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New article on heart health in endurance athletes

Old 08-09-21, 09:29 AM
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New article on heart health in endurance athletes

On a subject near and dear to our hearts (literally), Sweat Science author Alex Hutchinson has just written a new article in Outside entitled:

________

There’s New Evidence on Heart Health in Endurance Athletes

After years of debate on the dangers of “too much exercise,” researchers sum up the state of current knowledge
________

The concluding paragraph:

________
Overall averages don’t tell the whole story, of course. Maybe running lots of ultramarathons adds a few months of life expectancy for 99 percent of us, but shortens it by a decade for an unlucky fraction of a percent who have some sort of underlying issue or genetic predisposition. That’s why this research continues to be important, in the hope that we can eventually figure out what those red flags might be. In the meantime, if you’re playing the odds, I’d suggest you keep running, swimming, and cycling to your heart’s content.
________
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Old 08-09-21, 10:08 AM
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I had irregular heartbeat/a-fib symptoms in 2017. Doctors didn't help much except to refer me to a cardiologist which the insurance denied. After 2 doctors fighting for 6 months, they relented and approved a consult. By then the symptoms had disappeared.
Until last month. I went with the fastest group and went all out in the hills and really over did it. Weird heartbeat came back, along with discomfort and a feeling of dread.
Considering seeing doctors again,if it doesn't improve.
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Old 08-09-21, 10:15 AM
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Most important sentence...

"In the meantime, if you’re playing the odds, I’d suggest you keep running, swimming, and cycling to your heart’s content."


Statistically that is correct. Because we have such a high population of sedentary folks in the U.S. it's also the reason we have high population of obese people and people with high blood pressure, high cholestorol etc.
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Old 08-09-21, 10:35 AM
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Originally Posted by terrymorse View Post
[size=33px]Overall averages donít tell the whole story, of course. Maybe running lots of ultramarathons adds a few months of life expectancy for 99 percent of us[/size][size=33px]
[/size]

The risk of gaining a few months by playing the odds doesnít seem to be enough of a reward.

I would think there is a range in which the benefits far outweigh the risks when it comes to exercise. The tough part is finding that fine line where an individual doesnít constantly exceed that range, especially as a person ages.

John
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Old 08-09-21, 01:32 PM
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Originally Posted by 70sSanO View Post
I would think there is a range in which the benefits far outweigh the risks when it comes to exercise. The tough part is finding that fine line where an individual doesn’t constantly exceed that range, especially as a person ages.
That seems to make sense, but so far, science hasn't been able to find an upper limit to that range, where the risks outweigh the benefits:

________

Master Endurance Athletes and Cardiovascular Controversies

Though many uncertainties are present, there continues to be no definitive data to support practitioners advice against high-level exercise for healthy individuals who choose to engage in high levels of physical activity.

--Tso et al, Current Sports Medicing Reports, 2020
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Old 08-09-21, 02:54 PM
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[QUOTE=terrymorse;22177392]That seems to make sense, but so far, science hasn't been able to find an upper limit to that range, where the risks outweigh the benefits.[QUOTE]

I would think the best data for an upper limit would be monitoring someone to the point of death, or significant life threatening damage, while doing high intensity/endurance. That might take a number of years to collect data and the trigger point.

But the data leading up to it would probably be invaluable. The downside is 10+ years of monitoring only to have someone drop out of the study; due to injury or lack of interest in continuing with the sport.

John
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Old 08-09-21, 05:44 PM
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Originally Posted by big john View Post
Until last month. I went with the fastest group and went all out in the hills and really over did it. Weird heartbeat came back, along with discomfort and a feeling of dread.
Considering seeing doctors again, if it doesn't improve.
John - so sorry to hear. I have only had a few non emergency/accident related brushes with modern medicine, and have left every one of them without a diagnosis or cure. Still having vertigo induced pukefests and trips to the ER every six months or so. The not knowing is the worst. Hope the docs can nail this one for you!
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Old 08-09-21, 06:09 PM
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My calcium score is zero and I do not have A-Fib.

My heart stops in the middle of the night many times for 3-8 seconds. (24/7 monitoring for a month on three separate occasions)

I feel quite certain my death will be a not so sudden cardiac arrest while sleeping. I have seen two pulmonologists and four cardiologists.

