I have a PhD, no MD. The only experience I can share is that a relative of mine suffered from a myocarditis some time ago and that led me to dive into the literature.
I guess the best advice I can give you is to get a second opinion from a cardiologist with your history of a carditis and your current symptoms.
With that being said some questions from my side.
How was it diagnosed back then? Did you get a cardiac MRI done? Did it say something about a lowered ejection fraction (EF) or late enhancement? Any other abnormalities detected?
If no, did a cardiac ultrasound reveal a lowered ejection fraction or local/global wall hypokinesis?
In general ultrasound has a very low sensitivity in detecting an ongoing inflammation in the heart. Only if the inflammation leads to structural or functional changes (eg lowered EF) then the ultrasound will pick this up.
Testosterone is known to lower the immune systems ability to fight against eg a viral infection. So what you want to exclude is a reactivation of a latent viral infection in the heart due to TRT. Just to be on the safe side.
Maybe @spholtz can comment on that. I think he has an MD.
When I started TRT I got multiple ear and sinus infections never having had these in my life, as I acclimated to TRT things like this never occur again.
I got high potassium symptoms last night (increased dosage restarting TRT) and my heart was beating faster than normal, I had muscle spasms in legs and muscle were locking up on me.
Remember potassium allows the brain to communicate with the heart.
Without bloods/testing to confirm potassium being the culprit hereā¦ no offenceā¦ but taking a dieuretic isnāt a good idea. You have these issues EVERY time you go back onā¦ so why do you keep going back on? Do you really expect it to be different the next time round when youāre health parameters, weight etc have remained exactly the same? I apologise if Iām coming off like a dick, but this needs to be said, if you donāt seek helpā¦ you WILL die, and not within the distant future eitherā¦ more like intermediate future (say within 10 years)
You need a clear break from TRT, all things related to TRT and you need to get youāre health back on track. Iāll ask @flappinit to further expel advice regarding my concerns, I believe he/was is military, so he can be pretty Drillā¦ Sargentyā¦
(Marines are drill instructors, and DIās are way scarier than the other guys, sorrynotsorry)
I also donāt know shit about this though I donāt think thereās anything else I can say in this case. Flappinit needs to stop weighing in on stuff that he canāt change the outcome of!
Iāve had pharyngitis at the time and according to the doctor the infection damaged the cardiac membrane which caused myocarditis. Not sure if this is the right way to translate what he told us back then. FYI , i was smoking 2 packs a day along with very little sleep.
Yes MRI was done but i really canāt remember anything about the lowered EF or anything else.
At the end i did see another doctor after i left the hospital and he told me to rest for couple of months and stay away from stress.
Compared to year 2013 where i was diagnosed with myocarditis i am living and eating very healthy and exercise. Actually itās not even comparable.
Also i canāt be sure if TRT further increased my HR when i exercise but i just found out about this when i checked my pulse on the treadmillā¦
I am sure he will also tell me āYou are fine.ā. I will try anyhow.
Ok now itās come to a point where i canāt even do couple of reps before my heart literally stops me from doing more.
Is there any blood test i should be doing before i see a cardiologist?
I was itching to get back in the forum because of this topic. I to be when I exercise ( an talking light cardio) my heart rate goes to 140s. This with 4 mph 3% incline for 25 minutes.
Did you every check HR every 15-30 minutes after you exercise? I saw you only check 1x. What I noticed is my HR stays in the 90s for hours after cardio. Usually my rest hr during day is closer to 80.
Morning when I get up itās in 60s.
I have NI dilated cardiomyopathy. My EF was 45% in August. Dr said this could be why. But in November EF was 55% with ARB and BB treatment. So Dr said I have to retrain my heart to handle the exercise but this time with excercis and improved EF I should be able to improve HR. So we shall see. Said can take months of cardio.
Am doing exercise stress test Friday before I start the cardio. I just donāt see how itās healthy that a 25 minute cardio makes my HR high for hours. Dr said itās fine while I make my heart better. Idk.
Any way with the pro NP test. I actually just went to the hospital the other day for chest pain . Turns out to must likely be GI related. They took HS trip test. Was 6 then retook and was less than 6. The Nt pro bnp was 5 suppose to be less than 300. @johann77 if I am correct that means my heart is not working harder at all. Which is great since I have cardiomyopathy?
Thank you.
@kemosi take that hr after exercise. Lmk if itās elevated for hours after.
Mine does too after incredibly intensive cardio, itās normal, I can link literature to back that upā¦ not 90s for hours (unless Iāve just ran like cycled 40k or something)
Typically itāll be like 90 for an hour, then 80 for an hour, then 70s (RHR is about 58 without beta blockers, thatās what was on my last EKG)
In simple words. Nt proBNP is a marker for stress on the cardiac walls. Increased cardiac wall stress and therefore increased levels of Nt proBNP is due to an increased pressure in the left ventricle (overload). Itās used to screen for and to monitor dilated cardiomyopathy and other cardiac disease (eg is has been described that pericarditis can be differentiated from myocarditis by this test).
A value <50 is perfect (!) and levels over 300 are associated with an increased risk for cardiac events and mid term mortality.
At EF 55 and Nt proBNP <50 your heart is fine, the increased heart rate can also come from the medication you are taking (which essentially is telling you that they work, lower LV pressure but higher rate to pump the required blood volume)
ProBNP and Troponin T are both very low, thatās great!
Increased levels of Troponin T indicates dying of cardiac myocytes as it occurs in an acute myocardial infarction.
They tested troponin twice because it can take a couple of hours until troponin starts to rise after an infarction, so they were very diligent!
The ejection fraction is a measure of the cardiac output, so when the output of blood goes down, the heart needs to contract more frequently to keep up with the bodies demand.
This is however not the only cause why the heart can be higher either at rest or during exercise.
A high blood pressure is also frequently associated with a high resting heart rate. Blood pressure medication are able to reduce the systematic back pressure generated from the vascular system (backload) and thereby reduce the blood pressure and heart rate. However, it has been shown that during exercise this protective effect of this medication is absent which could cause again an increased elevation of blood pressure during exercise and a higher heart rate. I guess this is what they want to find out during the stress test in your case.
And other reason for an increased heart rate during rest or exercise was already mentioned by @unreal24278, the balance of the autonomous system between the parasympathicus (Ie vagal tone) and the sympathicus. In sensitive persons T can shift this balance towards the sympathicus. This causes also such effects as a higher resting heart or a slower recovery of the heart rate after exercise (slower withdrawal of the sympathicus due to a lower vagal tone).
Whatever it is in your case aerobic cardiac exercise is the best medicine available. In addition breathing exercises guided by heart rate variability was also shown to strengthen the vagal tonus and speed up recovery.
aerobic exercise, maybe guided by a heart rate monitor (talk to your cardiologist what a good max heart rate is for you).
I am currentky training for a half marathon. To prevent overtraining I use heart rate variability during exercise and at rest every morninh. You only need a chest strap from eg polar and an app eg HRV elite on your phone. Could be interesting for you aswell.
Interesting article
Did you have the stress test already? If yes how did it go?
I donāt think thereās anything else I can say in this case. Flappinit needs to stop weighing in on stuff that he canāt change the outcome of!