Heart rate discussion - Leaky Heart Valve

I found the heart rate discussion very interesting on this weeks episode (188). I have a leaky heart valve. It is a bicuspid aortic valve. I was born with it, but wasn’t found until my early 30s. I had already done 2x London Marathons and 2x Olympic London Triathlons. It doesn’t seem to effect me in general, but my heart rate will not decrease as quickly as a normal heart once exercise is over.

I believe this will effect the recovery sections of a workout. My heart rate will come down around 20 beats quickly. but then only slowly decrease from there. It will go back up pretty quickly again once the next section of a workout starts.

When I do muscular endurance sessions I think my heart rate will be higher than it would normally be with a normal heart. Hopefully I am getting the benefit that Chad intends. I tend do Grand Fondo’s. I am not sure what effect having this condition has on my muscular endurance during those events as my heart rate could be higher than it really needs to be.

My resting heart rate according to my Apple Watch is around 56 beats a minute, but as soon as I stand up it will be in the mid 70s.

I’m lucky as day to day it has no effect in every day life. I only need a scan every 2 years to make sure all is still good. I’m told it will need replacing one day, but not yet. I will be hitting 50 next year and hopefully I won’t need it changing just yet :slight_smile:

I know this isn’t a question, but after listening to the podcast I thought I would share my experience.


If you don’t mind me asking, what caused you to discover that you had it? Were there other symptoms that you noticed that led to having it checked, or did it come up somehow else?
Thanks for sharing your experience.

Not the same exactly, but I have mitral valve prolapse, which while diagnosed a number of years ago, is now leaking (regurgitating) and is affecting the ejection fraction. I have always had a “high” heart rate, and at almost 51, my max HR is still over 200 (my last stress test was officially 197) and routinely ride at 180’ish on long rides. With a family history of heart issues, I have been monitored regularly most of my adult life, and the cardiologists are not concerned about HR and last time I asked 6 months ago, he said not to change anything. I am due however for another check i a few weeks.

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@acavell That is a good question. I had a cough that I couldn’t get rid off. I finally went to the doctors and said I should have a chest x-ray. The results came back, nothing wrong with the lungs, but you have an enlarged heart. This was in the early days of the Internet so a quick search, death, death, SAS fit :smile: I was fit, but not SAS fit. I decided to wait for the doctors appointment and the above was the outcome.

Other things then began to make sense. After my 1997 marathon I decided to training smarter. I bought a book that explained how to train with heart rate. I tried it and it never worked. I couldn’t run and keep my heart rate in the zones. It was more a fast walk than even a job. It made no sense. It was very uncomfatable to run like that. Now I know why the heart rate would get higher than it should. My marathon time was 3h 22m so not bad, but I could never run to a heart rate zone.

I wonder if all my workouts are more VO2 than muscular endurance.

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@ZeroGravity I hope the check up goes well.

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In general, faster heart rates are better for regurgitant valves (assuming this is what you mean by leaky) - there is less time spent in the phase where regurgitation occurs i.e. diastole for aortic regurgitation, and systole for mitral regurgitation. The converse is true for stenosed valves, where slower heart rates are better, to allow blood flow though a tight valve. A slightly higher HR is a physiological adaptation to regurgitant valves - that said if your scans/Echo’s are fine and your cardiologist is happy then do not fret ! Best get your advice from a medical professional and not the internet


Thanks @jonathanwhiteside Interestingly my cardiologist said not to do weight training. Not sure why. I just do some light kettlebells.


heavy weight training potentially causes straining, which can potentially increase intrathoracic pressure (transiently) via a valsalva manouvre, which again, theoretically can increase regurgitation though the aortic valve (transiently) - this is theoretical and lacks robust data, as very few people have Echo’s during weight training ! Sometimes physiology is extrapolation :slight_smile: but, nevertheless I’d do the kettlebells, as it’s more useful for cycling than bench pressing your body weight


@jonathanwhiteside that is my plan. Much more fun anyway. :smile: In the long run I hope the exercise helps my heart.


Back from the cardiologist this morning, so a quick update. Short story is that there is no change in last 6 months (good) but the regurgitating valve is causing reduced heart function (bad). The cardiologist is of the opinion that getting it fixed or replaced sooner than later is the best course of action before there is a noticeable reduction in quality of life, at which point there is more permanent damage. He said probably within the next 24 months, while I am still relatively young (51) and the heart can fully recover. Next steps are the diagnostics and appointments building up to the decision to go ahead. I am very fortunate to have a world-class cardiology hospital here in town.


Wishing you all the best.

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Thanks. My concern, which the cardio agrees with, is the reduction in quality of life and rather than actual heart failure. I simply don’t want to be told to slow down and take it easy, not ride as hard as I do now, or not be able walk 18 holes of golf before they will do anything about it. I’m fortunate that my family doctor noticed this years ago and that I have the right people line up to monitor and take care of it. The prognosis sounds quite good overall. Besides, it gives me a whole new thing to research on the internet although watching a real procedure might not have been the best idea over lunch.

I totally agree with you until the golf :). Seriously I feel the same. I’m not told yet that it will affect my quality of life, but I want to be in the best condition I can be when something needs to be done.

Something I was going to ask. Do you have trouble cooling down. I find that if I don’t keep cool after exercising I just sweat up again. For example, if I go home from the gym I’m fine, but if I have to travel on the train into London unless the weather is cold I will get very sweaty again.

Golf is one activity my wife and I share and that allows me to indulge in other sports. Frustrating as hell though. I will keep going as hard as I can, for as long as I can in part as you say, to be ready for the day it comes.

Post-exercise sweating has never been a big problem for me as long as I take a reasonable cool down period, even after a taking a hot shower, except in maybe the hottest of summer temperatures.

Even now, in my basement training it’s about 18C/65F and with a regular house fan on low, I get off the bike almost dry. Hang out for another 5 minutes or so and I actually get cold and don’t get the post-sweats. I look at all those pain cave pictures with huge industrial fans and it just doesn’t apply to me.

It’s been a while but the see you in a year check up happened. Good news/bad news. Ejection fraction has gotten worse and now I am officially “on the trajectory” to mitral valve repair surgery. Good news is that I am still asymptomatic as far as I can tell (although getting back into TR workouts has largely sucked so far including a 60W FTP drop) and the repair is most likely a mitral clip via catheter, the least intrusive way possible. A drawback of our health system is I have no idea when this will take to happen, probably at least 6 months in my mind.

You take care. I had my two year check up. Nothing had changed. I’m sure my heart rate causes me more likely to find a session hard than my muscle endurance.

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Thanks. I am not too concerned about the procedure, more anxious to get it over with. I am wondering to what extent the declining ejection fraction has on my overall performance and what will change afterwards and how long recovery will be. I am sure it will probably occur at the peak of summer when I want to be outdoors doing stuff, not stuck in a hospital or not allowed to do anything physically stressing.