219 beats per minute: The day my heart short-circuited
Want to see an ER nurse panic? Ride up to the hospital on your bike, looking pro in your team kit, and tell them you’re having “a problem” with your heart. In ten seconds I had three nurses swarming me, taking my vital signs. I kept urging them to get the EKG before the episode passed, because this wasn’t the first time.
They did, and finally, I had the data needed for a diagnosis: Supraventricular Tachycardia (SVT).
Let’s rewind a bit.
March 28, 2015. San Francisco. It was a Saturday that started out like many others: I rode my bike to the Golden Gate Bridge, met up with a few friends and headed north into Marin. The plan, often the case on Saturdays, was to ride north and join a local group ride. We’d blast around a 35-mile loop to Point Reyes and back, occasionally sprinting for town signs and hilltops, earning the kudos and marginal gains in fitness they afforded. It was a warm, sunny day in the height of the NorCal racing season; suffice to say I was excited to get out and train with my friends.
The first hour of this ride was easy. We worked our way north through the local Marin towns, rolling easy with the usual banter animating the ride: dick jokes, Peter Sagan finishing second again (this was 2015, remember), someone’s hideous kit/sock combo, more dick jokes. Nearing the meeting spot for the group ride, we rolled up and over a small hill into the town of San Anselmo.
And then it happened.
I was coasting downhill when I noticed a slight flutter in my chest. I looked down at my computer and saw my heart rate was 180 beats per minute.
For context, during a hard day like that, I’d expect my heart rate to max out at around 185–190 when the pace got really hard, but not at this point, not before the hard part of the ride even started. My heart rate was climbing and I wasn’t even pedalling. For a moment, I tried to convince myself that my computer was giving me bad readings, but I could feel it in my chest. This was real.
I knew that something was wrong, but hoped it would stop. I kept on riding. I pedalled softly while my heart danced. We arrived at the parking lot of the Java Hut in Fairfax and I got off my bike, hoping things would calm down. I skipped the quick espresso. My heart rate stayed high, around 160, while I just stood there. I told my friends that something was up and that I might have to pull out. But how do you convey something so unnatural? Something that you and they have never felt? I couldn’t, not really.
Here is one of the really weird parts about this whole ordeal: during this episode, and the others that would follow, I looked totally normal to everyone around me. If anything, someone might notice signs of anxiety, but, beyond that, I was walking around, breathing easily. I wasn’t dizzy, and I never fainted — all (I would later learn) common symptoms of heart arrhythmia.
We started up the first climb at a moderate pace — a gentlemen’s agreement dictated no attacking until the second climb, yet I was barely hanging on. We descended and turned right, uphill towards the town of Nicasio and, as always, the strong riders dropped the hammer with everyone else following. I tried to keep up, but I couldn’t. I finally conceded that I needed to stop: my heart rate had just reached 219 BPM. That’s nearly 4 beats per second, a number I’d never seen before.
My friend Matt stayed back with me as I pulled over and sat on the side of the road, calming down a bit, until I felt I could ride back to Fairfax (albeit with a still-elevated heart rate). We went to a cafe, where I sat for a while again, ate some food, and after about 15–20 minutes, the episode passed. Matt and I rode back to San Francisco. By all physical measures, things were totally normal again.
Cue the soul-crushing anxiety.
Am I going to die? Probably not, I told myself, but that was my heart totally going bananas back there, so don’t rule it out. Is something seriously wrong with my heart? Umm, yeah — hard to contextualize “serious,” but that certainly was not normal. What about my life? My passion for cycling? Do I have to stop? Unclear. But this is clearly a cause for pessimism.
I saw a cardiologist in San Francisco and he did a full workup. Blood tests: normal. Echocardiogram (a sonogram of my heart): normal. EKG stress test (running on a treadmill all wired up like the Russian in Rocky IV): normal. The conclusion my doctor arrived at was that I was fine and shouldn’t worry. The event happened, it didn’t harm my health, and it was unclear if it would happen again. The only way to know for sure what it was would be to have an EKG during the episode; in the absence of that, any more testing would be either ineffective or too invasive. The first episode passed on its own and I didn’t get light-headed and crash, so the resolution was to just carry on, but return if things changed or got worse.
I went back to training and racing like nothing had happened, save for the knowledge and anxiety that something did happen, and it was really scary. What to do? Quit bike racing and other endurance sports? It might seem sensible to a normal person, but this was so hard to give up. It was impossible to imagine myself living a happy life not going outside and pushing my physical and mental boundaries, on the bike or otherwise. Furthermore, the doctor told me to go for it.
