Tachycardia 185 BPM after chemo/radiation, possible link? Anxiety?

[Tomaz26mb]

Hello,

my name is Tomaz, I am about to be 41 years old (well hopefully anyway) and last June I was diagnosed with rectal cancer, stage IIIB with 4 positive lymph node. Cancer was 4x6 cm, so huge beast....
I had 6 three week cycles of Oxaliplatin IV / Capecitabine tablets treatments which lasted until November 2020 and also 22 radiation therapy cycles. In December I was scheduled for surgery, but the tumour diapered. A day before surgery they did colonoscopy, a few weeks before MR and were surprised that there was now no signs of a tumour.. Not a lot of people have a so called complete response to chemo/radiation as the whole thing was administered only to shrink the tumour so surgery would be easier.. Lymph node the size of 4 cm was still visible on MR scan, but they said probably nothing to worry about as lymph node can remain big even if there is no active cancer in it.. Hope so as there are cases where cancer remained in the lymph nodes and then spread to near organs. In this case not to have surgery was surely a wrong decision, but as those surgeries are hard with many ill effects after + stoma bag etc, we decided to forego a surgery for now.. So I was discharged and am now on wait and watch approach with regular colonoscopy and MR / PET scans to be done in 3-12 month intervals.

I have been lifting weights for 20 years and was lifting also during my the whole treatment.. I took a few days off after IV chemo, but then continued. I was out of breath for sure as red blood cell declined from chemo, but other than that no problems. Did not do any cardio, only two daily 30 minutes walks. I was doing squats, pull-ups, deadlifts, bench presses etc for 1-2 sets of 5 reps. So about 20 minutes of heavy lifting and voila.. In December I also started running. After 20 years of not doing any cardio I decided I will combine weightlifting and running to improve conditioning and specially for heart health..

Late December I was watching TV and suddenly felt my pulse go up to 150 BPM (Garmin wristwatch). I was in shock. I am anxious person and I immediately thought I am having a heart attack. I did not have any chest pain but still, it was frightening. I immediately took beta blocker bisoprolol and half a pill of benzodiazepine (Bromazepam 1.5mg) to calm down and the pulse came back down within minutes..

[Tomaz26mb]

Then the same thing happened after about two weeks, this time while I was lifting weights - doing circuity style training with much lighted weights and 30 reps of main exercises for 3 cycles.. I was just finishing workout of squats, my pulse was 160 bpm as squats always fatigue me greatly, but when I sited down on a bench, pulse would not go down. I was sitting for a few minutes and my chest felt like it would explode. So I became very nervous again thinking dement now I will have a heart attack.. Went upstairs (I train at home), again took beta blocker and benzo and lied down. In a few minutes, pulse would go to 120, 110, 100, 90.. All good. But now I began to worry WTF is happening.

The third time was again a few weeks later, this time while I was in an MR machine having brain scan. Just a few minutes before it was over, bum, bum bum,.. Pulse up.. But this time I was of course not able to do anything about it as I way lying still in the machine, but it came down by itself in a few minutes..

I had enough at this time so I scheduled an appointment at cardiologist. He did an echo scan and results came back all clear. No thick heart muscle wall from all that heavy lifting, no increased aorta or anything.. A slight regurgitation on triscupital valve, but nothing special as people can have that from birth and it mostly does not cause any problems. Specially not that early. He gave me all clear for weightlifting and said that those tachycardias could be from vagal nerve so neurological / anxiety based.. He advised me to take beta blocker bisoprolol 1.25mg regularly and come back for Holter monitor if problems persist.
Tachycardia up to 185 bpm after chemo/radiation, possible link, anxiety?

[Tomaz26mb]

I thought ok all clear from cardiologist, I will continue lifting weights and running. I went for a run and felt uneasy from the start. Like I said I started running in december, right when those things also start happening. I never did much cardio before, only weightlifting and cycling to work, long walks, but no running.. I started in december very slow, Mafetone style where you run slow on very low pulse. I was careful that my pulse was never above 140. This meant combining walking/running in december, then by later February I could run 45 minutes on slow tempo with my pulse at about 130 all the time.. I thought wow nice improvement. When I started to run my pulse would go to about 160 but after a few of those slow runs I could now jog 30-45 minutes and pulse was 20-30 bps lower, between 130-140..

