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Delayed Afib when hiking
Longer story but I was diagnosed with afib (95% of the time) a few months ago after a total ankle replacement in Dec '24. I am taking Metoprolol succinate (25 mg) once a day and Pradaxa (150 mg) twice a day. A 24 hour Holter showed no afib after starting the meds. I started hiking again with no difficulty for hikes of 8 miles with 1500 feet of climbing but had to back off because of a reverse shoulder replacement. 3 months after that I started hiking again.
I have had a couple of incidents of dizziness and lightheadedness when hiking. Last weekend I had the second incident of low energy and very difficult hiking at Pt Reyes National Seashore on Tomales Point on Sunday 9/20. We did a 9.5 mile hike of moderate difficulty with ~ 1400 ft of climbing. This was similar to the hike in July when I had a similar problem. I was fine for the first half but just before and after the turn around I experienced very low energy and had to repeatedly stop and rest. It was like a button had been pushed. We were drinking and had a couple of bars at the turn. Time to the turn around was ~ 2 hours and time back was ~ 4 hours. After the hike I felt OK and drove 2 hours to home. Slept well last night and feel fine this morning.
When we were sitting and resting a couple stopped to ask if we were OK. We were at 7 miles out of 9.5 miles. The man stated that he was a retired doctor. I talked to him awhile about my afib history. He took my pulse and stated that I was in afib at that moment. I was able to slowly make it back to the car with several rest stops included.
After the first incident and prior to this second incident I had a month long Holter showed no afib. I did a lot of walking – average 5 miles per day with long of 10 miles but all on flat. I didn’t do any hiking because it was very hot and I was apprehensive.
I would very much like to continue hiking and backpacking. My doctor is hesitant to make any conclusions from this hike but I will be starting another month long Holter test next week. I will be doing a lot of hiking and will attempt to duplicate conditions so that data will be available during any periods of low energy, lightheadedness, and dizziness.
Has anyone else experienced anything like this? Again the transition from feeling great to basically having zero energy is very rapid. I of course want to continue hiking and backpacking safely. I am a 76 year old male.
Thanks in advance for any help or suggestions. Also wondering if anyone else has experienced this.
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@perner
I thought I was somehow going into afib on the climbing hikes but your post leads me to believe it might be the Metoprolol. My understanding is that catheter ablation isn’t always successful but can be a long lasting solution.
I read your message and am confused. Are you in A-fib 95% of the time or out of it 95% of the time? Why are you on a B/P med and a blood thinner for your A-fib? I get the blood thinner but the B/P med is not specifically for A-fib, either for rate or rhythm. You said that while hiking the feelings of weakness and fatigue were off and on. You mentioned drinking (water? electrolyte drinks? alcohol? what?) I am not being judgmental, just asking. I am newly diagnosed with A-fib (almost a year) and I am scheduled for an ablation. If you are not experiencing consistent episodes of A-fib, you should get a second opinion before this condition spreads! Mine are very episodic and I find no consistent triggers in spite of making major life-style changes. I have tried anti-arrhythmic meds (may work but are very scary to read the side effects.) I also exercise daily and work out pretty hard. Almost all my episodes start at night with absolutely no known trigger. I do not have sleep apnea. I would suggest to you that you see an electrophysiologist before you have A-fib all the time, like a forest fire. Go to YouTube and get the facts of A-fib--how it works, how it spreads, how it is managed in the newest understanding and treatment of the disorder. So excuse my intrusion and just my opinion, but you are young enough that this matters! I'm 79 and I am not willing to live the rest of my life in this annoying and debilitating disorder.
@perner I have a friend who had something similar, but her heart rate dropped, like in some comments below, when she exercised. She had to have a pacemaker implanted and is doing much better now and able to exercise regularly.
