Heart condition and VO2max training

Thanks to COVID-19 I found out in mid 2020 I have a serious heart condition I have inherited from my family. The cardiologist tells me that typically they only find out a person has a biscupular ventricle when they are in the morgue. The reason being as the general public don’t usually feel the effects of the condition until it is too late, the ventricle valve ruptures and death (usually in the mid-sixties) is almost instantaneous. My case as an avid TR cyclist was training indoors with a mild cold and felt an unusual pain across my chest. My Dr does an ECG on me the same day and could not get a reading for V1 a same day appointment with a cardiologist with a scan investigation identified my condition. A note of my history as an athlete I have always been a fit person starting with a runner doing 800m later in life in fact 9 years ago moving to cycling and then finding indoor training as a very effective way to improve fitness. My question to TR podcast panel is how do I train to get faster when I have a condition that limits my VO2max? A foot note my FTP is usually between 2.75 and 3.5W/kg and lately as I trained for the UCI Grand Fondo I could not raise it beyond 3,05W/kg

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What did the cardiologist advise?

And why are you describing this specifically as limiting your VO2max, as opposed to any other aspect of training and fitness?

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I would first make sure you have a conversation with your cardiologist. Talk about types of workouts, power, heart rate, and what he’s comfortable with you doing and not doing. I’d also talk with him about treatment options - is this an “is what it is” scenario, or is a valve replacement or similar an option?

Until I did that, I personally wouldn’t be comfortable doing much more than endurance pace.

Remember, more important things than FTP, take care of yourself first!

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@JoeX it is specific to VO2max as my research revealed that this valve controls the return oxygenated blood to the heart to pump into the muscles and obviously this is directly related to your VO2max

@BCM the cardiologist and my research says that the only thing that can cause an issue is high force exertion ie weight lifting, short sprints (breath held) intervals.
Treatment when the time comes is a stent on the valve to prevent rupture. This is determined by the dimension (diameter of) the valve reaches a certain limit. I can’t remember the specific size but I have an appointment every year now to check this. The cardiologist is impressed with the size of my heart muscle’s I am not sure if this is a good thing :hushed:

But the valve is used at all times right, even when resting or doing endurance work?

And your condition affects when it fails rather than how much work it can do?

Is there another name for your condition the cardiologist has given you?

The only place on the internet ecosia and google can find this phrase is on this thread.

And if you meant ‘bicuspid valve’, this is a part of everyone’s heart - not a condition.

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I think he means this

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Sounds like a potential and general limiter to me.

It’s the potential complications that are the main concern.

I would think that general aerobic exercise and training would be appropriate, and if vo2max goes up or down as a consequence, so be it. Even strength work that doesn’t stimulate/stress the CV could be good.

I would not think that training or racing to exhaustion would be a good idea.

All in my totally unqualified opinion, of course.

I finished med school and this is beyond me too. It would seem to me that a progressively worse cardiac function is something inevitable and I have no idea if training will make it worse or better. This is a question to ask to your physician not the Internet


@ArHu74 you have the correct condition there, the valve is supposed to look like a Mercedes Star but as mine only has 2 it sides not three it causes a back flow of oxygenated blood limiting VO2max work.
Interesting in the stress ECG the clinician was struggling to get my heart rate up enough to complete the observation. The years of training has built a stronger heart that beats slow even under load.

@JoeX i am thinking about a polarised training plan but not sure what the intensity part would look like. In my last month of training I was preparing for a 110km uci grand Fondo TR AI was prescribing VO2max which was for just impossible to do with the fatigue I had and the BAV. Before I started TR I did a lot of road riding 7 to 8 hours a week. The last hour was crit racing on a Sunday which was a high level of intensity. I got very fast until I lost weight and my fitness tanked in 2018 this coincided with starting TR SSMVB. In 2019 my fitness returned moving me up to B grade in Masters Cycling equivalent to cat 2. In Jan 2020 I got Covid and this affected my lungs and tanked my VO2max.

As mentioned it’s going to be difficult to give good advice here. I have the same condition and don’t have any issues with Vo2 work that I can tell, but getting clear advice from doctors on how to think about balancing this condition with strenuous exercise like the kind we all do here has been very difficult in my experience.

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My younger brother (45 yo)and sister (52 yo) both had this. Both had stent and new valve put in last year and are doing well.


Are you sure about this?

I’m very interested and I hope I’m coming across as constructively critical.

I would expect the doctors to say that below a certain level of effort nothing is unusual, but above a certain level of stress the back flow occurs? Or does it always occur, just more as the effort level goes up?

Either way it sounds like threshold should be your top interval effort. No sense in dying while prepping for a cat 2 race is there?

Going back to your OP it sounds like the medical personnel already recognise you have a strong/fit heart apart from this condition so I doubt you are gaining health with greater performance training.

NB why does everyone think polarised is what they need/want? :sweat_smile: I really think you need the opposite!

Thanks @Dhaulagiri
What training plan do you follow? What workouts do you find Difficult/impossible to complete?

@JoeX all to happy to discuss this and get another point of view.
So many articles I have read say “Shortness of breath: Sudden trouble breathing during physical exertion is the main symptom of aortic regurgitation.” this I can attest to when doing FTP and over to VO2max work I find I can get to 90s then the lactate burn in my muscles goes through the roof. I worked out a 5s pause and I can go again. An article I read somewhere said because of the single opening the BAV doesn’t close as well as a TAB and so backwards flow occurs during intense exercise.

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@tomclune good news that is fantastic.
How did they find out?

Not sure the opposite is working for me now. Before AI I always struggle in the last weeks before a race when intensity goes up and fatigue goes through the roof. The workouts are shorter but focus on “that zone” as Couch Chad says sharpening the blade. With AI not much has changed I keep failing VO2max workouts but the machine says I need to do them😞

Typically I find threshold the hardest but I think that may be due to an inflated FTP :grimacing: ? My HR typically gets higher during those than during VO2 but the intervals are also much longer. In general it does feel like my HR is more a limiter in these scenarios than oxygen uptake, but whether that’s due to this condition or not is unclear to me.

I typically follow SSB → Sustained Build → Century plans. Lots of long threshold work…