhaps it’s best to get an opinion from a cardiologist who can take everything into consideration.

  131. LAL says

    I am an fairly unfit (30 lbs overweight) 43-year old woman with no related health issues. I don’t work out. I am not anything resembling an athlete. My resting heart rate is 43 bpm a minute, and has been in the low to mid-40s for many years now. I’ve had three EKGs, and have been told by my doctor that I have asymptomatic bradycardia.

    How could my bradycardia be nothing to worry about when it clearly isn’t a result of regular, strenuous physical activity? Should I expect it to turn from asymptomatic to symptomatic at some point?

    • Larry Creswell, MD says

      We usually reserve pacemakers for patients who have SYMPTOMATIC bradycardia.

      Yes, some asymptomatic patients will eventually become symptomatic.

  132. TJ says

    Hi Dr. Creswell, thank you for this site. I’m a 38 year old endurance athlete, I have been running ultra trail marathons ( 50 -100 mile races) with a few 26.2 road marathons sprinkled in, for the past 6 years. I just went to have a checkup, first checkup in 20 years, he said I have a murmur, wants me to see a cardiologist just to check it out. I was not aware I had a murmur, I have extremely low resting heart rate about 40-45, so am assuming I’m have athletes heart. What wold the treatment be for a murmur? Is it sage to continue running races? Can a person die from athletes heart? Are those the cases where people die after a race? OR am I good to keep running? Any long term affects from athletes heart? Is it better to cycle off and back on to endurance races? Do most ultra runners have this condition and not know it? Thank you!


    • Larry Creswell, MD says

      There are many causes of heart murmurs. When we can hear blood flow in the heart with a stethoscope, we call it a murmur.

      In athletes, sometimes just increased blood flow through a healthy heart may produce a murmur.

      Other causes of a murmur are due to leaky or narrowed heart valves or abnormal holes between the chambers of the heart.

      Perhaps your cardiologist will be able to sort things out by physical exam alone. If not, we often use ultrasound (echocardiogram) to look for problems that produce a murmur.

      Any treatment and any recommendations regarding safe levels of exercise would depend on the cause.

  133. Adam says

    I am an active (non-competitive) swimmer, runner, hiker. I have an enlarged left ventricle with a lower, normal range EF of 55%. I have no symptoms and feel great. Can the heart go down in size and can the EF number improve? My resting heart rate is approx 40-44.

    • Larry Creswell, MD says

      Yes, with reduced or no training, the left ventricle size and wall thickness may decrease.

      EF of 55% is normal. No reason to hope for more.

      Low resting heart rate is usually a healthy adaptation to exercise.

  134. Morgan says

    Hello Dr.
    Thanks so much for the blog.”
    I am a semi Elite marathoner and ultra marathoner.In 2010 I went into afib after a hard training run.In the ER they wanted to cardio vert me I chose not to and waited it out it went away by the next morning.More recently I went into afib again I was cardio verted after about 4 hours in afib after meds only got me to a flutter.I have been training hard ever since with no reoccurrence of afib.After I was released my doctor scheduled me for a Eco in which the results revealed thickening and stiffening of my heart wall.Also weakening whatever that means.My cardiologist said I had excessive athletes heart and said the measurement was 1.22 and normal was below 1.1.I asked about HCM he said he did not think I had it because the thickening was not really in the area for HCM.He recommended that I exercise no more than an hour each day and he would see me again in eight months.Running is a huge part of my life and I am in the best shape of my life.He told me no more marathons or even half marathons but I could race the one I have trained for which I am running tomorrow I’m so confused he said have fun!I thought he would be more up on recent studies of AHS being that he was a 2:30 marathoner in his day and is a top recommended cardiologist in my area.I would appreciate any suggestions and advise in comments thanks for your knowledge and wisdom.
    Sincerely a confused runner with what I hope is just AHS.