So back to the story, on that day I was running the same usual tempo, very slow, but my pulse was 140, which was odd. It should be about 125 with so slow speed. But I thought ok maybe I am fatigued, I will continue to run on higher pulse for a change. Specially as cardiologist gave me all clear the day before. I continued for 30 more minutes and pulse kept creeping up higher and was 150 bpm the last 15 minutes of the run, which again was odd as I never went above 140 and was even slightly faster on previous runs.. Then just a few minutes before finish, BOOM. This time pulse shot up to 185 bpm. My Garmin started beeping like crazy, I panicked. I became light headed, tore down my watch and chest strap as I did not want to even look at my watch. I was thinking there you go, heart attack... I was 300m from home so I was thinking to either call 911 or slowly walk home and lie down. As I am 40 years old my MAX pulse should be about 180 so 185 value was scary as this was even above my max. And maybe it went higher, I just pulled off my watch and strap. I managed to get home, lightheaded, panicked and frightened, lied down, took beta blocker and benzo again and slowly pulse was back down. Walking home felt like walking on clouds, probably from 185 pulse and adrenaline from panic attack...

[Tomaz26mb]

I am now continuously on beta blocker bisoprolol 1.25mg, but I take only half the pill daily. So I take only 1/2 of the lowest possible strength and in the last month, I did not have any tachycardia attacks. So obviously beta blocker, even such small dose, is working. But as my blood pressure was about 115/70 even before BB I feel dizzy sometimes as BB also drops your pressure, which was normal/low even before.. But my main problem at this stage is I am afraid to lift weights. I am afraid to go running as I do not want this thing to happen again. Pulse up to 150 was ok, not so scary, but seeing 185 bpm on my watch really scarred the s..out of me.. So no more running, only walking, I still lift weights, but check my watch obsessively and just wait when my pulse will shoot up again.

This is not a way to live.. Does anyone has similar experience. Could it be chemo related?

I read that chemotherapy can weaken ones heart and that Capecitabine can cause cardio toxicity, but not sure if this could still be 5 months later. As I saw cases where people had heart problems immediately after chemo treatment.. I am also not sure if doing cardio where I did none before started those heart problems and if I was only to lift weights maybe it would not happen. I probably had 150+ bpm many times before while doing squats, but as I did not have chest strap on and did not check my pulse, I had no idea and did not worry.. So maybe the solution is to just stop wearing Garmin as I think those devices are no ok for anxiety prone people. Specially since my cancer diagnosis I am now even more anxious..
But the funny thing is that cancer diagnosis and cancer treatment etc all went well. I had no problems with anxiety, no problems doing chemo/radiation, was happy all the time, no depressions. Now the heart problems really derailed me.. I am now constantly thinking about my heart and that I will have a heart attack.. This is really ****ed up. Cancer which is much more serious disease and could kill me in a few months did not cause anxiety problems and now some "imaginary" heart diagnosis is making my life hell and unable to sleep. I was thinking of going on benzos, but this sh.. is heavy addictive and at 40 years not sure this is a good idea. Sure it would help with my anxiety, but other than that..

[Tomaz26mb]

From time to time I just say to myself to stop being such a pussy, continue lifting and if it happens it happens (heart attack / AFIB). Siting in the corner of the room, rolled in a ball and feeling scared is not a way one would want to live anyway. But on the other hand if there is AFIB or some other thing like paroxysmal supraventricular tachycardia etc it should probably be checked out some more, before I continue lifting heavy weights.. I could try with light weights, but that never worked for me. I either go heavy or not at all.

I was thinking if there is any connection with doing cardio and those problems as like I said I never did slow steady cardio before other than cycling to work, a lot of long walks and never had those problems until I started running I know they suggest doing cardio even for real heart patients, even HIIT style training, but anyway.. Maybe slow and steady is not good for me

Also I do not see how anxiety could run my pulse from 150 during run to 185.. Why would I by anxious at the end of the run. Why would I be anxious watching TV.. Or maybe this all is going on inside the brain without you even knowing?

