V tach, Semi Vtach, Pre Vtach?

Almost 60 year old now, When younger , did commute year round 4 years never missed a day. Also did 4 long distance  rides with loaded bike, biggest one was 8000 miles Alaska to Boston.  Also did Ironman triathlon, marathons, Mt Washington hillclimb, etc. Total lifetime bicycle miles is approx 55,000, with a few years/periods totally off the bike due to marriage/work/kids/etc. When I am riding, I stack the miles on. 

For the past 23 years have been riding hardboot race/carve snowboards, very intense, good core training. This is where my situation starts,  My first day snowboarding for season,  after 3 warm up/go gentle runs,  the last run I was going in for a break,  and when I got the bottom, I was out of breath,  this is normal, but this did not slow down as usual , soI went into the 1st Aid door, 50 feet away.  I had a blocked left marginal,  was ballooned and 2mm stent. I now feel great,  and after 10 days of cardio rehab, am double stepping stairs again, with ease.

On the 10th day at rehab,On the arm spin machine, flywheel, after 8 minute warm up of 60 watts,  I got it going to 100 watts,  ok fine, I am good I went to 160 watts in a burst, held it there, and all is fine. After checking the data afterwards, I got a few Vtach 4 beat, for 2 seconds (if that), starting at 130 bpm.  Ok, I have found my limits, and something to stay away from.

Sinced then, no more arm spin machine,  I am holding a steady enrgy flow, on the leg push machine, aero spin bike, and treadmill,  with no Vtach at all.  However , I do push it a small amount , when at 8 minutes out of 10 minutes,  all warmed up, so hard not to.  At this point in time, the head instructor is saying he is seeing, a small amount of "pre Vtach",  "semi Vtach", which he describes to me as he some how is seeing it "about to go" Vtach" ,  I need/want  him to explain to me , show me exactly what he is seeing. 

Can any one else here , please explain this , or have had similiar incidents?


Pre/Semi Ventricular Tachycardia ??

by Gemita - 2023-03-16 15:58:35

Alpineboard:   I see you have had a stent placed in your Left Marginal Artery, which is a branch of the Circumflex Artery. 

When my husband started having bursts of non sustained VT (a common arrhythmia defined as 3 or more consecutive ventricular beats in a row, at a rate greater than 100 bpm, lasting less than 30 seconds), his doctors immediately looked for evidence of blocked arteries and he was found to be almost 100% blocked in his main artery, the Left Anterior Descending Artery.  His non sustained VT was a clear sign that all was not well and it probably saved his life.  However in the younger athletic population, bursts of non sustained Ventricular Tachycardia can be extremely common and of no concern as you will know.

As to your question and description of pre-Ventricular and semi-Ventricular Tachycardia, I would understand this to mean that your ECG is showing early signs of a non sustained Ventricular Tachycardia (see above definition).  Until the rhythm disturbance deteriorates into actual runs of “confirmed” non sustained Ventricular Tachycardia on your ECG, it will be difficult to assess the significance of these pre/semi-Vtach episodes (not an expression that my doctors use).  

I would want to ask your Cardio Rehab instructor to explain your ECG changes that he is seeing and the significance of these, especially as you have had your blockage cleared and stented?  I would particularly want to know whether the stent is still functioning well?  I would also want to know just how much you should really be pushing during exercise if you keep getting these early ECG rhythm changes?  But perhaps your Rehab team are not at all concerned, particularly if you aren't getting any troublesome symptoms?  

My pacemaker downloads often report "confirmed" runs of non sustained VT (around 8-12 beats duration).  I luckily do not have any evidence of coronary artery disease, but I do have intermittent atrial tachyarrhythmias (SVT, Flutter, Multi Focal Atrial Tachycardia and AFib).  

Early Vtach

by alpineboard - 2023-03-16 17:49:22

Thank you Gemita. With my many miles of bicycling, I am much stonger in my legs as compared to my upper body. I am still very stong in my upper body, but my legs have more miles in them. My instructor has seen this in comparing me using the arm only spin machine, to the leg spin machines.  He said I am rock solid 120 bpm on the leg machine, even when doing prologed changes of greater energy,  I stay right at 120 bpm, day after day. 

So after my upper threshold upper body vtac discovery, it was decided to do only leg machines , so to get a better analysis of my present condition. So far  when doing leg machine work, I am very solid steady 120 bpm.  Also keep in mind that this is very early season for my bicycle 2023 season, and that I am getting in shape as this analysis is proceding.  

From what I have read, any one who has had a recent heart attack, the scarred area can lead to an electric signal distruption that leads to Vtach , so Vtach after a heart attack is common, as time goes by, and training continues, the scarred area will rejuvenate and any possibilty of  Vtach will slowly go away, as well as these early vtach signs should diminish. Hopefully!  My instructor said 6 months. The most scary times are early preseason,  and for now, most of those early season miles are done, and i am starting to feel better riding.  Still being aware to go easy on climbing.

I just got back from a ride, and there is not any symptom  or reason to think that my stent is malfunctioning. That one time Vtach incident was from when I was pushing the limit to find the limit.  Thaks for your help and information. 

Hope all goes well for you

by Gemita - 2023-03-17 04:00:00

Alpineboard, you have made an excellent recovery following your stent.  As long as you listen to your body and don’t push past your limits, you should remain safe.

You mentioned a heart attack in your last comments?  I wasn’t aware that you had had a heart attack prior to your stent, certainly not from your introductory post?  Clearly not everyone suffers a heart attack from a critically blocked artery, at least not the lucky ones!

While arrhythmias can occur after any trauma and particularly after a heart attack, stent complications can also be a cause for arrhythmias which is why I mentioned this.  Unfortunately stent thrombosis/in-stent restenosis can still happen during the vulnerable period following a stent (first three months to up to a year) and I expect you are receiving anti platelet therapy (Aspirin or Clopidogrel) to protect against this?  Today’s stents feature different drugs that minimize the risk of both complications, but anti-clotting pills are still needed for up to a year and beyond in some cases, to protect us following stent placement.

I wish you all the very best and please keep up the brilliant work and come back and let us know how you progress

added information

by alpineboard - 2023-03-17 08:43:11

I gave the short version at my first post, as I know some do not read long posts. There are more intersting details , with some very interesting coincedences to my event, also that involve two other seperate cases of heart attacks, that I spoke with and knew to get help, as I had previosly informed them of my event details. We are all getting older, and Pre season training very carefully is a serious situation.   Yes on the apirin and copidogrel.

Thank you for the info and kind words.

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