Diagnosed with myocarditis, no idea how long I have had it but mild symptoms come and go every so often (for a number of years now). When I told the cardiologist that I was training for a marathon she recommended me to stop and do no more than half maratons. Is there data to support that certain volumes of training can have negative consequences in this regard? I am a little bummed as my plan was to go on and start doing Ultras, but ultimately my health is a lot more important.
Commenting on this requires a lot more information, e.g. why do you have myocarditis, what sort of workup have you had, management, other risk factors, and so on. I do not feel comfortable making general statements about training with myocarditis, though I can say the volume-related comment by the cardiologist is made up. That doesn’t mean it’s a bad (or good) recommendation, but it’s made-up nonetheless.
Myocarditis is typically a transient, self-limited condition, related to viral infection in most cases. It is very unlikely that you have had this for several years, although the possibility of chronic myocarditis would raise concern for an autoimmune disease that would require specific diagnosis and treatment.
If I had active myocarditis, I would not be doing dedicated “training” until it was sorted out.
Hi Jordan, no idea why. Likely a virus in the past. Presented to doctor with chest pains that were long-standing but becoming more frequent approx 12 months ago. After echo, the cardiologist suggested the pain was likely due to an old lung infection and scarring in the lungs and scheduled no follow-up. BP was also high on 24 hr monitor and was given meds by a local doctor. Moved house and got a new doctor who wasn’t happy with just giving a repeat prescription and referred to new cardiologist who did another 24 hour monitor and subsequent cardiac and renal MRI, which showed scarring in the heart.
The cardiologist didn’t say it was volume-related, that was my interpretation as she mentioned training for a half marathon is fine but not for a full.
Hi Austin, thanks for the reply. Maybe I misinterpreted the cardiologist and I had myocarditis but what remains is scarring. I’m not familiar with this condition. I did get the okay to train in general so perhaps it was something in the past, with mild symptoms that have occurred for as long as I can remember, but have died down relatively speaking.
A cardiac MRI would clearly show whether there is active myocarditis, so if that was not seen and all they saw was “scarring”, you do not have myocarditis. However, we are obviously operating with limited information here in terms of your cardiac evaluation and cannot give you specific advice.
Exercise should be restricted in the setting of active myocarditis, or with certain other heart conditions (e.g., LV non-compaction cardiomyopathy, or arrhythmogenic right ventricular cardiomyopathy).
If you have no symptoms at rest or with exertion, have normal cardiac biomarkers, and if you do not have any of these conditions beyond some non-specific “scar”, I am not sure on what basis the cardiologist is recommending this arbitrary limitation for you of a “half marathon but not a full”.
Thanks Austin, I probably didn’t get the full picture. I cannot remember if the cardiologist said had or likely had or how it’s specifically diagnosed with confidence. Everything else seemed fine. It is hard to remember when you have 20 minutes with the specialist and they are covering renal results, cardiac results, BP and medication changes, especially when I don’t understand these areas well.
Appreciate the input and food for thought when I have my follow up.
Apologies for digging up a previous thread. To clear it up a little, I did see the cardiologist again recently and she mentioned that the scaring was indicative of having had myocarditis at some point (I did not actively have it). I am not aware of when this may have been, but as you mentioned Austin, potentially down to an illness.
I am not sure if there were any other ways she deduced it was myocarditis, but I assuming I never had a heart attack and I am also assuming (?) from an ultrasound, ECG, holter monitor and cardiac MRI they would be able to see this.
The scarring itself does not affect pump function, however, the holter monitor did show an arrhythmia, with the pacemaker firing but a skipped beat every so often (sorry I am butchering that). The doctor did mention that this is associated with high levels of fitness and is nowhere near AFib or anything to be acutely concerned about.
So all in all, I am not worried, but coming back to my initial questions. I did ask is it okay to train for a marathon. I have read that excessive endurance exercise (EEE)is associated with increased heart scarring and I have listened to the podcast you have done on endurance exercise.
Her concern was that EEE could make the scarring worse (as per the associations) so she was recommending keeping the mileage where it is (40km/pw).
I tried to read some of the research but I don’t understand the heart, the full body of literature plus the context. I am not asking for your approval to train or not, but do you think there are strong mechanisms between excessively exceeding the CVD training recommendations (say 6 hours of running pw) and increased cardiac scarring?
Apologies for digging up a previous thread. To clear it up a little, I did see the cardiologist again recently and she mentioned that the scaring was indicative of having had myocarditis at some point (I did not actively have it). I am not aware of when this may have been, but as you mentioned Austin, potentially down to an illness.
I am not sure if there were any other ways she deduced it was myocarditis, but I assuming I never had a heart attack and I am also assuming (?) from an ultrasound, ECG, holter monitor and cardiac MRI they would be able to see this. I also had symptoms of minor chest pain at random every so often that has been going on for a long time.
The scarring itself does not affect pump function, however, the holter monitor did show an arrhythmia, with the pacemaker firing but a skipped beat every so often (sorry I am butchering that). The doctor did mention that this is associated with high levels of fitness and is nowhere near AFib or anything to be acutely concerned about.
So all in all, I am not worried, but coming back to my initial questions. I did ask is it okay to train for a marathon. I have read that excessive endurance exercise (EEE)is associated with increased heart scarring and I have listened to the podcast you have done on endurance exercise.
Her concern was that EEE could make the scarring worse (as per the associations) so she was recommending keeping the mileage where it is (40km/pw).
I tried to read some of the research but I don’t understand the heart, the full body of literature plus the context. I am not asking for your approval to train or not, but do you think there are strong mechanisms between excessively exceeding the CVD training recommendations (say 6 hours of running pw) and increased cardiac scarring?