Ask the Doctor
Consultant cardiologist Dr Mark Dayer addresses your heart health concerns
I get chest pains sometimes. Do I need to worry?
Chest pain is one of the most common reasons for seeing a cardiologist. But the vast majority of people we see do not have a serious underlying problem, and only about one in 20 need an operation. As cardiologists, we naturally worry that the chest pain is due to a heart problem. If you develop sudden onset severe chest pain, call an ambulance. It doesn’t necessarily mean you have a serious heart problem (see nhs.uk/conditions/ chest-pain); most people notice chest pains from time to time. But always err on the side of caution.
There tend to be three characteristics of the chest pain that mark it out as being to do with the heart. The first is that it tends to come on with exertion. The second is that it tends to be in the centre of the chest and ‘crushing’ in nature. It often spreads to the arms and/ or the jaw. Many people describe it as a sensation or discomfort rather than pain. The third is that it tends to go off with rest.
It’s more likely to be a heart issue if you are an older man who is a smoker (the least at risk are young, non-smoking females). When chest pain is due to the heart, it’s termed angina. This is usually caused by narrowing of the arteries that supply the heart muscle itself. Treatment is with drugs, including the much-maligned statins, percutaneous coronary intervention – where affected arteries are opened up via a procedure from the wrist – or coronary artery bypass grafting, i.e. open heart surgery.
It’s important to seek medical advice if you are getting chest pains. Regarding the fatalities that occur in endurance sport – rare but not unheard of – the most common are older people with narrowed or blocked coronary arteries.
Sometimes when I am riding hard, my heart rate goes erratic, I feel breathless and have to stop or slow down. What’s going on?
This is quite a common story. Palpitations are when you notice your heart beating more strongly, more rapidly or irregularly. Once you get to 50, the odd thump and bump is a regular occurrence. But in some people there is something more significant going on. It’s rarely lifethreatening, but there may be a problem which could become more serious if not dealt with.
Atrial fibrillation is one of the most common significant rhythm problems. The heart normally beats in a regular fashion, guided by an impulse from the sinus node. A normal resting heart rate is around 60-80 beats per minute, but in athletes it can be as low as 50bpm, 40bpm or even into the 30s.
It’s a matter of real debate in the world of cardiology, but it is now generally accepted that high levels of endurance exercise over many years can predispose people, usually men (women seem less susceptible), to atrial fibrillation. I hope in time, big-data analysis from platforms like Strava (see below) will provide greater insight.
Atrial fibrillation occurs when the normal pacemaker function of the sinus node breaks down and chaos reigns. Typically, people get a fast, irregular heartbeat, which is much less efficient, and they become breathless easily when exerting themselves. Atrial fibrillation can come and go, and often in athletes seems to come on with exertion, which can be incredibly frustrating. It’s generally not a life-threatening problem, although some people need bloodthinning medication to prevent stroke, and it’s important to ensure there are no other serious underlying causes.
Detraining sometimes works, but this is naturally unpopular among cyclists. It can be treated by tablets, but if they don’t work or have unacceptable side effects, then a procedure called an ablation is often very effective in younger, fitter people. Losing weight (if you are overweight), stopping drinking alcohol, and getting really good control of your blood pressure (if it’s high) can also help and are important steps. Surprisingly, drinking coffee (sensibly), previously advised against, seems to be associated with a reduced risk of getting heart rhythm problems.
Is cycling good for my heart?
Yes! Despite all the scare stories you read, for the vast majority of people, exercise is a good thing. Nothing in life is without potential downsides and risks, and extremes are best avoided – don’t overtrain, and listen to your body.
You can help! Working with cycling techie Ian Green, Dr Mark Dayer has set up a website analysing cyclists’ workloads and heart rhythm problems using Strava data. To sign up, go to: cricklesorg.wordpress.com.
Got a question for our medical experts? Email david.bradford@futurenet.com