Help with enlarged heart questions

[Import]

Hi. I’m looking for some help with the following. I’m 35. I went to the doctor complaining of upper back pain and he sent me to a cardiology clinic out of due diligence. A resting echo showed left ventricular dilation – LVDD 6.3cm. Follow up MRI confirmed that all four chambers are mildly (and symmetrically) enlarged. Function is normal in all four chambers. LVEF is 60% according to the MRI. Echo said 55%. Wall thickness of whole heart is normal – LVPWT is 1.1cm. No signs of disease, infarction, inflammation or other damage. I’m 6 feet 2 inches tall and weigh 92kg. The MRI report said that the enlargement was just outside normal range normalized for my height and weight and that this would be even more so if I was an active athlete.

I have no symptoms of heart disease. No dysnpea, no ascites, no oedema and am able to exercise fine. A stress echo came back negative – I pushed out 10 mets and exceeded my maximum heart rate with no ill effect. I cycled for three hours at the weekend with my heart rate between 65 and 75% of maximum.

I have a low true resting heart rate (<60 when lying down at rest and awake) and have sometimes registered my heart rate in the 40s when at rest. This is with a heart monitor that I use when cycling, not just counting. My BP is diastolic average 70 and systolic average 135 (dropping to circa 120 when at rest for a period of time. I have prominent sinus arrhythmia with my breathing, occasional junction rhythm, occasional skipped heartbeats and occasional left bundle branch block. My skipped beats increase when I am in a state of anxiety. When I first started feeling the back pain and got told I had a dilated heart I was getting lots of them.

Aside from the anxiety-related increase in skipped beats, from what I’ve read, those cardiac symptoms mentioned above are not uncommon in an athletic heart and nor is enlargement.

Now, I am by no means a professional athlete. I have never done a marathon, nor a triathlon and could only dream of an ironman, but I have been active in sports and exercise sustained over the years. Mixed martial arts, 4 times a week until about a year ago, heavy weightlifting until about 4 or 5 months ago and cycling both two and from work and also sustained distances at weekends.

I guess I’m interested to know how much exercise one needs to do to get an athletic heart and if indeed I may have one? Could I naturally have a big heart due to my size and weight which has gotten that little bit bigger due to sustained exercise over the years? The Dr reviewing the MRI certainly seemed to think it looked a bit like an athletic heart syndrome. If so, is this dangerous?

The clinic that referred me for the MRI dismissed it on the basis my heart rate was not low enough when I came to see them. It was 60bpm at the time and I felt a little anxious. So they put me on 5mg ramipril.

[justworks]

Sounds more like it mate. If they did a cardiac MRI, it'd have picked up any underlying disease/cardiomyopathy/myocardial injury then and there. You have had all possible tests and everything came back negative. So relax !
And by the way you do double the exercise I do in a month on a weekly basis, which means you might be bit of an amateur athlete at heart. But since in Australia more people lead an active life style, so you just dont realize how good you are doing compared to morbidly obese Britain for that matter.

[skel00]

Hey Import, you are going through almost exactly what I am going through. 6'6", 125kg and 6 months ago my heart was normal now its 6.8 LVD, I'm getting skipped beats and have been put on ramipril 5mg in an attempt to remodel it.

I've spoken to three different cardiologists in Spain, the UK and the USA now to try and get an understanding of why its happened. Like you, perfect function and no signs of disease.

The UK guy was concerned a large heart can weaken over time and lead to problems, ie early stage cardiomyopathy he put me on rampiril. The US guy wasn't convinced I have a problem as many athletes have large hearts and mine looks healthy, he didn't think ramipril would help. The Spanish guy was also less concerned and didn't opt for ramipril. All three are at the top of their game running cardiac units at their respective top private hospitals.

Its all very confusing, I am concerned about going back to swimming, basketball and boxing, my three sports I use for fitness only as I have read the horror stories about athletes dropping dead during exercise but at the same time I don't want to the muscle to weaken.

I'll keep you up to date with my progress. Right now I've been told zero alcohol, take multivitamins, rampiril wont hurt and back in 6 months to check the progress.

[Import]

Hi mate.

Yes certainly sounds similar. I hve been to see two cardiologists. One back in June, when they first found the enlargement. He seemed to think, mainly because of the palpitations, that it might be a form of dilated cardiomyopathy so he put me on 2.5mg Ramipril for three months. He said, at that point, if the heart hadn't responded to the drug, then he would probably take me off it.

Three months later I went back and the scan showed no change in size, but instead of taking me off it he upped the dosage, mainly because he said it seemed to help with the palpitations. He said he'd see me again in a year for another scan.

I went for a second opinion with a second cardiologist. He favoured that it might be a natural reaction to prolonged exercise and told me he agreed with the first cardio that I should have a repeat scan in twelve months, but he said I should come off the Ramipril. So I came off it. They both said I could drink alcohol in moderation - I maybe a couple of glasses of wine a couple of times a week.

After about two to three weeks I began to feel a bit off colour. Tired, abdominal discomfort, back pain (which is what I had before that made me go to the doc in the first place) and extremely tired legs. I'm now a bit worried as I have read that these symptoms can be early symptoms of cardiomyopathy and I think I've noticed a decreased tolerance to exercise, although it's too early to tell at this stage.

My GP doesn't think those symptoms have anything to do with my heart as he says typically you would expect disfunction before you begin to feel them and my EF was 60% (and it is unlikely it had deteriorated that much since September), so he is suggesting it might be gastro problems.

Only time will tell, likewise I'll keep you updated on my progress.

All the best with it.