Correspondence

Off at the Races — A Graphic Patient History

N Engl J Med 1998; 339:707September 3, 1998

Article

To the Editor:

A 58-year-old avid rower was profoundly frustrated by his poor performance in the Grand Masters Singles race during Boston's 1997 Head of the Charles Regatta. While putting his scull up on the rack, he appeared ashen and morose to a fellow oarsman, who was a physician. The man said that he could not understand why at midrace he was 10 seconds behind a competitor he had easily beaten the month before. The physician took his pulse and then brought him to the emergency room at Mt. Auburn Hospital, in Cambridge, Massachusetts.

The man had been in excellent physical health, highly conditioned by year-round intensive training in preparation for the event. He had no history of palpitations or other cardiovascular symptoms. He routinely measured his performance during practice trials and races by using a wrist device to track his pulse and a hull-fitted instrument to monitor the speed of the boat. Printouts of simultaneous recordings, made at 15-second intervals, were used to analyze each run.

When he came to see me in the office a month after the race, he brought along the charts from two practice runs and the race itself. The printout for a trial run 10 days before the race showed a reasonably consistent boat speed (approximately 3.9 m per second) that accelerated to a sprint during the last 300 m (Figure 1AFigure 1Heart Rate and Boat Speed during a Trial Run (Panel A) and during the Race (Panel B).). The heart rate was steady at about 170 beats per minute. The printout for the day of the race showed a somewhat high initial heart rate and boat speed due to the event's “flying start” (Figure 1B). When the quarter point approached, the boat speed declined abruptly and remained low, save for a moderate closing sprint. At just the time of the mysterious deceleration, the heart rate increased. During the subsequent 15-second intervals, it fluctuated erratically until the end of the race.

After the race, his pulse was found to be irregularly irregular, and atrial fibrillation at a ventricular rate of 77 beats per minute was documented on the electrocardiogram obtained at the hospital; nonspecific ST- and T-wave changes were present. An echocardiogram showed mild biatrial enlargement, trace mitral and tricuspid regurgitation, and mild pulmonic insufficiency. Within 24 hours, his heart had reverted to normal sinus rhythm, which has persisted.

This rower's only known paroxysm of atrial fibrillation struck shortly after the start of his most important race of the year. It lowered his cardiac output, his speed, his ranking, and his spirits. It was not a good day at the races.

Stephen Goldfinger, M.D.
Massachusetts General Hospital, Boston, MA 02114

Citing Articles (1)

Citing Articles

1. 1

   KRISTEN K. PATTON, ERAN S. ZACKS, JOSEPH Y. CHANG, MARISA A. SHEA, JEREMY N. RUSKIN, CALUM A. MACRAE, PATRICK T. ELLINOR. (2005) Clinical Subtypes of Lone Atrial Fibrillation. Pacing and Clinical Electrophysiology 28:7, 630-638
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