Editor's note: VeloNews spoke with Dr. John Mandrola, a cardiac electrophysiologist who is also a cyclist suffering from atrial fibrillation (AF), about how heart-rhythm problems can affect endurance athletes. This Q&A originally appeared at VeloNews.com.
VN: What are the warning signs for heart arrhythmias?
JM: A lot of the time in athletes, atrial fibrillation begins as premature beats, as just shorter periods of irregularity and you feel something in your heart. If you’re an endurance athlete and you get those warning signs, that’s when it’s time to start thinking about going in and getting your heart looked at; if you’re feeling stuff like skips or jumps of your heart rhythm, you don’t really know if it’s V-tach (ventricular tachicardia) or AF.
The majority of the time, those are not dangerous or life threatening, but that’s the time to get it looked at and at least raise your hand and say, ‘Okay, what is this?’
The problem, though, with an evaluation for an endurance athlete, they go to the doctor, and the doctor has no idea what they do [as an athlete]. It’s tough because 999 out of 1,000 patients he sees don’t do the stuff that [endurance athletes] do. Your reader has to be wise to the fact that a lot of doctors don’t really understand what they do [as an endurance athlete].
What do you tell people that do develop AF?
JM: The first thing that a person with AF ought to do is figure out what company that it keeps, because the first thing we ask as doctors is, ‘What else is going on?’ Is AF associated with heart failure or valve disease, or is their thyroid out of whack, or is there something really wrong medically? So a basic medical checkup and a basic heart check up is the first step.
Then they have to be armed with the knowledge that their lifestyle likely may be playing a role. I’m not saying they have to stop exercising. I would never say they couldn’t do this. But if you’re in AF or having AF, you really don’t have a lot of good options if you want to continue doing what you’re doing; drugs really take away what makes you good at what you do. All the drugs for AF slow you down. They affect your cardiac output and some of the procedures for AF are scarier than the disease itself. [Patients] have to know that.
Why are physicians reluctant to speculate as to why someone develops a heart arrhythmia?
Doctors are trained to see problems in a silo. A doctor will see a patient, but will see him or her as the heart rhythm problem. And that heart rate problem probably came from a part of the heart that had a scar and that needed to be fixed. But one of the things we’ve learned from AF is that you can’t ignore the context — chronic stress and endurance exercise, but it might be high blood pressure or obesity or alcohol.
If we ignore that and just try to deal with the problem in a silo rather than as a human being, then that’s one of the reasons why we’re struggling with heart rhythm problems, specifically AF. Whatever we use to treat AF -- drugs or ablation -- AF can come back. New research is showing that if you look for the factors that are leading to the problem, the patients do better.
So I don’t completely think it’s a code of medicine, it’s just the way we’re trained. We’re trained in systems: heart problems, kidney problems, brain problems. And we’re not trained -- and I know this is a goofy word -- holistically. Specialists see their organ but they don’t see the whole person.