I have read all the studies. They have no clue nor is there any remote possibility of a clinical study. MI patients on the other hand are big money makers.

I accept it but what I do not accept is the arrogance of the Medical Community. For instance, I have felt my heart stop and told Docs. "No, you cannot feel your heart beat." Me: I can hear it and feel it. "No, that is impossible" When I have felt it stop, I put my little pointer finger onto the that little spot on the wrist and there was nothing. Nothing. I love the word, "idiopathic". It is Latin for, "We have no ******g idea, have a nice life"

In the end, each of us has to make a decision and it comes down to quality of life.
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Old 08-09-21, 06:14 PM
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Originally Posted by tigat View Post
John - so sorry to hear. I have only had a few non emergency/accident related brushes with modern medicine, and have left every one of them without a diagnosis or cure. Still having vertigo induced pukefests and trips to the ER every six months or so. The not knowing is the worst. Hope the docs can nail this one for you!
Thanks! I do seem to feel a little better today. I was thinking my post might have been out of place on this thread but actually it fits in with the risk/reward thing.
Usually the doctors just say something about how I "look good for may age". Seems hard to get them to take me seriously.

Here is a thing Mrs. John discovered for her vertigo.
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Old 08-09-21, 06:40 PM
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Originally Posted by big john View Post
I had irregular heartbeat/a-fib symptoms in 2017. Doctors didn't help much except to refer me to a cardiologist which the insurance denied. After 2 doctors fighting for 6 months, they relented and approved a consult. By then the symptoms had disappeared.
Until last month. I went with the fastest group and went all out in the hills and really over did it. Weird heartbeat came back, along with discomfort and a feeling of dread.
Considering seeing doctors again,if it doesn't improve.
FWIW, I have maybe once every 3-6 months a short period of unexplained high heartrate (typically 140 to 150) that lasts for usually 5-15 minutes (although once it went 2 hours). My primary doctor tells me that until/if we can 'catch this event on an EKG' there is little that can be done diagnostically. So until these become either more frequent (where a Holter monitor might help) or longer, I (like you) am kind of stuck in diagnostic limbo.

dave

ps. I have never encountered one of these while exercising. OTOH, if I was out on a moderately hard ride how would I know that I was encountering a 150 bpm heartrate event?
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Old 08-09-21, 06:47 PM
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Originally Posted by big john View Post
I had irregular heartbeat/a-fib symptoms in 2017. Doctors didn't help much except to refer me to a cardiologist which the insurance denied. After 2 doctors fighting for 6 months, they relented and approved a consult. By then the symptoms had disappeared.
Until last month. I went with the fastest group and went all out in the hills and really over did it. Weird heartbeat came back, along with discomfort and a feeling of dread.
Considering seeing doctors again,if it doesn't improve.
I had what I thought was a heart "event" riding several years ago (I'm 61 now). I took myself to the ER. After checking me out, and the next day taking a stress test on the treadmill which I passed "like a 35 year old" they said, the only thing they could figure was that my electrolytes were depleted. And, that the nurse initially put the little sticky things for the EKG in the wrong place. Was fine afterwards.
I have since had two different arrythmia things--one caused by a single dose of Cipro (never take that poison, please), and the other after having Covid in early 2020. They both have passed, and both times the docs didn't really have much to offer. I think anxiety is a huge factor, especially when we get older - the feeling of dread you describe. I use CBD now and I'm sold on this for anxiety and post workout recovery. I'll go to the doc if something seems really amiss of course.
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Old 08-09-21, 07:21 PM
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Originally Posted by DaveLeeNC View Post
FWIW, I have maybe once every 3-6 months a short period of unexplained high heartrate (typically 140 to 150) that lasts for usually 5-15 minutes (although once it went 2 hours). My primary doctor tells me that until/if we can 'catch this event on an EKG' there is little that can be done diagnostically. So until these become either more frequent (where a Holter monitor might help) or longer, I (like you) am kind of stuck in diagnostic limbo.