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1 Reaction@sjm46
Thanks for your input. After experiencing fatigue almost all the time I was diagnosed (Holter monitor for 24 hours) with afib (95%0 of the time. I was prescribed Metoprolol (a beta blocker) which was confirmed to eliminate the afib (Holter monitor for 24 hours) and did indeed feel much better and was able to walk and hike on mostly flat terrain for 10 miles with no difficulty. I tried a 9 mile hike with some climbing in it and ran into the extreme fatigue problem. Once that extreme fatigue started it did not stop. Then had a Holter monitor on for one month which showed no afib problem again mostly on flat terrain. I then tried a 10 mile hike and had another extreme fatigue problem. I assumed that somehow the afib was being triggered for some reason but it might be the Metoprolol which limits adrenaline to the heart which limits maximum heart rate and also limits pumping power. I now have another 30 day Holter monitor test starting in a few days to see what is going on. I will challenge myself with very many long hikes with climbing to try and recreate the problem. I am close to 77 want to live with as few limitations as possible. Two years ago we did Kiliminjaro and the Inca Trail. We have plans to do a Mt. Langley and Mt. Whitney night/5 day backpacking loop next year but this extreme fatigue initiated by climbing problem must be resolved.
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1 ReactionI love to hike and enjoy the mountains, however, since my AFib diagnosis I can't travel to high elevations or hike up hills without going into AFib. I experience dyspnea, dizziness, and fatigue when I push my heart too hard. I wear a continuous oximeter to measure my oxygen level when hiking, my oximeter will alarm when my oxygen level drops below 90%, When I travel over 5000 feet, I need extra oxygen. I live at 4500 feet and my heart does fine jogging 5 miles on flat surfaces without oxygen.
The VO2 Max test is non invasive treadmill test your Cardiologist can order that may be very helpful to assess your heart's response to exercise and your oxygen update. I went into AFib after this test three years ago. I have modified my exercise routine and I have not experienced an AFib episode in 2 years. I take a low dose of a statin, but no other heart medications.
I also recommended getting a smart watch. I always wear my Apple Watch because my heart can go into AFib without any symptoms at a low heart rate. My watch will send out an alert.
The "AFib Cure " book by Dr John Day is also a great reference for lifestyle changes and treatment options.
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1 Reaction@afm
Hi, just another thought. Do you train for incline at a gym or anywhere in between hikes?
When I started section hiking the Appalachian Trail in 1997, I was a runner and living in Florida(flat). I thought I was in shape, but boy was I wrong! It was a rude awakening. I didn’t feel crushing fatigue, but then I was 42 at the time. Started training on incline treadmill and stepclimber at my gym, and what a difference. Also got heavily into strength training, including legs. Big difference.
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1 Reaction@sjm46 Once a person is diagnosed with AF, the physician will determine the patient's CHA2DS2-VASc score. Doctors use that score to assign a risk of thromboembolic stroke. If the score is 2.0 or higher, the patient is prescribed a DOAC (direct-acting oral anti-coagulant). This is routine and done by all cardiologists for all patients, certainly in N. America. So, with a large burden as afm has claimed, the risk of a stroke is high, close to six times what your regular patient with no arrhythmia might have. Incidentally, the gravest risk is from a clot leaking out of the left atrial appendage (LAA) where blood circulates poorly during AF. I know you know this, but readers later may not have learned about this risk.
You asked about BP meds. Many times signs of atrial or ventricular enlargement are due to mitral valve prolapse/regurgitation and due to hypertension. Each patient is assessed for all sorts of things when presenting with an arrhythmia of any kind, one of them being a test to see if they have underlying hypertension or pulmonary hypertension. Hypertension is highly linked to ventricular enlargement, sometimes atrial enlargement, and often with mitral valve prolapse. If there are even slight signs of incipient extents in any of these, then it might be a great time to beat back any hypertension. I'm guessing our friend was on the edge, maybe above it, and his/her physician felt they should commence taking BP meds.
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1 Reaction@janet23
Thanks - good information. My focus now is on challenging my heart to reproduce the problem when wearing the one month Holter to produce enough data for a good diagnosis on what is going on. It seems now more probable that the cause might be the Metoprolol. But the data will tell the tale.
@kudzu
I haven't been doing that lately but was doing actual stair climbing at our community center which has a double flight of stairs. Never had any problems doing the climbing but stopped due to a shoulder replacement procedure 5 months ago.
Good! Is there a way to figure out how many times you’d have to climb to replicate, say, a 1,000 or 1500’ elevation gain?
You can’t replicate the lower o2 at real elevation, but it might be interesting to know.
My reasoning is that if the heart is accustomed to climbing, it might be less stressed and less likely to flip into AFIB. Don’t know.
Also, is the exertion of climbing or lower o2 at elevation triggering it? Again I don’t know.