  135. B says

    Thank you so much for this blog. I’m 34 years old. A mom of 2 and a teacher. Was big into cardio fitness. 1h20-2h a day running, stair climbing, elliptical, etc). In September 2015 I started having chest pain (dull sternum area and sharp in left rib area). After a month it started to get worse (left rib area) when I would lie prone. Sitting up would definitely ease the pain. Finally went to ER. They said slight ST elevation…probably pericarditis. It wasn’t. A couple more ECG’s showed slight ST elevation. ECG’s in January and Feb have been normal with no ST elevation. 2Stress tests normal. Cardiac MRI with and without contrast showed mildly enlarged heart (symmetrical…2 echos did not pick this up), mildly to moderately enlarged left atrium and LV EF of 55%. No signs of pericardial disease, no wall thinning or wall motion, etc. The 2 Echos I had showed all normal except for “trivial tricuspid regurgitation”
    My first Holter in Nov 2015 was normal. Resting HR 58-60. One Ectopic beat. Down to 44 at one point at night. The second Holter done in Feb 2016 showed 27 supra ventricular ectopics and 7 ventricular ectopics…an episode of 42 BPM mid afternoon and in 50’s during sleep.
    I was told I have an athletic heart and that my pain is musculoskeletal. I don’t buy this as I continue to have chest pain and PVC’s.

    I continue to have the mid sternum dull constant pain. With occasional intense pain in the same area just off to the right. Sometimes the odd sharp pain in the ribs below the left breast. I get light headed sometimes going sitting to standing.

    The palpitations are getting out of control. Big strong beat that leaves me breathless for that second. Feeling them more at night lying down but also throughout the day.

    I stopped exercising Sept 24 2015 and have don’t anything but slow walking only a couple times since then.

    BP runs low 100/79-98/65….

    Any thoughts on the ST elevation/early benign depolarization and is disappearing? Can deconditioning cause this?
    Any thoughts on the MRI? Does this sound like Althetes heart?

    • Larry Creswell, MD says

      This story is obviously complicated. Best to have a detailed discussion with your doctor to get your questions answered.

  136. Lisa C. says


    I am a 47-year-old female runner, and I just completed a major (for me) endurance event in January (called Dopey at Walt Disney World–I did a 5K, a 10K, a half marathon, and a full marathon in 4 consecutive days). I started running two years ago after a couple of decades of not doing any athletic training, but I was an Olympic hopeful in Tae Kwon Do in my teens and early 20s, so I did a LOT of very hard training back then.

    I have a very low resting heart rate (mid 40s), and I have no idea what my maximum heart rate is, but I sometimes get up to over 200 during speed training with no symptoms at all, and my heart rate recovery is very quick.

    What I am concerned about now is that I will sometimes have a fluttering feeling in my chest with a fast heart rate for just a few seconds (maybe 5 seconds or so), but no dizziness or any other symptoms. It happened once yesterday and once today. I am just aware of it and I tend to be an anxious person.

    I felt palpitations about 5 years ago and my doctor sent me to a cardiologist who did a stress test and gave me an event monitor for a couple of weeks, and they did not find anything and attributed it to anxiety. This was before I started running.

    Do you think that these flutters are just related to common changes in athletes, or do you think that I could have suddenly developed a horrible heart condition despite not really having any risk factors for heart disease? I don’t want to go through a bunch of unnecessary tests (especially since my health insurance is only a catastrophic plan), but I don’t want to drop dead either. Would I be experiencing symptoms during running if something was wrong (because I have never felt anything wrong during exercise), or could these flutters mean that I have developed a new condition and somehow damaged my heart?

    Any advice or reassurance you could give me would be appreciated!

    • Larry Creswell, MD says

      Lisa asks about palpitations–the subjective sensation that one’s heart is racing or has skipped a beat.

      Palpitations deserve evaluation because they may be due to some sort of arrhythmia. Typical evaluation might include an EKG and/or a Holter monitor (a longer recording of the EKG, perhaps over 24-48 hours).