Coping takes knowing, and I couldn’t really appreciate the severity, or lack thereof, of my condition. People have nagging injuries with sports all the time: tweaked knees, sore backs, etc. They train and compete while managing these injuries, and back off when their conditions warrant. But this was my heart. It felt much more serious, even if doctors were telling me I was clear to train and race. The result was a lot of anxiety, always staring down at my heart rate displayed on my bike computer, wondering if things were normal or not, and if I was going to have another episode.
I did have another episode. Five more times over the next two years, at increasing frequencies. The subsequent episodes were less intense and passed on their own rather quickly, but their frequency indicated the situation was worsening, even in the absence of more serious symptoms. Still, I knew I had no way of getting more answers without being able to get an EKG during the episode. It’s hard to express in words how frustrating this was.
The situation finally came to a head on February 18, 2017. I’d since moved to Boulder, Colorado and joined a local racing team. I was out on a training ride with my teammates. Same scenario as in the past, but this time it was a bit worse. I crested a hill going full gas and sat up as I coasted down the descent when that unmistakable pop in my heart rate happened again. I rolled back to the meeting point behind the others, sat down and told my teammates what was going on. They were bit confused as to how to react. They had planned to keep riding and I said I needed to go back to my car. They asked if I needed help and I said no. I told them to carry on, thinking the episode would stop, but it didn’t after a few minutes. Then it occurred to me I should ride to the emergency room. I was genuinely concerned that things were different this time, but more importantly, I knew that I could get an EKG, and then I would know what was actually happening. Back on the bike, this time to St. Anthony’s hospital.
I got to see an ER nurse panic. Or at least move very fast.
Without getting too far into the weeds, Supraventricular Tachycardia (SVT) occurs when certain pacemaking cells in the heart fire in a way they shouldn’t. That was my diagnosis. Those cells cause a short circuit and an abnormal rhythm. In my case, a very fast one. The doctor told me it wasn’t life-threatening and that I should not come back to the emergency room if it happened again unless it lasted for hours and it still didn’t pass. After some additional tests and a chest X-ray, they discharged me. Again, perfectly back to normal. I left the hospital exactly as I arrived, on my bike, saying a friendly goodbye to the nurse I’d freaked out just hours before. I will say that I left with a sense of relief. For the first time in two years, I knew what was going on.
In all of my research, I didn’t come across SVT as a possible diagnosis of my own condition. In large part this is because I was likely born with this “aberrant pathway” in the normal electrical circuitry of my heart. All of my research into heart arrhythmias focused on exercise-induced ones, of which there are many, and well-chronicled in Lennard Zinn’s book The Haywire Heart. Zinn was a bike racer for decades until he experienced different and more severe arrhythmias himself.
Clearly, exercise was triggering my SVT, but it didn’t create it. I can think back to some friends who described similar events now with no relation whatsoever to endurance sports.
A friend of mine got in touch with Zinn, who referred me to an electrophysiologist in Boulder named Dr. Sameer Oza. Given the source of the referral and the town I was in, I was confident in Dr. Oza’s ability to understand my situation, especially as it pertained to endurance sports. He confirmed the ER doctor’s diagnosis and laid it out very clearly.
This wasn’t going to kill me, he said. Right, I knew that part by then. It was “benign,” he said. That’s a good word to get from the doctor! However, he also said this was not going away. Fuck. In fact, it was likely only going to get worse. Double fuck, and I could see this was already happening.
The good news is that, unlike many other arrhythmias, SVT is curable. The process is called an ablation. Sounds straightforward and chill, right? Well, kind of, until you really start to consider what an ablation procedure entails.
They run catheters into the major veins via the groin, get to the heart, pump it full of adrenaline, recreate the arrhythmia, locate the problem cells and kill them with heat or cold. Granted, Dr. Oza was not proposing to crack open my chest and conduct open heart surgery, but this is hardly a normal trip to the doctor to turn your head and cough. And it’s not without risk. I was to be put under general anesthesia, something not always done in these procedures, which has its own rolls of the dice. Even more worrying was the very low, but non-zero, risk that I’d end up with a pacemaker. All for something they said wasn’t going to kill me.
So, what to do?
