Medical Query: 'Disturbances in Heart Rhythm'.

Discussion in 'Joining Up - Royal Navy Recruiting' started by j24, Jan 24, 2015.

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  1. j24

    j24 Midshipman

    Hi,

    Not sure if there's still anybody on the forum who can provide medical advice on certain conditions and issues, but I will post anyway in-case somebody has experienced something similar, or who have also fallen under this category..

    Just over three years ago, I went to the infirmary next to my campus at University with a concern of an awareness of my heart-beating. It happened once on that day and I thought it would be convenient to get it checked out seeing as an infirmary was so close by. Was nothing too alarming, could just feel my heart take an extra beat. The Dr put me on an ECG and after ten minutes of monitoring picked up two ectopic-beats, or more medically known as PVCs (premature ventricular contractions), and confirmed what it was. After taking me off, the Dr reassured me that it was completely inconsequential and it didn't surprise her with me being a student: 'stop drinking energy drinks late at night whilst writing your essays, caffeine is a common culprit with these', and sent me on my way. She was right, cans of cheap red-bull from the off-license a couple nights before helped me with meeting a deadline. After that, forgotten about.

    Only until I put my application forward for the Royal Marines recently, and then found the updated Medical Eligibility and guidance [AFCO5] notes under Heart and Cardiovascular disorders: Disturbances in heart rhythm, as a possible bar to entry.

    This sent me into sky-fall with anxiety, as it jolted my memory back to going on an ECG at Uni, and fearful it was put on my medical records after submitting myself to the infirmary those three good years ago. When I checked with my GP, the notes were there that I'd had this ECG done. [F*ck]

    After more reassurance from my own GP, she said they were normal and most, if not all people experience at least one ectopic-beat per day, some people are aware of them, others aren't. I explained to her about 'disturbances in heart rhythm' on the medical guidelines for the RN, and she said she wouldn't class an ectopic-beat, or 'heart palpitation' as a disturbance in heart rhythm. Something like A-fib, or Supraventricular tachycardia would be [which are medicated with Beta's]. Her reassurance unfortunately wasn't enough as my GP isn't an SMO from Lympstone, and probably isn't fully aware of the demanding physical stress and rigours of Commando training... Still, I requested to have an echo-cardiogram to make sure there was nothing wrong with my heart.

    Whilst having my echo done, the technician said my resting rate was around 54 and query'd if I participate in endurance training. I told her I competed in the BUCS Cross Country at Uni and was training for the Marines, as-well as a die-hard XC MTB'er. It confirmed and reassured her that I have a mild form of athletes heart. She said if I wasn't somebody who trains, it would have been a concern for her, for a 'normal' person to have a resting rate below 60. It's called Bradycardia, apparently. Other than that, my heart was structurally in top form [BP: 120/70: optimal range].

    I went home and did some research on athletes heart [syndrome], and some top athletes like Chris Hoy, who has been reported to have a resting rate as low as 28, perplex cardiologists, because their heart rhythms are grossly abnormal on ECGs. I even actually read somewhere that some Marines are so fit, their hearts have S3 gallops out of their normal heart rhythm range. Clearly a result of endurance training. Chris Terrill narrated on his Commando on the Frontline series that by Commando phase, each recruit will have the equivalent fitness of an international athlete. Makes sense..

    I haven't got to my medical yet, and I'm really concerned in telling the medical examiner about this and it becoming a PMU. I feel like I've shot myself in the face by getting a sticky-label put on my medical records, because I don't live with 'heart palpitations', or take medication for anything. My GP saw the anxiety it was causing me and said if she could remove it for me, she would. [Unforunately it's all on an NHS national database now.]

    Jeeze, long post! But thanks
     
    Last edited: Jan 25, 2015
  2. j24

    j24 Midshipman

    Also funnily enough, I saw a recruit in training post a tweet on Twitter saying: 'Ectopic Heartbeat, we meet again'. So clearly recruits are having these during training.