      • Liam says

        Hi Dr Larry,

        I appreciate your blog massively! There’s such a grey area in hcm and cardiomyopathies and whether its enlarged for a good reason or bad. I will try to make it short and simple for you. I had skipped beats in 2014, I was 19 years old. Never felt them before so I had an echocardiogram done – revealed nothing , a 48hr holter monitor – revealed a few PACs/PVCs what have you, And then a stress test Bruce protocol, lasted 12 minutes before I abruptly ended it due to what felt like a skipped beat. I am worried a lot about HCM, due to these grey areas in ecgs and echo’s. My main question is – would one of expected to see hypertrophy by age 19? And what’s the likely hood of developing it between now and then, 22 years of age? Any help, Larry, is much appreciated. Thank you, from the UK

        • Larry Creswell, MD says


          Good questions. Apologies for a slow reply. Interestingly, I’m on a plane now returning from a short visit to the UK.

          Ordinarily HCM becomes manifest by age 19 or 22–either because hypertrophy is discovered or because of an arrhythmic event. Also, some cases of HCM become known because of a family history.

  137. Mike says

    I’m a 50 year old male who played basketball in high school and have lifted weights 3 -4 times per week and performed light to moderate cardio two times per week ever since. I feel like I’m in the best shape of my life. At my last physical the doctor found a murmur and refered me to a cardiologist. The EKG was normal but he was still concerned about the murmur and wants an ECG. I have no dizzy spells, swollen ankles and have never been short of breath. He wasn’t at all reassuring and truth be told I wasn’t impressed with his demeanor. Could this be at athletes heart? I’m kind of freaking out a bit.


    • Larry Creswell, MD says

      Your cardiologist will be in a good position to know if you have features of the athlete’s heart syndrome. This would be a good question to ask.

      New heart murmurs deserve evaluation. As you’ve pointed out, this would include physical exam and might also include additional testing such as ECG or echocardiogram.

  138. Angie says

    Hi – I’m a 39 year old OCR runner. I’ve been having skipped beats when exercising – happens only when heart beat is raised high and then I stop to rest and heart beat starts to slow down – that’s when it kicks in. Misses every 3rd beat or so until my Heart rate has slowed down a bit.

    A 24 hour ECG has shown few episodes of 2nd Degree AV Block (mobitz 1) when exercising (as felt and described by me) and 1 episode of 2nd degree AV Block (wenchebac) in the evening. I’ve been referred to a cardiologist but its a 3 month wait.

    My main worry is should I still be exercising? I was training 8-9 times a week 45 minutes to 1 hour HIIT and weight training classes plus running 15 miles obstacle course races most weekends. I’ve now had to pull out of races as too worried but 3 months with no exercise is a long time if I don’t need to stop. I took 3 weeks out completely but have now gone back 2 – 3 times a week – its still happening though.

    My Dr doesn’t know if its ok for me to exercise or not – can you advise?

    And does this sound like athletes heart or some thing else? Should I be concerned?

