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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The diagnosis took 15 minutes in the ER, flat on my back, via an ECG. As soon as the leads were attached and the monitor commenced, they saw the telltale signs (for AF, no P-wave, variable timing in the R-R interval). I was taking no medication, using no significant alcohol, taking no supplements. Just undiagnosed sleep apnea.
Metoprolol is a 'rate control' medicine, not an anti-arrhythmic. It is intended to keep your fibrilling rate low. The results vary widely between patients, as do the amount of suppressed rate during NSR.
Yes to feeling like each of my legs feeling like they'd just gained 10 pounds, suddenly. I also felt my rapid heart rate in my left chest wall.
@gloaming
Thanks again. My wife wanted to take me to the ER but when I finally got to the car after a couple of minutes I felt fine. The doctor I met on the trail said that by the time we got to the ER the afib symptoms would most likely be gone. I will have to wait for the Holter and then do some stress test hikes which I already have planned out to trip the extreme fatigue response. I as well as others have no feeling of heart racing or palpitations. I actually feel fine but it feels like someone handed me a piano. My doctor was very careful about speculating on anything which I told him. He immediately ordered another 30 day Holter with more elevation gain hiking to provide data to determine what is going on.
Thanks again for taking the time to provide more info. I really appreciate it.
@afm
I like your mentality-go ahead and challenge that thing. That takes guts; you will get this figured out and get it under control with the drs help.
I have a similar set of experiences (fatigue hiking up hill) and I blame it on metoprolol. 2 years ago I had 3 stents placed in arteries that were 100% and 95% blocked. I have recovered from my heart attack and have been taking a low dose (12.5mg once a day) metoprolol since. My heart rate is slow and steady and seems to be limited to about 90bpm. I am told that the low heart rate is good, however my heart seems to not be able to raise above 90 when I exert myself like walking up hill or need to climb stairs. I regularly walk my dog on 5 mile or longer walks and whenever we go up hill my legs get heavy and I feel fatigued and the feeling subsides when we return to level or down hill walking. I set up my bicycle for aerobic training (as suggested by a cardiologist) and observed that I could not work my heart rate over 100bpm without significant effort and noted that when I had stepped up cycling effort my heart rate would drop before increasing with a corresponding period of being short of breath and feeling exhausted. In short, I experience temporary fatigue when I need to exert my body and I don't like it and I attribute this to metoprolol.
I have discussed this with my primary cardiologist and others I had asked for second opinions and thier directions were similar. A low heart rate is preferred relative to the chance of an Afib related stroke. I did experience Afib 2 years ago and have not experienced it since.
@4aces4me If you are eating or drinking anything containing caffeine, eliminate. Eat an extremely healthy diet. I am 77. And dont be walking in hot sun. Only early and late in the day.
@perner
Thanks for your reply. That is very interesting as I am experiencing a similar phenomena. No problem walking 5 - 7 miles on the flats but the two 10 mile hikes in which I included some moderate climbing is where I ran into the extreme fatigue with dizziness problem after ~ 500 ft of climbing in the first 4 - 5 miles. I am assuming that I was in afib based on the input from the doctor I met on the trail last weekend but I have no hard data to back that up. I am taking double the dose of Metoprolol as you at 25 mg once a day. I will buy a heart rate monitor and use it when hiking. Low heart rate would also explain fatigue and dizziness based on getting insufficient Oxygen to the muscles and brain.
Have you considered catheter ablation to solve the afib problem?
Thanks again
@lindy9
Thanks. I don't drink a lot of coffee and generally eat healthy. The hike we did last weekend was cloudy and foggy with drizzle for all of the hike. I also don't tolerate heat very well.
I dont know what your idea of a lot of coffee is, but I cannot drink one half cup of coffee made in the US, and could not when I was young neither. I had serious afib. Have none without it.
@afm
I don't believe that I have experienced Afib since December of 2023, a month after my heart attack when I tried to quit metoprolol (and failed). My fatigue is directly related to the inability of my heart to respond to the increase in energy needed on hills and stairs. My cardiologist has not discussed ablation with me.
@lindy9
I have one cup a day in the morning. Caffeine doesn’t affect me much at all. Occasionally I will drink a cup just before bed and sleep well.