    So I'd really like a medical officer to explain what the guidelines mean surrounding 'disturbances in heart rhythm' and how they are classed as bars. There's such a broad range of arrhythmia's, from harmless to serious, so it makes the guideline a little convoluted and confusing.
     
    Last edited: Jan 25, 2015
  3. I'm in no way medically qualified so I can only speak from my own experience. At my RN medical I was made TMU for a suspected heart issue - which was the first I'd heard of anything like this, been training with no issues, never been to the doc with any issues, I was fit and healthy until he routinely 'listened' for problems with the stethoscope. My point saying all this is - if there is something there, it will most probably be found and you'll be TMU whilst they investigate. Best course of action if you proceed and get booked in for a medical, go to your GP and get them to give you written reports etc on everything so you can give this to the doctor administering your RM Medical. You need to declare existing medical issues as if not and it is a bar to entry you will get you booted even if you've begun basic training. I'm guessing many people do attempt to join thinking they're fit and healthy, go to a medical and something is actually discovered that they didn't know about and they can't join. It must be frustrating but unfortunately it's just one of them. I can understand the RN's point of view that the issue is not only your health during training etc but the impact this has upon your oppo's should you become unwell. I think you should apply as it may not be a bar to entry but again, I'm no Doctor
     
    • Like Like x 1
  4. j24

    j24 Midshipman

    I agree. I just somehow think it's going to be a significant issue somehow. When the Drs are listening to your heart with a stethoscope though, they're listening out for abnormal sounds and echo's the heart can make. Murmurs basically. Luckily there's two types of murmur's: functional and physiologic. The physiologic ones are the types where your heart most likely has a structural defect and is a bar to entry, whereas the functional types are considered benign and innocent, the result of just an extra sound the heart makes. My mate who has gone infantry is serving with an innocent murmur
     
  5. As Squashedbanana has mentioned.. if you are declaring it. Make sure you have all the the relevant supporting documents to take to your medical. If you've done any tests to prove you are fit in this region by a GP- take it! Chances are you are still going to be made TMU and possibly sent to a SMO to give the answer but as long as you have more supportive information with you, it can't hurt. I only wish I done that when I was made TMU to shorten the process!

    I wish you the best of luck!
     
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  6. Yes I know of a few serving with murmurs too so wasn't to panicky given my clear history. Just sharing my experience is all. Anyway do yourself a favour and take a bunch of paperwork with you if you go for a medical will save you time in the long run. Try as you'll always wonder what if. All the best
     
  7. j24

    j24 Midshipman

    Yeah thanks guys. It's just really difficult now carrying this anxiety on my shoulders, with a potential PMU round the corner, it's actually quite stressful and worrying. Is Angrydoc, or somebody qualified still not active on here - who can get a solid, evidence based answer? PRMC forum say he's [angrydoc] a genuine SMO. Also, would AFCO staff not be able to deal with this kind of query, or would I have to wait until I get to the MO who will then send it to RN medical top-brass?
     
    Last edited: Jan 24, 2015
  8. I'm not Doctor (obviously) but your situation seems a bit sticky for a careers adviser to give you a definitive answer... But what do I know! You could ask the AFCO, maybe Ninja knows a little?
     
  9. j24

    j24 Midshipman

    My mum and girlfriend however say ignorance is bliss. 'It was three years ago and you were told then it was no issue of concern. The first Dr told you to forget about it. You were told by your own GP it's no issue for concern either, whatsoever. So don't declare it'.

    I had to explain to them though that failing to declare anything that's present on your medical record can result in a dishonorable discharge. I'm aware that during day two of RT, you have a second thorough medical, where the MOs check your vaccinations, inoculations and also, so I'm lead to believe, scan through your passed over medical records to make sure there's nothing foul at play through misinformed information or deception from the first medical. I'd love to know what they would say during RT with it being discovered and me having no clue that it was an issue, through both time and forget - I don't suffer from anything symptomatic to have made me go back to the Drs about it.