    Thank you

  139. Johnny says

    Doctor please help. This sounds like a cliche but I feel like I’m going out of my mind. Ive had every test going including Holter on numerous occasions, for 24hrs, 48hrs, 1 week and two weeks, x-Ray’s, Ultrasound, stress tests x3, I’ve also seen two cardiologists over the last two years. I’ve trained hard 5 times a week with weights, run and biked since I was 17 years old I’m now 46. I also work two jobs to pay the bills. 2 years ago I started experiencing missed beats in the gym during my warm up. I put these down to getting older. Then while driving at work my heart which usually chugs along at about 43bpm suddenly dropped to about 15/20 bpm for about 8-10 seconds. This resulted in me going into extreme panic followed by shock and my colleagues taking me to Hospital. BTW I’m a police officer with twenty years in the job, not easily flustered or shocked! This has happened on several occasions since. All the tests including blood etc always come back normal. I have been kept overnight in hospital on a few occasions as my heart rate has dropped to about 33bpm while in bed. I have also been advised I have type 1 heartblock and bradycardia with wenkebach. The only thing that slightly complicates matters is I have alpha 1 anti trypsin deficiency and my liver gamma level is about 200, although my lungs are perfect and have just been identified as having the condition. Needless to say although I have had palpitations and the odd missed beat while wearing holters etc I’ve never had the scarily low heart rate. My last cardiologist has discharged me advising “it’s probably a series of ectopic beats” and “unlikely to be life threatening” he also advised I purchase the Alivecor monitor to record the beats if possible. I have bought the Alivecor and carry it everywhere but by the time get it out they have passed. When it happens I genuinely feel like I’m dying and it scares the hell out of me. It’s as if my brain is goes into overdrive trying to get me heart going. I’ve stopped training altogether as when I do it makes me feel awful. I’ve lost all confidence in my body and feel like I’m waiting to die. My doctor thinks I need therapy and doesn’t seem convinced these episodes are even happening. In the absence of any concrete diagnosis I’ve read literally hundreds of pages on the net but no one seems to share this low heart rate symptom. BTW the slow heart has happened while out walking, driving and watching TV never while exerting myself. Sorry for the long dreary monologue, literally any help appreciated.

    • Larry Creswell, MD says

      You might discuss a longer-term (say, 30-day) event recorder, in the hopes of capturing the episodes for review.

  140. Dave O says

    I just turned 63. I’ve run for 37 years and cycled for 25 or so. For years my resting heart rate was upper 40’s to low 50’s. Over the past year or so it’s dropped further sometimes I’m as low as 40. I do tend to work out (run or bike) every day weather permitting and sometimes do both activities in a day. This year I went to a cardiologist in part due to getting older and some family history. No issues with my echo or stress test. My question is can ones heart rate get too low? Should I perhaps cut back a bit on both running and biking? Running hard I can get max rate up to 150 or more. No issues with exercise intolerance. I love cardio workouts but as we age should we back off a bit? Thanks.

    • Larry Creswell, MD says

      We worry when the heart rate is low AND produces symptoms like light-headedness….OR if the low heart rate is caused by the problem that’s known as HEART BLOCK.

      Your cardiologist will know to watch out for those issues.

  141. Herb Fox says

    So, I went in for a physical a little over a week ago and mentioned my low heart rate and what seemed to be “skipping” heartbeats. So, they did an EKG and told me that there appeared to be an electrical communication issue. They said they would pass on the strip to a cardiologist to offer an opinion. I go home and change my clothes to go and ride the bike. My history was a runner in high school and college, got away from it for a while, started running again and ran 5 or 6 marathons and 5k, 10k type races almost every weekend. Degeneration of my knees led to three knee replacements and no more running. Around 3 years ago, I got on my daughter’s hybrid bike and, since then, weather permitting (I live in Maine) I’ve increased my mileage and miss very few days. For the month of August, I had done 461 miles, hilly miles, and averaged just over 16mph, again, on a hybrid. So, back to heading out the door. Phone rings and it’s my doctor and he tells me, in a non alarming way, that I need to go to Maine Medical Center for an EKG and that he’d call to tell them I was on my way. Again, I picked up no sense of urgency and stopped to pick up a cup of coffee on the way. When I get there, they streamline me into a room, wristband, nurse telling me that things were likely to get hectic and I finally ask, “what is going on? I feel great.” I got out my cellphone and showed them my workouts from August. Anyway, they send me home after an hour or so and my wife, an RN, is kind of astounded. The next Tuesday, I”m fitted with a monitor and followup with a stress EKG two days later. While I never heard the term athletic heart syndrome, the doctor told me that as long as I was asymptomatic, I could get back on the bike. My pulse when I was a serious runner in college and later when I ran marathons was low to mid forties at rest. Does this scenario fit the pattern for athletic heart syndrome? I’m scheduled for another followup, a stress ECG in two weeks.