dave

ps. I have never encountered one of these while exercising. OTOH, if I was out on a moderately hard ride how would I know that I was encountering a 150 bpm heartrate event?
What I've had is the very irregular beats while sitting around in the evening but the recent thing had me experiencing the high heart rate while just warming up on a short ride. I went home and the next day it went high again but then went back to normal for the rest of the ride. frack
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Old 08-09-21, 07:29 PM
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Originally Posted by big john View Post
What I've had is the very irregular beats while sitting around in the evening but the recent thing had me experiencing the high heart rate while just warming up on a short ride. I went home and the next day it went high again but then went back to normal for the rest of the ride. frack
FWIW, the 'deal' that I have with my Doc is that if I have another event that lasts more than 20 minutes, I am to get my butt to the ER as quickly as possible for an EKG. Good luck.

dave
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Old 08-09-21, 07:44 PM
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Originally Posted by DaveLeeNC View Post
FWIW, the 'deal' that I have with my Doc is that if I have another event that lasts more than 20 minutes, I am to get my butt to the ER as quickly as possible for an EKG. Good luck.

dave
Is the Holter monitor the one they put on you for 24-48 hours and the cardiologist reviews it? My doctor wanted to do that last time but insurance said no.
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Old 08-09-21, 07:50 PM
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Originally Posted by big john View Post
Is the Holter monitor the one they put on you for 24-48 hours and the cardiologist reviews it? My doctor wanted to do that last time but insurance said no.
Yes - that is it. In my case the chances of the device seeing anything useful over 2 days is pretty small.

dave
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Old 08-09-21, 08:36 PM
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Regarding the point of the OP. Hell yeah, I'm going to ride. Maybe there's a small added risk to my heart, but there's surely an even bigger risk of serious injury in a crash. Not that I'm reckless- I try to be careful in every way I can, but riding is way too important to me. I'd rather have a shorter life that I enjoy by doing plenty of riding than a very long life sitting on the couch. And I doubt that the latter would be a long life because my mental and physical health would surely deteriorate without riding.

​​​​​Regarding big john , yeah, I feel for you. Both because of the weird heart things and especially because you aren't easily getting the care that you should be getting.
I may have symptoms similar to yours, I dunno. Up until 10 years ago, I could rev my heart in intervals as far as it would go and it would be just fine. But starting in my early 50s, I find that when I get my HR up "too high" too quickly*, I have this terrible feeling of malaise and feel the need to urgently get the HR down. This coincide with an unfortunate change in my heart rate recovery. Previous to this, after getting up to Z6, my HR would go right down by 50-60 bpm in the following 60 seconds. Ever since, it doesn't. It doesn't go own at all for the first 10-15 seconds after an interval ends, and after 60 seconds, it's gone down by 20-35 bpm.

I've had pretty much every kind of test, carried that 24 hour monitor that records everything, etc. Never been able to reproduce it in a way that the doctors could detect. An no doctor (I've seen multiple cardiologists, pulmonologists, etc.-_ I do have good insurance) has heard this description and identified a recognizable medical problem. And never had any evidence of afib. But it comes back - particular doing intervals - and I just hate it.

But I haven't stopped pushing myself or going full gas when I'm able, and nothing really bad has happened. Except that obviously, it limits my athletic ability during hard efforts. So maybe it's harmless. Or maybe one day I'll drop dead on the bike.

*"Too quickly" I can get the malaise by doing 60 second intervals (60 seconds on/60 seconds off) at 140-150% of FTP, and the feeling may show up at 170 or 175 bpm, say after the 4th or 5th interval. But if I'm putting in a hard steady effort at 120% FTP, I can go for 5 minutes and my HR will go up to 178 or 180 bpm, without the malaise.
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Old 08-09-21, 09:02 PM
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Originally Posted by DaveLeeNC View Post
Yes - that is it. In my case the chances of the device seeing anything useful over 2 days is pretty small.

dave
I had one they put on me for a week. Revealed nothing. Stressed me the hell out though! I'm lucky now finally I have a couple good docs who aren't into over-prescribing/over-testing/yadda yadda----hard to find these days.
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Old 08-09-21, 09:58 PM
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I feel better knowing that others have experienced some of the same stuff I have and are still riding and pushing through it.
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Old 08-09-21, 10:38 PM
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I had one of these monitors for a couple weeks after some vertigo issues:


(not my chest!)
There was a button to push if I had any events - I pushed it a couple times even though it wasn't bad just so they'd have something to look at. The whole thing got downloaded when it was over; it wasn't a wifi device or something.