    If it wasn't for the updated Medical Guidelines PDF, this would have been the case for me. Because I managed to print off a previous edit of the guidelines where 'Disturbances in Heart Ryhthm' isn't listed. It was only the updated guidelines I came across that ended up shock-fully re-jogging my memory.
     
    Last edited: Jan 25, 2015
  10. I was cleared to Commando Course with an arrhythmial and a resting HB of about 51 at the time. However, I was in Service, and I required a RN Surg Cdr Consultant Cardiologist to clear me. I suspect you'll have a bit of a wait, but should be fine.
     
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  11. j24

    j24 Midshipman

    Thankyou Alfred, sounds a little re-assuring. My mum [she's the one trying to keep my head level with this issue] even said: 'one of their senior cardiologists will just test you and get you cleared'. My mindset takes these things as black and white, I know that's not a good thing. However, because it says 'Disturbances in Heart Rhythm' as a bar, I instantly think the door is closed. Every case is assessed individually I've also been told, so I think I need to strictly look at this objectively.
     
    Last edited: Jan 24, 2015
  12. j24

    j24 Midshipman

    ..Would love to hear from one of the moderators. Ninja, Angrydoc, Nemesis..anybody?
     
  13. j24

    j24 Midshipman

    This post from 2011 off the PRMC forum appears to be something similar, and doesn't sound too good in terms of a successful outcome..

    Aril 27. 2011: http://www.royalmarines.uk/threads/palpitations.39469/#post-275776

    'Hey,

    Basically, I used to occasionally have palpitations when I undertook heavy exercisebut I thankfully don't get them anymore. It's been 18 months since the last one and that was only a minor one. I also learnt that I could just crack on through it after learning that it wasn't anything malicious through a series of tests at Papworth, where they specialise in heart problems.

    I told the doctor at my medical about them as, quite frankly, it's an issue that shouldn't even come in to the decision to allow me to join. However, I got sent back after a while (to Ipswich - a four hour round trip!) so that the doctor could open an email and read it out to me saying I was "currently considered unfit for service". I'm travelling at the moment so I obviously can't get hold of my local AFCO to talk to them about it (I will do when I get home but that's over three months away). I'm putting together an appeal against the decision with a strong letter from the cardiologist I saw at Papworth.

    Has anyone else been through the application process who used to suffer from palpitations and what was the outcome?

    Cheers, Tom'
     
  14. Ninja_Stoker

    Ninja_Stoker War Hero Moderator

    The bottom line is you'll be asked to produce a recent ECG if a heart defect is either detected by the medical examiner during the medical or if it's in your medical records and/or declared on the medical questionnaire.

    The danger is delving too deeply into the technical aspects - if it's benign you're OK. If the medical examiner is unable to declare you fit to enter on the day it'll be referred to an Occupational Health specialist or a cardiologist if needs be.

    The main thing is not to let it put you off applying and heading-off unnecessary delays at the pass by providing the medical data on the condition in time to meet the first appointment.

    Statistically, most are proven to be OK but it's impossible for anyone here to second guess without the qualified technical knowledge and access to a recent ECG.

    Good luck, stay positive.
     
  15. j24

    j24 Midshipman

    Thanks Ninja. As I said earlier on in the thread. A picked up arrhythmia, heart palpitation, or whatever you want to call it is entirely different to heart murmurs. Murmurs aren't considered a disturbance in the hearts rhythm, they're just extra sounds the heart can make. I think what I've learnt though, is that only a serving Commander Consultant Cardiologist is the one who will have the definitive answer as to whether it's a bar or not. The Medical Examiner will have no choice but to send it higher up for an answer anyway, I'm sure that will happen. So far, the cardiologists who carried out my echo, and two GPs I saw say these events are completely benign and irrelevant to your health. Gives me no option but to stay positive on that basis.
     

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