Angina like symptoms - Heart, Hydration, Overtraining?

Hi, I’ve posted this in other places over the past, but never here, and if you could take a moment from your busy day and offer me some advice I would greatly appreciate it. The short question is for many years I’ve had angina like symptoms when I ride that usually get better 30-60 minutes in and I can perform in the Z3-Z5 as I feel like I should.

First just a little background. No athletic experience in school. 44 years old, been averaging about 5K miles a year since 2011. When I was 14-15 years old I did a small local group ride, when the fast guys showed I would try to keep up, if I went hard enough I would feel my left arm start go numb just slightly.

Fast forward 25 years later this problem was showing up when not even going that hard at the beginning of a ride, the feeling of numbness would start up around 120 bpm, and sometimes progress to a squeezing pain. It would usually get better, and I found if I started an hour before everyone else with a slow warmup I could avoid it altogether.

by 2018 it was bad enough I mentioned it a PA at my small rural hospital/clinic, as I have never actually had a General Physician. The PA scheduled me a treadmill stress test. During the test I had no issues getting my heart rate up to 154 and felt zero tightness. The cardiologist seemed almost annoyed and had nothing to say other than I had a fine heart.

In 2020 I decided to hire a coach and try to get really serious about training during Covid Lockdown. The coach encouraged me to get more medical advice about my heart issue which still happened. I ended up seeing the same cardiologist. He struggled to understand why I was evening exercising as hard. He did an EKG which showed my heart had enlarged since the last one in 2018. He was confused because my Blood pressure along with all other tests were good. He thought I might have Hypertrophic Cardiomyopathy. He ordered a Nuclear Stress Test, and again during this test I had zero problem getting my Heart Rate up and no symptoms.

on my last visit to this cardiologist he said my heart was fine, The enlargement was uniform. He wanted to prescribe me beta blockers. I had a friend who was on beta blockers and he said he was unable to raise his heart rate much past the 130s. I never filled the prescription and never went back.

So I’m 100% the problem is worse for a couple days after a big ride, 200-300 TSS. I’m also certain the problem is worse when I’m not adequately hydrated. I also DON’T feel like I’m overtraining. On I’ve been holding a low 60s fitness score for months.

I’m strongly thinking about switching to structured training and using trainer road for indoor training this winter, but when I have tried to use structured training in the past, I struggle to hit the numbers I’m supposed to in the time I have.

Thanks for reading and appreciate any advice.

Have you had any imaging done? I would definitely consider talking to a different cardiologist that has worked with athletes. Are you using any device to monitor HRV for training stress? There are also devices like the Fourth Frontier X2 you might consider depending on your budget that can provide you ECG data during your workouts so you can monitor any anomaly’s yourself. It is interesting you didn’t have any issues during the stress tests but if you’ve been consistently having this issue for years it certainly seems like something worth investigating before pushing yourself too hard. Have you done bloodwork to make sure you don’t have any nutritional/electrolyte insufficiencies that could be causing issues?

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I took a beta blocker for about 9 years to reduce my resting heart rate (was mid 80s). I had no trouble getting my heart rate into upper 160s, and would occassionally hit 171 or 172 when pushing hard and then hitting a hill. I’m 54, so 170ish is normalish for where my HRmax should be.
I did have a feeling that the BBlocker may have held my progress back some, and an Internist I ride with thought that is possible. My blood pressure was too low on the original dosage, so they cut it in half. The specific drug and the dosage should certainly be up for discussion and adjustment if you needed one.
I’ve been off them for a couple years now (because I’m in much better shape, and my resting HR is down in the 50s), and the max I’ve seen since is 174, so HRmax may be up a little. My LTHR is also up a few beats from 154 to 157 also.

Do you have any history of severe anxiety or panic attacks? They can cause very real physiological symptoms. I got this cardiologist and electrophysiologist because I was on the stationary bike and the grip HR meter went from 112 to 209 and I felt a weird rush from my core outward and my left arm was cold to the touch for about 4 hours (went to work and coworkers could feel one hand hot, one hand cold). I was sure it was my anxiety driving it so I wasn’t too worried, and waited for my doc to call me back. I ended up getting a stent, but the blockage I had wouldn’t have caused the cold arm. I tested the HR Meter (grip) while wearing a chest strap and witnessed another 209 later, so confirmed malfunction.

Also, 2 years before that cold arm episode I had chest pains in the night (gas/angina) and spent 2 days at the hospital, and they released me with “we don’t know what was wrong with you, but it wasn’t your heart”…2 years later I got the stent in a major artery. So, beware…something undetected can progress.

Do you have a blood pressure cuff, by any chance? If the symptom lasts, you could compare left vs right arm blood pressure, maybe. I’d check compare them when you don’t get the symptom, too…for all I know the predominant arm is always 14 higher on the systolic or something weird.

And don’t dscount that your symptom could be the result of some impingement, that you get from your body position changing as you get fatigued or relax or something like that.

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Yes imaging has been done 3 times, the first stress test in 2018. In 2020 I had a heart sonogram, and then the nuclear stress test which is gold standard (I was told)

Bloodwork was done both times and everything came back normal.

I am not using HRV, I use a Garmin Vivoactive 4 but I don’t think it can do HRV. I’ve thought about trying HRV with the whoop band, but it seems a bit expensive.

The Fourth Frontier X2 looks amazing, never heard it, would love to try it.

During both stress tests I was very wound up and nervous, and my sympathetic nervous system was already fired up before the test started. I’ve found that when I get really fired up for an event, the problem is less pronounced or sometimes completely gone.

Thanks Mike,
My resting HR is around 53. No history of anxiety or panic attacks. It’s actually the opposite. The more panic’d I am before a ride the better I do.

I did try the blood pressure on different arm test a couple years ago. I think I found my left arm was consistently a bit lower.

The body impingement is a possibility. The problem is defiantly worse when my hand is supporting weight. If i set up, or can rest my forearms on the bars it sometimes helps.

I was thinking the cardiologists bike surely has different geometry than your setup, so that could be why the issue didn’t present during the in-office tests.

If that’s the case you just need to break into their lab in the night and take measurements to use on your bike. :wink:

I have a shoulder impingement in left arm, and in February started having nerve issues in that hand and now the forearm, and then I wrecked 2 months ago and hurt that hand/wrist. So, I feel ya with the frustration.