Any cardiologists our there?

[Heartquestion]

A bit of background:

I have had heart palpitations all my life. Had them investigated with an ECG years ago and was told they were benign. They are pretty regular (every few days) but don't bother me. They are worse if we I drink too much caffeine and am stressed.

I also have a low resting heart rate-usually about 57. I am pretty fit, work out a lot and run regular half marathons.

I'm also known for having white coat syndrome with my bp although I had high blood pressure in my two recent pregnancies. My children are 3.5 and 1.5

Recently a doctor sent me for some investigations. My bp was high in the surgery and a heart murmur was detected. This is not the first time this has happened. I got investigated about 5years ago for the same issue. Back then the ECG was fine, ECHO was fine and my bp was put down to white coat syndrome as regular checks of it proved it was fine. Again, I have been checked for bp issues all my life (I'm 37) now and all tests show it's white coat syndrome.

My recent bp tests were fine and my recent ECG was fine however my ECHO is scheduled for a few weeks time right after an endurance event where I will be walking a marathon over 24hrs up hill.

My doctor has told me not to do it. He says putting a strain on my heart whilst the investigations aren't complete is unwise. However, he also says a benign heart murmur turning into a dangerous one in 5 years is unlikely. I really want to do this event and have raised a lot of money. Cardiologists, do you think he's just covering his back?

I organised a 3 Peaks charity expedition last year. I was told categorically to not take part.

The team I put together were fit people. Runners, cyclists, hikers - they all struggled, they didn't complete it.

I'm a cardiac nurse specialist and no I don't think your cardiologist is 'covering his back' - I think he's covering yours and has your best interests at heart. The best advice is not to do the marathon until you've completed your investigations and got a clean bill of health. Any health professional who came on here and said otherwise while not having access to your full medical history would be unprofessional.

Thanks. We know it's a big challenge. We are a very fit bunch and have done a lot of training. We are just going for a rough 24hrs so no racing. Just aiming to complete.

However, from what you say I could have an echo and be given the all clear and still be at risk??

Thanks Ella. It wasn't a cardiologist, a gp.

I'll have a think over the weekend.

However, from what you say I could have an echo and be given the all clear and still be at risk??

My echo flagged some changes and they did an MRI to look in more detail at measurements, blood flow etc. and confirm the diagnosis. I now just have annual echos for monitoring

A big challenge like that isn't totally risk free for anyone. The problem is that, depending on exactly what's going on with your heart, it might be extra-risky for you at the moment.

Until you've had the tests, it's going to be very difficult for you or anyone else to decide if you're happy with any extra risk, as you don't currently know what (if any) there is. At least after tests you will be able to make an informed decision.

Also, do check any paperwork for the event as there is sometimes a clause about seeking medical advice / participating against medical advice.

Yes an EChO isn't as good at imaging as MRI so I would say that you need to wait until you've seen a specialist or your GP has discussed all the results with you.

Thanks Ella. In your experience do echocardiograms miss problems regularly? Is this common?

A cautionary tale. My ECHO was fine and was done after a through ECG picked up a life threatening condition (Complete heart block). A previous and fairly recent ECG showed as normal. No symptoms other than a bit of occasional dizziness and a very low heart rate (40) as measured by a fitness watch which alerted me in the first place that all was not OK. thought I was fit, bit not fit enough to have the heart rate of an athlete. I had a pacemaker within 3 days of diagnosis and feel great now. Your call OP but please take no chances. It's not worth the risk, even for 2k for charity. And just to add that my fitness watch said that I had an excellent heart rate for my age...it wasn't it was deadly!

I was going to say just do it - "walking a marathon up a hill" - on the basis that you regularly run halfs so walking a full, even with elevation, is likely to be less stress than you're used to.

The Three Peaks is NOT "walking up a hill". They're serious mountains, plus you've got the sleep deprivation and lack of recovery to contend with.

I've done the Three Peaks. I've run marathons. I've literally just run a hilly trail marathon. I've also had cardiac symptoms in the past which turned out to be benign. There is no way that I'd have taken on the Three Peaks or any other endurance event against the advice of my doctor.

I've also had to defer a major marathon event, so I feel your pain. Can you still attend, but do less of it? Snowdon's pretty easy on the right path and the first bit of Ben Nevis isn't bad. If you do all of Snowdon and half of Nevis then you've still done your bit without taking on the hardest sections and the evil pile of (loose) rock and steps that is Scafell Pike.

you've still done your bit without taking on the hardest sections and the evil pile of (loose) rock and steps that is Scafell Pike

Inevitably in the dark...

