Ventricular Tachycardia forces retirement from competitive sport

Officially announcing my forced retirement from competitive sport.  However I’m happy to be alive and tremendously grateful to all the wonderful NHS staff, my friends and family.

It all started back in December when helping pace Sonia during a workout of 3x 5km. Towards the end of the final rep, feeling well in control, within an instant I felt like I was being suffocated. It forced me to stop running but luckily my breathing kicked back in as normal. Sonia shot by me, so I decided just to walk/jog the final 800m to the finish point. As I stood there I started to feel quite faint and had a very rapid heart rate. Thinking I was just a bit under the weather I tried to jog home, however my legs had nothing left, even walking was tough.

As I started to walk in the direction of home, I bumped into a friend and fellow runner. She came over to check if I was OK, as it was obviously unusual to see me walking! As I was talking to her I was struggling to catch my breath and focus on what she had to say. It felt so strange and all I wanted to do was to get back home. At this stage, Sonia had ran back and said she would return with the car.

Half way up the hill, as I felt progressively dizzy, I decided to stop and rest. I was bent over just trying to keep my head low. It seemed like an eternity for Sonia to return and all I can remember thinking was that I hope I would see her face again. That’s how bad I was starting to feel. At one point, I also considered asking a passer by to call an ambulance, however I didn’t want to seem over dramatic so eventually talked myself out of that.

Sonia arrived and I climbed into the car. The relief of seeing my beautiful wife again and being able to talk to her settled me somewhat and once we arrived at home, I went to lay down on the bed. After about 20 minutes, as quickly as the issue had first arisen, I suddenly started feeling OK again. I went downstairs, had a nice lunch and carried on as normal.

A few weeks passed with many successful workouts and runs. Then on 27th December, the same symptoms arose. This time I was on the static bike, in the garage and so I had the advantage to come straight back inside. Again I was dizzy, short of breath and with a crazy heart rate. This time I popped on my heart rate monitor and was recording heart rates of 240bpm!! After roughly 30minutes of writhing around on the floor looking pretty pathetic, I instantly recovered back to normal.

Now I was slightly spooked as it was the second occurrence and that heart rate concerned me. I did a bit of Googling and happened across something called the Valsalva manouvre which was a suggested technique to reset a rapid heart rate. I also planned to book in with my GP, but it was the Christmas period and I was due to fly to Germany in two days for a NYE race. As such, I decided I would go and see the Doctor in early January.

I was understandably a little apprehensive towards racing in Germany. After a cautious start, I built the pace and ended up running around 5:05/mi for 5 miles. I was very pleased with this given the little training I had during recent times. I was also extremely relieved that I did not have a repeat episode.

Saturday 4th January – only 2 repetitions in to a bike session, BANG! It’s happened again. This time I went for ~1hour before my body reset to its natural heart rhythm – the longest I’d taken to come around. I had tried the Valsalva, but to no avail.

An urgent appointment to see my GP resulted in a private referral to a Cardiologist who I booked to see as soon as possible. Running and cycling took a back seat although I continued to exercise at a relaxed intensity without any further issues. Blood tests, ECG’s and Echocardiagrams were performed with no obvious cause for concern. I was also fitted with a 7 day ECG monitor and asked to try and trigger another episode. After how it had made me feel, again I was apprehensive, but happy we would be closer to finding the cause. Despite valiant attempts I could not trigger one, despite pushing as hard as I could, day after day. Early workouts did however show me hitting heart rates in the 190’s with my resting around 60bpm – both values being around 10-20bpm more than I’ve been able to produce over the past 10 years at least. After about 10 days since the last episode and mid-way through my 7-day monitoring, my normal heart rate rhythm resumed (max ~170-180, resting ~45bpm)

Back to the cardiologist for the results, now 3 weeks since my last episode with lots of successful workouts at high intensity. Monitoring was also inconclusive. This was not a surprise as I had not triggered an event. There were a few skipped beats here and there and I was proud I’d managed to record a heart rate of 32bpm (although I think this was extrapolated over a very short timeframe of a few seconds). So Sonia still holds the title of best household resting HR. The parting advice was to carry on as normal and visit a medical facility to record an immediate ECG if an episode re-occurs.