My heart shows a little bit of the stuff that everybody gets - little calcium, little myopathy, little arrhythmia, docs aren't worried. I'll probably die of something else.
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Old 08-10-21, 02:16 AM
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Originally Posted by terrymorse View Post
On a subject near and dear to our hearts (literally), Sweat Science author Alex Hutchinson has just written a new article in Outside entitled:

________

There’s New Evidence on Heart Health in Endurance Athletes

After years of debate on the dangers of “too much exercise,” researchers sum up the state of current knowledge
________

The concluding paragraph:

________
Overall averages don’t tell the whole story, of course. Maybe running lots of ultramarathons adds a few months of life expectancy for 99 percent of us, but shortens it by a decade for an unlucky fraction of a percent who have some sort of underlying issue or genetic predisposition. That’s why this research continues to be important, in the hope that we can eventually figure out what those red flags might be. In the meantime, if you’re playing the odds, I’d suggest you keep running, swimming, and cycling to your heart’s content.
________
Seems to me that you ave to take care when you get older. I loved treadmill sprinting before a gym spinning class; nice warm up, kinda gets you in the mood for the serious stuff.
Then I pulled a muscle trying to do 10mph on this treadmill.
Talked it over with another guy my age (we were both early seventies) and he said he'd given up on running. Too many injuries.
Maybe the heart, too, being a muscle, thrives on hard work, but as you get older . . . just pull back a bit. Short and sweet is best for me since I have other stuff to do anyway; there's no harm in the leisurely bike ride now and again, but when you see those hills approaching . . .how can you not attack them? It is such fun!
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Old 08-10-21, 02:45 AM
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Originally Posted by big john View Post
Thanks! I do seem to feel a little better today. I was thinking my post might have been out of place on this thread but actually it fits in with the risk/reward thing.
Usually the doctors just say something about how I "look good for may age". Seems hard to get them to take me seriously.

Here is a thing Mrs. John discovered for her vertigo.
Carol Foster, MD Vertigo Treatment Oct 11 - YouTube
Interesting. I've done similar maneuvers for years to treat my own occasional vertigo. Never got a proper diagnosis. Most doctors aren't interested in chasing down vaguely annoying symptoms, no matter the impact on our quality of life. Heck, most doctors I've met are basically meat machine mechanics and if it's not in the Chilton's for Humans manual, they shrug you off.

Mine is probably a combination of routine sinus and ear congestion for allergies, nasal polyps that are getting worse (but I doubt I'll get an ENT outpatient surgery appointment until after the pandemic has settled down), a busted up C1-C2 from a car wreck 20 years ago, and lifelong problems with occasional severe headaches (variously diagnosed as migraine, cluster headaches and trigeminal neuralgia -- neurologists never seem to agree on anything).

Sometimes Sudafed, guaifenesin and switching antihistamines helps, which indicates allergies and sinus/ear congestion. And I use Flonase and ipratropium bromide nasal inhalers. Sometimes this stuff doesn't help.

I get palpitations and skipped heart beats a lot -- I can see it using my Wahoo Tickr and an HRV app -- but even when it shows up on my EKG most doctors don't seem concerned. My immunologist says quit drinking coffee and taking Sudafed. Probably right, but that's not gonna happen until they find a fix for the chronic congestion, sinus pain and occasional dizziness.

Anyway, sympathies to folks struggling to get a diagnosis and responsive doctor. I've had a few good docs but they're few and far between. Most seem to have lost interest in their work long ago, or are looking for a really exciting patient, not someone with routine maladies. And this was before the pandemic. I'm not expecting much right now due to the pandemic.
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Old 08-10-21, 02:55 AM
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Regarding the sudden death thing that seems to affect some high profile athletes who stayed in good shape after retirement, that would be among the least of my worries. If it happens, I probably won't even know it, or it'll be over with quickly even if I'm aware of it.

Among the most recent I can recall offhand was Marvelous Marvin Hagler, the retired middleweight boxing champion who died unexpectedly earlier this year at 66. Not "young," but Hagler was always well disciplined, stayed in good shape after retirement, and wasn't known to abuse drugs or booze (other than a brief period after his final career loss to Ray Leonard, according to insiders who knew Hagler back in the late 1980s-early '90s). He was often interviewed later in life and always seemed mentally sharp, and looked fit.