Not a cardiologist, but work in a cardiac field. A heart murmur is essentially when the sound of blood flowing through your heart sounds a bit different to how it should do normally. It can be a completely benign condition with no obvious cause, or it could be that one of the valves in your heart isn't working properly (there are other causes, but as you were investigated before, I'd guess those are a pretty unlikely). If the cause was a slightly dodgy valve then it may well be no worse than 5 years ago but it's literally impossible to say for sure. Sometimes valve problems can get worse for no apparent reason. An ECG can sometimes pick up these problems, but not all the time.

My DH did the 3 peaks a few years back and I would be extremely unhappy about him doing it without getting the all clear from a cardiologist. Pay for a private echo if you can.

Re are MRI's better than Echoes.....they are different types of imaging and as such each has its strong points.
Echoes are very good at looking for valve issues and pump function of the heart. MRIs can be better for assessing structural abnormalities.

Generally speaking people will generally have an echo first (after ECGs etc) as they can give a lot of information and are quite readily available, MRIs are usually a follow on from an echo.

Based on what you've said (and I'm not a cardiologist) I would say you would probably be ok but I just wouldn't take the risk for such an endurance event - if it was a 5km round the local park I'd say give it a whizz....but not something like the 3 peaks challenge!

It wouldn't matter if you'd raised 2 million for charity. My lay man advice would be a big fat not a chance to you doing this until you know you are totally heart healthy.
You need to be fit and well for your DC not taking risks.

As someone said previously it's not that ECHO misses anything - it very much depends on what you are looking for specifically and all the other clinical details which will influence which imaging should take place. So without knowing or having access to all your info I won't say anything other than get the ECHO and wait for the results before you do this challenge.

Is it's possibility to contact the cardiologists secretary and explain about raising money for charity they might be able to bring forward the appointment or put you on a cancellation list?

I wouldn't disregard your GP's advice. At best it's benign but at worst you could have a serious issue that ends up being fatal! Why take the risk!

I had similar symptoms - v low heart rate (was actually sub 40 on occasion and I'm no athlete) and a murmur that needed investigating. I also can't have caffeine or pseudoephedrine. It did end up being benign but the cardiologists took it incredibly seriously.

I dont think you should do this either, can you just not explain to your sponsers, I am sure the charity wouldnt want a mum of young children putting herself at risk.

If I had sponsered you, I would pay it anyway as the good intent was there, just not possible to complete at this time.

The NHS is not a fan of wasting money. If they felt that it was unlikely to show any changes you'd have been told "you had one 5 years ago so you'll be fine". The fact that they think it is worth repeating the tests means there is a chance something has changed.

I agree with pp, call them and explain, ask if they can call you if there is a cancellation last minute prior to the event. If they can't fit you in postpone, there are other chances to do this and I'm reasonably sure the people you raised money from would rather that than you having a cardiac episode whilst taking part.

Does anyone have any experience in that area specifically? For example an echo, multiple ECGs missing a major issue?

That's the wrong way to think of it, you could have had nothing in the old investigations but developed something since.

I'd guess the GP is concerned about a cardiomyopathy, these can be congenital but can also develop later, they are a rare complication of pregnancy for example.

Now cardiomyopathies are the things that see footballers keel over dead in the middle of a match because they do not mix with exercise.

In addition surely you have had to sign a form saying you are in good health in order to take part in the event? Any investigation will have an impact on the insurance for the event.

Phone the department and ask for an earlier appointment, say you can do a short notice cancelation.

It really is not worth risking it.

I'm not a cardiologist, but I used to be one of those people who perform ECGs and echos.

No idea why someone is recommending an MRI.

@Ellapaella and @Notabadidea would either of you mind if I pm'd you about a cardiology appointment my son is waiting for? I'm so anxious and as you both seem to work in the field I'm hoping you might be able to offer some reassurance.

Op, sorry to butt in. Hope you manage to get your scan done and get the all clear to take part in your event.

Just an update. I managed to get my echo!!....and as suspected no issues whatsoever. I was then free to do the climb which was an amazing experience. Please don't be put off by the three peaks. It's awesome and totally achievable. Thanks for all the advice and support and best wishes to all.