I thought it over for about five days and decided to go forward with the ablation, and to do it soon. The risks really bothered me, but rational thinking and advice from other doctors convinced me that the risks were far, far lower than other risks in my life. I thought a lot about quitting bike racing, and maybe even cycling altogether. But it was so hard to imagine being happy without it. I thought about going back to other sports, like rock climbing, which I used to do with the same fanaticism as cycling. I thought I might get away without having episodes, until I considered being up on the wall, facing a dangerous fall, and an episode happening then. That was a scenario a close friend of mine actually witnessed, fortunately without serious consequence. The overarching conclusion I came to is that my happiness in life is intrinsically tied to going outside and enjoying intense physical exercise; so long as that’s true, the SVT will be an issue. There would never be a good time to do this, so best to just do it now.
I’m young, I’m strong, let’s do this.
March 13, 2017: Time for surgery. My dear mother, bless her heart, came out to Boulder to look after me. I went to Boulder Community Health at 11 am to prep for surgery. The procedure was to take two to four hours, and I was to spend the night under observation at the hospital. I was under general anesthesia, so the most I remember of the whole procedure was the various preparations with a host of nurses, one of whom said she was going to “slip me a martini” before wheeling me into the operating room. I came out and Dr. Oza showed up soon thereafter explaining that everything went to plan, that he clearly located the arrhythmia, burned the cells and then spent 30 minutes trying to recreate the arrhythmia to no avail, suggesting he succeeded. He said I had a 95% chance the SVT would never come back.
I’d like to say to that it was happily ever after from there, but there was a bit of a ripple. At 9 pm that night, the nurse came into my room and asked if I’d like to get up and walk around. Since the surgery, I had to lie flat to let the puncture points in my groin heal and prevent bleeding. Naturally, I said yes. However, I didn’t make it far. Without getting into too much detail, I experienced a vasovagal episode, where my heart rate dropped dramatically causing me to lose consciousness. This is hardly an uncommon occurrence, especially considering the circumstances, and I’m not one to be dramatic, but this was a seriously terrifying experience. I came-to with nurses and doctors surrounding me and alarms going off. I learned soon thereafter that I experienced a couple pauses in my heart rate of nearly five seconds, before coming back on my own.
The next morning, Dr. Oza came to visit me having reviewed the EKG records, and — as is seemingly par for the course of this two-year ordeal — told me I was fine and that I had nothing to worry about. Harrowing as it was, I was convinced.
I also do wonder how the environment of the hospital and the natural reaction of all the doctors affected my perception of the event’s severity. Still, five seconds is a really long time for your heart to not beat. This event, like much of this whole experience, remains hard to process — terrifying and severe by objective criteria, but otherwise not really that serious according to doctors and specialists.
I left the hospital and went home at 11 am the next morning, a mere 24 hours after I arrived. Kudos to modern medicine.
Recovery from the ablation was relatively short and straightforward. I wasn’t allowed to exercise for 10 days, with the exception of light walking, which was actually encouraged to prevent blood clots. I felt nothing odd in my chest, and the rest period was intended to make sure the puncture sites in my groin where they accessed my veins healed fully before exertion. I will say that I underestimated how tired I would be, and how cautiously I’d react towards exercising again (bro, you did have heart surgery). I assumed that “light walking” would mean casual and pleasant strolls around my neighborhood, but in reality, I found myself wanting to turn around after two blocks in those first few days after the procedure. I spent the majority of that first week on the couch. I had some pain and a lot of tenderness in near my groin. By the weekend I was progressing much more quickly, and by the following Tuesday, I woke up feeling just about normal.
A week and a half after leaving the hospital and almost two years to the day from the very first episode, I met my friends at our normal spot, at the normal time, for our morning ride around Boulder. The pace was was casual, and the glances at my heart rate rather frequent, but I felt fine. I steadily increased the volume and intensity of my rides and returned to racing within a couple weeks, all with the knowledge that I most likely (95%) would never experience SVT again. Dr. Oza said if I went six months without another episode, I’d almost certainly never have another.
That was a year and a half ago. Today I feel great; I ride and race a lot. Six months came and went and my heart is only doing the dances it’s supposed to do. If anything, the last year and a half showed me how common this is. Recently, cyclocross racer Jeremy Powers was diagnosed with SVT. A friend I know from the local crit scene reached out with nearly identical symptoms and the new guy at work who sits next to me just had the same surgery. At the same time, I witnessed a pro rider die of a heart attack at Paris Roubaix, reminding us just how fragile, and complicated, our bodies are. It seems unfair that these things often come down to luck, but it’s true.
Like many, I hold on dear to this beautiful, exciting and painful sport. I expected my health to sustain this crazy passion of mine for decades to come. I still expect that. What this experience taught me to is to take nothing for granted, to enjoy every mile out there, and to appreciate my own vulnerability.