    • Larry Creswell, MD says

      From a patient perspective, the workings of a medical evaluation for a heart problem can sometimes seem mysterious.

      There aren’t enough (medical) details in your report for me to try to explain things better. On the bright side, it sounds like you’re being thoughtful in getting things sorted out with your doctors.

  142. Henry Miles says

    I have a quick question. I use to be a competitive swimmer and even tried to go to the Olympics, therefore my training regime was intense. I stopped training at around 25 when did not make the Olympic team for that year. Well as the years passed I gained about 100 plus pounds, of which I lost about 70 is the last 4 years or so. I am 45 at the moment and enjoy swimming and running again. My current workouts go between 4000 and 6000 yards swimming and then two running sessions of about 3 miles each plus about 3000y swimming on the same day. I have seen my heart rate go down into the mid 30’s on several occasion during the night but generally have a resting heart rate of between 50 and 60 maybe over at times

    My question is this, I swam this week and saw my heart rate went up to 215 (This went on for a very short time, probably less than a minute) I feel fine and have no after effects that I could tell. I like pushing myself, but the question is , is it normal to go that high and should I be concerned?

    All heart measurement where taken with the Apple Watch and Garmin Vivofit hr. Switch all measurements over to the Apple Watch.

    • Larry Creswell, MD says

      Short periods of a very high heart rate, where there is no other obvious explanation, may be an arrhythmia. Best to see the doctor about sorting out.

      Sometimes the various heart monitors may record an erroneously high heart rate.

  143. Rudy says

    My heart rate at rest is 48 when am ready to fall asleep at night
    I do lifting 4 days a week for the last 10 years
    I had racing heart beat few months ago and saw a doc he said that my sintercentricular sectrum was 1.2 cm.and that was too tick
    After taking medicines (concord)for 1 week decided to visit another doctor and did the same tests and said your heart is a normal heart
    If you had a problem it would have taken more than a week to disappear and he said that the 1st doc maybe did a mistake or……

    Does this make any sense ?

    Thank you

    • Larry Creswell, MD says

      I’m not sure how to sort that out from afar.

      You might just ask the doctor (either one) to reconcile the inconsistency. Perhaps there is a good explanation.

  144. Chris Sinfield says

    Thanks for the blog, really very, very interesting.
    My story is not different to many. I’m 54, cycle 150 miles a week over 5 or 6 days and walk 5 miles if unable to cycle and have done for 10+ years after a break from my mid 20’s. I’m 6 ft and 180lbs, nothing to suggest anything amiss aside these PVC’s I get.
    I was assessed from an event monitor 10 years ago and told benign PVC’s, and I’ve disregarded them until recently I began to notice them more and more and so bought an FDA approved event monitor and have found between 5 -10k multifocal PVC’s a day with an occasional run of NSVT, max 7 or 8 beats. The ECG is, as far as my untrained eye can see, classic PVC morphology though clearly I’m not a cardiologist but they match exactly traces I’ve reviewed on websites.
    My GP paid attention when I showed her the print outs and I’m lined up for a work up.
    I don’t consider my exercise schedule endurance level or excessive. I use a chest strap and while cycling and my HR is between 120 and 150 over 90 minutes or so and peaks at 190 on a hill climb (one or two per ride) with a recovery to 120 in 60 seconds and 95 in two minutes. My night time RHR is 55, daytime, 65 so not drastically low. I had a CT calcium test because my Dad died at 62 from coronary artery disease and the score was 1, which apparently is a good score for my age.
    I guess my question is really at what level can “athletes heart” develop, whether I may have it and whether these PVC’s are related ?
    Many thanks!

    • Larry Creswell, MD says

      There’s no absolute threshold for the amount of exercise needed to produce “athlete’s heart.” It’s probably different for each individual.

      You have “athlete’s heart” when you have the findings mentioned in the blog piece….regardless of how much exercise was needed.

      There are many reasons for PVC’s. Athletes may sometimes have more PVC’s than “normal.”

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