I was starting to feel much more confident that maybe it was just some random issue that had now resolved. Four days later, Wednesday 29th January, it happened again :(. This time, Sonia drove me immediately to the Loughborough urgent care centre. I walked in under my own steam and explained my symptoms to the receptionist. There was not too much concern which reassured me. I was asked to take a seat and someone would be through shortly. A few minutes later I was taken through to triage and quickly attached to an ECG. Seconds later the room was a hive of activity with a number of emergency medical staff in attendance. The machine was going nuts with alarms and I was learning my heart was in “Ventricular Tachycardia” or VT, the most dangerous of heart arrythmias. This is where the ventricles are not contracting correctly, starving my body of oxygen. My heart rate was also showing as 240bpm!!

One of the most distressing parts of this episode, was that Sonia was sat at the end of the bed watching me. I was trying to provide reassurance I was OK and making light of the situation. I got the feeling the medical staff were also trying to do the same with me, however as time progressed I had defibrillator pads applied to my chest. Now I was starting to panic a little, even though, looking back, I was only experiencing the same symptoms I had in my previous 3 episodes. Without warning I suddenly felt a pain in my chest that caused me to lurch upright. As I did so, I will never forget the fear I sensed from Sonia as she was unaware what was happening. I never want to put her in such a position again. the good news, however, was this pain was my body kicking me back into a normal sinus heart rythum and my HR immediately stabilised around 70bpm. I felt all of the blood rush back to my extremities and again joked with everyone in the room that I was ready to get up and walk back home.

We waited about 30minutes for an ambulance and I was told I was being taken to the Cardiac Care Unit at Glenfield Hostiptal in Leicester, one of the country’s leading specialists heart locations. I felt very relived to be going straight there but fully beleived I would only be going for a cautionary check over and would hopefully be out either that evening or first thing in the morning. I was about to receive my second shock of the day!

Upon arriving I was checked over by many highly skilled individuals and started to undergo a number of investigations. I was quickly told to expect this would now be the end of any serious competitive exercise and I would likely be on medication for life and would required an “ICD” – an internal defibrillator device that attempts to pace you out of VT and/or delivers a very powerful shock if not. This all sounded scary, but I was reassured by the fact I was still alive. Indeed, most of the medical professionals who visited my bedside remarked that it was very unusual for anyone to be in such a state of VT for as long as I have been managing without either blacking out or going into full cardiac arrest. I now realised why the earlier paramedics had the defibrillator pads ready. In the middle of the night I was awoken by one of the doctors who was very keen to double check I hadn’t been having any chest pains as my blood tests showed elevated levels of Troponin T, an enzyme that is released during muscle damage related to heart attacks. Luckily this is also released from leg muscles when smashing a run or bike workout too, so I think this was all put down to the activity I was performing immediately before I went into VT.

I’ve never been admitted to hospital as an in-patient and so everything was so very new. In some ways there are parallels to being imprisoned; trapped on your bed (I was connected via a multitude of wires and tubes, so there was no leaving!) with no real understanding of when or if I would ever be released. The only good news was that I knew it was all in my very best interests and I was surrounded by lots of highly skilled and caring people who were trying their very best to ensure my release. I was brought food, drinks and pots to do my business in. Nice! I could also see my heart rhythm 24×7 which I started to transfix on, getting increasingly anxious that I may, at any time, revert back into VT. Even eating on the first night was causing my heart rate to rise, so I ended up very much without an appetite. I tried to sleep the best I could on the first night, but with my HR around 70-80 I knew that was not very normal for me.

The next morning came and my HR had come down to around 60bpm, still 10-15 beats above average but I felt fine taking into consideration my current situation and experiences of the preceding evening. I was also reassured that in the 10-11 days following previous VT episodes my heart rate had regularly been 10-15 beats higher than normal both whilst resting and whilst exercising, so I lived in hope that this would be a medium term state. More specialists came to visit me at my bedside and hear my story and soon I was transferred onto a remote telemetry system which gave me the freedom of leaving my bed and walking around the ward. It was a big step, however the biggest loop on the ward was a small 50m corridor that I could walk around. The other massive benefits were independent use of the toilet facilitates and being able to chat to fellow patients – an activity that was soon to result in the forming of many strong friendships and was providing an incredible level of reassurance things were going to get better.

