Elevated HR during training, wanna train hard anyway.

Medical Q&A [Moderated]
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Firstly, let me say thanks to you both Jordan and Austin for the work you do. I appreciate having access to this kind of forum for real information and input. My apologies for the long post, but I wanted to give thorough information. I very much appreciate your time.

I’m a 5’9", 36yom firefighter. In 2018 I began a diet and lifestyle change. After seeing a cardiologist for palpitations and my PCP advising me that I had fatty liver and was on my way to some bad juju, I decided it was time to NOT weight 264 lbs anymore. I felt terrible most of the time and wanted change. I’m happy to say (this morning anyway) I weighed in at 193lbs, and I usually stay between 190-195 depending on activity for the week and calorie intake.

Some medical hx: I was never actually diagnosed or put on medication for hypertension, but it runs in the family and at that size I can’t imagine I wasn’t at least textbook pre-hypertensive. Was diagnosed with GERD, was on allergy meds, and feeling the heart issues and drinking way too much dark beer. A holter monitor didn’t reveal anything markedly concerning (according to them). To be sure they ordered an echo and I was diagnosed with left ventricular hypertrophy and with, in their words, “slight” pulmonic regurgitation, nothing that would require intervention of any kind. I’m happy to say I’m currently not on any acid reducing medicines or allergy medicines anymore. I supplement with Whey protein, Vitamin D, and some magnesium and that’s it.

Being a firefighter my health is something I take pretty seriously now. On two occasions (while wearing turnout pants and my helmet on a hot day) I’ve come close to passing out post-workout, once I actually had to get down before I fell, but I never lost consciousness and it resolved quickly.

My reason for posting is that I’ve become more and more aware recently that I’m getting some pretty high HR numbers in my workouts. I’ve also only begun wearing an Apple watch during workouts in the last year or so (series 5 if that makes a difference for HR accuracy?), and so I’ve been getting acquainted with my own vitals during workouts in a way I previously couldn’t.

During sleep I tend to be in the 50’s and as I’m sitting here typing I’m at 72, up walking and taking care of things during the day I tend to be in the 80’s/90’s. I understand for my age that recommendations for max HR would put me at 184. However, I find it easy to surpass this number in my workouts, and most certainly on the scene of a house fire if I’m doing interior attack. That said, full turnout gear, SCBA, and tools or a hose line add a LOT of weight and rise in body temp. This is something that’s always concerned me, but I tend to (and I know it) catastrophize things, but I’m also good at listening to reason. That’s why I’m here instead of Googling myself into being scared and not training.

I like my workouts to resemble the job, so I do a lot of wearing my turnout pants and flipping tires, hitting tires with a sledge, sled work, using a hoseline as a battle rope, dummy drags, sand bag work, etc. I do also train barbell movements, squat - press- deadlift. Running is kept to a minimum for IT band syndrome in my left leg.

I’m wondering if this is something to worry about. The last house fire I worked interior (it was a hot fire and nearly 100 degrees F outside that day) my HR had spiked to 204 while working. I’d say I was at RPE 9. During workouts however, when things aren’t as hot, I get into the high 180’s/90’s HR and RPE might be 6-8, depends on how hard I go from being cold or if I warm up first, etc.

I am completely open to recommendations/input. There are still times when I feel my heart rhythm might be a little off or feel like it skips a beat, sometimes I go days with nothing and then I might feel 1-2 times a day, but enough that I feel like something’s not right and I often (for whatever reason) feel the need to cough when it happens.

I haven’t been back to the cardiologist since I got all the weight off, but I’m just wanting to make sure I’m not putting myself in danger with these kinds of numbers. I’m feeling better than I ever have in my life overall and I want to keep training hard. I’m hoping that as I continue to train and condition that my HR won’t spike so hard during these workouts, but doing some reading has caused me to throttle back a little bit or take longer rest periods in workouts sometimes when I don’t feel like I need/want to.

If you’ve made it this far, THANK YOU for taking the time to read this, for all of your work, and for your dedication to health.

Sincerely, Jeremy

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Is there a particular reason you are monitoring your heart rate?

We can’t give you specific advice about this from the rate alone, without seeing what the actual underlying heart rhythm is during these episodes. But if you have never had any significant cardiac history, are not passing out with exercise, etc., then there’s a good chance that continuously monitoring your heart rate is generating more unnecessary anxiety than its worth.

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Thank you for the reply Austin. The self-monitoring was brought on by the initial feeling of palpitations that landed me with a cardiologist to begin with. Ever since then I’ve given it attention during workouts based on the recommendations of 220 minus age. I’d say the episode of having to get down before going down did get in my head, suddenly feeling weak and “the lights going dim” so to speak. That said, that episode happened about a year ago, and I’ve had 1 time since that I felt close to it again about 15-20 minutes post a pretty intense workout. I’ve been in both fire and plenty of workouts since then without that same feeling. It’s definitely not an every time thing.

I went through a divorce end of 2019 and the stress of that landed me in the ER once for an abnormal rhythm that the check-in nurse saw when they obtained initial vitals, but EKG didn’t catch it happening and cardiac bloodwork came back clean. So no, I wouldn’t say I have significant cardiac stuff going on, but sometimes I feel things that are enough that it takes my attention off of what I’m doing, which can feel significant and generate anxiety.

I’m more than willing to go with how I feel vs monitoring numbers, I just didn’t know if it was dangerous to train/work in those ranges based on my history.

Thanks again sir for your time!

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Those heart rate numbers themselves don’t necessarily raise concern on their own, but again - I don’t know anything about the underlying cardiac rhythm, which is the more important thing in most situations. If your evaluation has never revealed an abnormal rhythm and did not raise enough concern from your cardiologist to pursue further rhythm monitoring, I probably wouldn’t give excessive attention to these numbers or track them with a device.