Any thoughts and/or experiences here would be helpful And sorry for long post. Just wanted to give you all the details as it is hard to explain in a few sentences.

[Gabbar99]

You need to get an ECG while you're in the high heartrate. I had heart rate shoot up and it turned out to be atrial fibrillation. But other conditions can cause tachycardia.

Get the halter monitor thing done or something else so they can see the rhythm while these tachycardia events are happening.

Keep bugging your cardiologist. Something is going on and it needs to get fixed.

[Tomaz26mb]

You need to get an ECG while you're in the high heartrate. I had heart rate shoot up and it turned out to be atrial fibrillation. But other conditions can cause tachycardia.

Get the halter monitor thing done or something else so they can see the rhythm while these tachycardia events are happening.

Keep bugging your cardiologist. Something is going on and it needs to get fixed.

Thanks for reply!

Yeah, I also think something is going on as I did not have those problems before.. The problem like you said is that as it happens I am no where near hospital and by the time I could get on ECG it is over. Holter will probably also not reveal much if those things happen only once per week or even less. I know there are now some Holter monitors that you can wear for a week or even more which only record once someting weird is going on, but I am not sure this is available here..

I was thinking of ordering Kardiamobile device or Apple watch / Samsung Galaxy watch / Fitbit.. Any of the FDA approved devices for AFIB. The most commented and highly appraised is Kardiamobile. But it only detects AFIB. For various tachycardias you have to record ECG and send it to cardiologist so he can read it. Also not sure it would work here..

If I may ask, how did you treat your AFIB? Did you get ablation done or with meds? Still on them? Also how was the feeling while it happend. There is probably no way to know right? I have a stethoscope at home as my mum worked as family doctor and I thought maybe I could use it to detect AFIB. As abnormal rythm should for sure be heard with stethoscope. I tryied searching YOUTUBE and found some AFIB sounds recordings

I will stay on low dose beta blocker for one more month to see if tachs return, then I will stop taking it and try to record next tachy if it returns. Or try to get Holter / Cycloerometry like you suggested and hopefully it happens while I wear it

thanks again for help

[Gabbar99]

If I may ask, how did you treat your AFIB? Did you get ablation done or with meds? Still on them? Also how was the feeling while it happend.

I've been an ultra runner for years in addition to lifting weights. I read a bunch about Maf training and other heartrate training and in ~2015 got a heart rate monitor and wore it for awhile. Found that I actually had to push more than normal to get my heartrate up to the Maf rate of the mid 120s (I'm in my 50s). If I just cruised, it'd be about 115, If I walked, it dropped below 100 pretty quick. Sometimes I'd run tempos or intervals and get it up to the 140s. A couple times looking later my cheap monitor said a max of 175, but I just figured it malfunctioned, which is quite likely. Stopped wearing the monitor for a few years.

Then in 2019 I fixed up my bike and started cycling and decided to try some triathlons. Starting riding an exercise bike at the gym at the university I work at. It had a built in heart rate monitor and it showed the same as running: ~115 when cruising, 125 when going a decent pace.

I started to get into doing the courses on the bike computer and competing against my colleagues. Set a goal of being #1 at our university (including students) on all 44 of the courses for the Fall '19 season. And I did it. It was fun to push harder and harder. Got so I could go for 20 min or more with my heartrate in the 150s.

Then weird things happened. My heartrate would jump up to 180, 200, 220 at the peak. Even weirder, it'd be in the 140s when cooling down and later in the fall in the 140s when barely warmed up. I figured the monitor on the bike didn't work (I always used the same bike). Then tried another bike and saw the same thing. Dang, all these bikes have faulty monitors. Taking my pulse manually on my wrist didn't quite work for some reason. Got out the old monitor: same thing. Bought a new, good monitor: same thing. Okay, I had to admit something was going on.

Asked about it on a triathlon forum and they were like "duh, you have afib". Got into see a cardiologist (took a few months) and had afib confirmed. I was in persistent afib, meaning I was in it all the time, not just when exercising. I felt fine, I never would have noticed without the bike monitor.