And the odds are that most folks who stay fit, eat well, get enough rest, etc., will live long enough to die of some lingering misery anyway. Considering how my parents and grandparents went out -- all lingering deaths, after years with cancer, COPD, congestive heart failure and/or dementia -- I'd rather go for the quick unexpected finish, preferably during a bike ride or run, or maybe while sleeping.
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Old 08-10-21, 06:52 AM
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Originally Posted by big john View Post
Is the Holter monitor the one they put on you for 24-48 hours and the cardiologist reviews it? My doctor wanted to do that last time but insurance said no.
There are newer event monitors that wirelessly communicate to a phone that is provided to you. The testing is 30 days. If you have an event of some sort, you push a button on the Android screen. Insurance did not cover it for me. It was around $1000 twice and the one time they did it free.

The first time of an event, I got a call from India at 2:50 am asking if they should send an ambulance. Why? We can't tell you. You had a problem. What problem? Call your Cardiologist. Ahh.....he is asleep. What problem? Sorry, we can't tell you. I told the fellow that I was on the way to a 400Km bike ride. Am I ok? Aside from the people monitoring events and calling you and scaring the crap out of you, these event monitors are easy to wear and can give useful info to your Cardiologist. I just wish it wasn't so expensive.
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Old 08-10-21, 07:01 AM
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Originally Posted by canklecat View Post
Interesting. I've done similar maneuvers for years to treat my own occasional vertigo. Never got a proper diagnosis. Most doctors aren't interested in chasing down vaguely annoying symptoms, no matter the impact on our quality of life. Heck, most doctors I've met are basically meat machine mechanics and if it's not in the Chilton's for Humans manual, they shrug you off.

Mine is probably a combination of routine sinus and ear congestion for allergies, nasal polyps that are getting worse (but I doubt I'll get an ENT outpatient surgery appointment until after the pandemic has settled down), a busted up C1-C2 from a car wreck 20 years ago, and lifelong problems with occasional severe headaches (variously diagnosed as migraine, cluster headaches and trigeminal neuralgia -- neurologists never seem to agree on anything).

Sometimes Sudafed, guaifenesin and switching antihistamines helps, which indicates allergies and sinus/ear congestion. And I use Flonase and ipratropium bromide nasal inhalers. Sometimes this stuff doesn't help.

I get palpitations and skipped heart beats a lot -- I can see it using my Wahoo Tickr and an HRV app -- but even when it shows up on my EKG most doctors don't seem concerned. My immunologist says quit drinking coffee and taking Sudafed. Probably right, but that's not gonna happen until they find a fix for the chronic congestion, sinus pain and occasional dizziness.

Anyway, sympathies to folks struggling to get a diagnosis and responsive doctor. I've had a few good docs but they're few and far between. Most seem to have lost interest in their work long ago, or are looking for a really exciting patient, not someone with routine maladies. And this was before the pandemic. I'm not expecting much right now due to the pandemic.
C2-7 are messed up on my neck. I get occipital neuralgia attacks quite often. I occasionally (not often) get Trigeminal neuralgia. The difference is quite simple. With occipital neuralgia, you wish you were dead. With trigeminal neuralgia, you think you ARE dead. This pain makes broken bones seem like a mosquito bite


I recently found a new pain mgt doctor he applied a nerve block to a couple occipital nerves at the base of my neck and the pain was greatly reduced. The next step was RF ablation of those nerves. It is no silver bullet. The cause of the problems are in my neck and that pain still exists, but the pain into the eyes and double vision is pretty much gone at this point. Just sharing in case you were not aware of this treatment.
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Old 08-10-21, 08:16 AM
  #25  
pbass
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Originally Posted by DiabloScott View Post
I had one of these monitors for a couple weeks after some vertigo issues:


(not my chest!)
There was a button to push if I had any events - I pushed it a couple times even though it wasn't bad just so they'd have something to look at. The whole thing got downloaded when it was over; it wasn't a wifi device or something.

My heart shows a little bit of the stuff that everybody gets - little calcium, little myopathy, little arrhythmia, docs aren't worried. I'll probably die of something else.
That's the same one I had. Like you, didn't show anything to worry about, unless of course as my doc said, I wanted to worry and keep trying different tests and whatnot to see if something would pop up - they'd be happy to comply...
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