By Friday I was told I needed a cardiac MRI to get a very accurate picture of my heart to check for defects and reasons behind my symptoms. This would be key to figuring out what has been going wrong and to help formulate a plan of what is needed to get to discharge. Then, without much notice, I was told I was being moved wards. I was now deemed less of a critical risk as I was moving around, so up I went to ward 28. In almost the same space of time, I started to realise I may not be getting an MRI today and that not much happens over the weekend in hospitals for anyone but the most critically ill patients. Again, I felt fortunate to not be categorised as such!

Facing a weekend of ward confinement with very little progress towards discharge due to happen, we quickly formed a group of fellow patients I coined the Ward 28 Day Room crew after the small room we often found ourselves in as the only refuge from our bed spaces. Hardly touching our mobile phones we spent all weekend watching the sport, swapping stories and experience of life. It brought us all close together and rallied to keep everyone’s spirits high. The nurses and staff were also thoroughly involved in the banter and doing everything they could to keep us all positive. Outside of this reaching out to fellow athletes who had also suffered from cardiac arrhythmias further assisted in providing reassurance that I was not alone and quickly highlighted just how many elite level competitors have been afflicted. Only the day after being admitted, 38 year old (same as me), Vasil Kiryienka of Team Ineos had just announced his retirement with “Cardiac Issues”. Sonia and my friends visited daily, seeing her was the single biggest reason to keep going and stay positive.

Monday arrives and I feel very fortunate to one of the senior sisters who was my acting guardian angel. She’d managed to do everything she could to progress my case. I quickly learnt the news I was scheduled an MRI for 11:30 that morning. As a claustrophobic, I went into the machine with more anxiety but it was quickly quelled by thoughts of the reward of an accurate diagnosis. Cardiac MRI’s require you to hold your breath many times, often for an unspecified amount of time. Felt like a workout, bonus! Results were next to follow but required a number of specialists and teams to review before these could be discussed, so a bit more waiting made all the easier with the Ward 28 Day Room Crew.

The diagnosis is so far slightly inconclusive. A slight thickening of the heart muscle with some scarring, cause unknown. Current theory is potentially a combination of hereditary factors, historic over training, historic stress on the heart whilst having a virus or infection and age. More tests will help get closer, but we may never know. However the key aim now is to avoid VT at all costs, this is the rythumn that often results in Sudden Cardiac Death, so not something to encourage ever again. The first guidance I’ve been given is to take beta blockers daily for the rest of my life. Fine, no biggie.

However, the second piece of advice I’ve been asked to follow is to exercise only once every 2 days and all must be of easy-moderate intensity. This must be a novel rarity for a cardiologist to prescribe a reduction in exercise levels! No intervals, no racing, no chasing the random guy who’s just ran/cycled across my path. This could be the toughest challenge yet. Since I can remember, competition has always been central to my existence. I’ve always striven to be the fastest, craziest, most intense athlete (even though not always the one winning the races). How will I now suppress these urges that have defined me for so long? The only thing I’m grasping on to at the moment, is I NEVER want to put Sonia in that position again and I’ll do everything I can to avoid it.

I’ll return to the hospital in a few months time to be rechecked to see if there has been any change in the cardiomyopathy, to rule out any other cause that could be making it worse. For now I’m facing into the prospect of a new chapter in my life and regularly reciting the mantra “Don’t be sad it’s over, be happy it happened”. Not just the achievements, but the journey and the amazing people I’ve met (most notably my wife & number 1 superstar) doing this sport we all love.

I hope I can be of help to anyone who may go through similar experiences in the future like a good number of the running community provided for me. I also hope I can add to knowledge and understanding of such conditions and how people can be better equipped with the right knowledge to keep their own heart health in peak condition.