Cardiologist put me on metoprolol, a beta-blocker. Was going to get a cardioversion, but then a reverted to sinus rhythm on my own. Then back in afib a week later. Then went a few months where I was in afib for a month and then out for a week. This past fall I was in afib for four months straight. btw, I can tell within seconds if I"m in afib when I take my pulse.

Doc was in no big hurry to do anything. I had no symptoms (or so I thought) and he's mostly trying to keep sicker people from dying. But I kept reading "afib begets afib" and that I should do something. I bugged the cardiologist and he sent me to an EP.

The EP ordered a cardioversion, which was done in January. He also put me on flecainide, a rhythm control. I've now been in sinus rhythm for over two months. Don't know if I'll be on flecainide and metoprolol the rest of my life, but I'll stick with it for now. Triathletes say the metoprolol kinda takes away your top gear, but I'm willing to take it easy for awhile and let my heart remodel. I feel so much better and less tired now. I thought I had no symptoms, but I think I was the boiling frog.

The EP didn't give me any hard restrictions. I asked him about weight lifting and he said "that's okay, as long as you're not going hard like a bodybuilder or something" and I said actually I do go pretty hard. I did no exercise for nearly two months and just started back lifting and riding. I wear a monitor and try to keep my heartrate under 120. It is hard to hold back. I've read up on it and you don't want to go hard and you really don't want to do is the holding breath / Valsalva maneuver. Transient high blood pressure is a risk.

I've been off all caffeine and alcohol for over a year. I should lose weight, that is a risk too, but my good intentions / I'll start tomorrow diet hasn't really had any effect yet.

I got a free heart monitor app on my phone and it shows sorta an ECG. The day after my cardioversion, I was having some skipped beats and I took screenshots of those, normal scans, and saved scans from when I was in afib and sent those to the EP. He said those were very helpful. Not a real ECG and not as good as an Apple watch or Kardiamobile, but might be useful.

[Tomaz26mb]

Thanks for detailed explanation Gabbar, that was usefull. You must have very good conditioning with heart rates so low. When I started doing Mafetone training I was in the other camp together with most posters, just rolling my eyes when I saw that my pulse is up to 160 as soon as I start jogging. I knew I neglected cardio too much, but I just kept making excuses and reading various forums where BBs discussed how cardio is of no use, how lifting weights is cardio anyway as heart does not know when you lift or run as long as it is elevated.. Well I proved it myself this is not true. I lift weights continuously for 20 years, 3-5 times a week, but my cardio/conditioning is bad. And on top of that I cycle 30 min to work and 30 min back 9 months of the year, walk up hill once a week for 30 minutes and go for daily long walks, most of it on slight incline and my walking speed is very fast. Now that I started measuring my runs I can see that I walk about 6.5 km/h which is the speed of my slow jogging.. I also did include some cardio before/after lifting from time to time, but not much. And all in all I was so deconditioned that when I started running like I said my pulse would go to 160 immediately and would cycle between 145 and 160.. I did at least 3 runs per week from december of last year to march of this year and situation improved damaticaly, from one run to another. Just again goes to show how your heart and blood vessels adapt quickly when you start training them apropriaterly. After 10 runs or so my jogging pulse was already about 130, which is a huge improvement from 150-160, but even 130 is nothing compared to your numbers. Wow... But I never knew my pulse was that high as I never wore chest strap when going for a hike up hill. Also my breathing was quite ok and if I was to guess I would say my pulse was about 145.. Then when I started to wear chest strap I saw it is closer to 165... But again you do not feel that, specially if you go to gym regularly as you are used to high pulse.. This is also what I liked about Mafetone when he explained that most runners/hikers do it wrong. TRaining aerobically most of the time. They think they improve aerobic and heart etc but are mostly in the anaerobic zone. So was I when I went up the hill. And my primary mission was to walk for heart health, but If I was to check my pulse before I would see that I was walking way too fast and everything above 140-145 was already anaerobic zone. So is lifting weights.... Deliberate, steady, slow cardio is hard to replace, altought I know a lot of people (myself included) would rather do HIIT, hill sprints, etc.. Everything to avoid boring 45-60 min slow and steady cardio..