How are you measuring heart rate? I'd be very concerned if I was seeing a sustained heart rate of 190 for anything other than maybe a super sprint, let alone >200. First make sure your monitor is correct, and if so I'd think you want to look into getting a patch monitor to check for afib.

Sounds like a bad heart rate monitor.

I’m not a doctor, just an interested person. Treat my note as anecdotal and potentially leading you to do your own research or getting medical screening…

Intro
High HR like this is considered a tachycardia. Same for your low resting HR, which formally is a bradycardia. The first one is not normal in your case, the latter is common among sporty people.

Procedure
Coronary calcium test seems way off. It’s good to know if you’re particularly at risk and need changes in your life or medicine, but this wouldn’t diagnose you.

You need:
A) assessment:
- heart USG to see if you have heart bruises
- some blood tests for heart protein(s) (I don’t exactly know what they are, but basically look for signs of heart damage, but this must be done between hours to max days after an episode)
B) diagnosis:
- static ECG (doesn’t harm, super easy to do for any time between 10s and 3h)
- stress test with ECG to see the pattern of the ECG when the tachycardia happens
- holter device, if the above two don’t show the tachycardia episode
C) treatment:
- depending on the type of tachycardia, you might be fine with no intervention (most of the cases), ablation or pacemaker

Guess
My crystal bowl 2021-retrospective guess and a forest lady magic advice? You’ve developed a form of arytmia either from covid or from the anti-covid jab. If you’re not losing consciousness or feeling chest pain during these episodes, then you heart still pumps oxygenated blood and it’s not damaged. If so, you’ll most probably be fine. Supplement with potassium and magnesium, avoid alcohol.

Ummm! okay, Was this a Chat gpt response?

To the OP, as other noted, first make sure your HRM is working correctly. If you experience these readings, I'd start by taking your pulse along the wrist. It's Simple, count the number of beats for 15 sec then multiply by 4.

It would be strange (unlikely even?) to have a HR of 220 and not feel symptoms much less to run distance. Did your cardiologist think that you actually hit 220. If you were deconditioned then your bike HR would also be elevated out of proportion to usual riding HR.

When I see A fib with rapid ventricular rate I typically see HR in the 150 up to 180 (but I'm not a cardiologist). For HR in the 220 I'd think of ventricular arrhythmias but perhaps the cards peeps can chime in. When it's that high without sx i think of bad readings.

Not sure if I should feel praised or offended. Anyway, I tried to structure & shorten my message, so that it’s well understood and clarifies the process of diagnosis. I think it was worth spending extra minutes to do so, because the topic is of life or death caliber. Happy to be corrected if I wrote something wrong.

On HRM
As per the HRM, on a Garmin basis. The upper limit is 230, above that the Garmin will stop recording, probably assuming it’s an error. However, e.g. if anyone’s heart “beats double” (upper and lower half out of sync), then it’s easy to mislead the HRM with 200+ bpm reading. It’s not straightforward to say whether such a reading from Garmin is then correct or not. But anyone with such an unexpected 200+ bpm reading would also feel it, palpitation-wise, by putting his/her palm on his/her chest.

Sorry. No offense meant. Your suggestions were good but It was so structured and concise that I thought it was auto generated. My bad!

Every time I see one of these threads, first thing I have to ask, and something you did not mention, did you stop and take a manual HR when the monitor was saying 220?? It should go without saying, but seems like everyone these days just relies on their machines, and ignores the obvious first step when seeing something wonky on the monitors..

This is TRUE

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E-DUB
Chief Janitor @Slowtwitch
Life is short. Dont be mad all the time.

Fellow ST members have provided you with a few tactics and recommendations - it'd be good to reply back on what you think & might proceed with, if anything.

@monty, I appreciate you may never have gone over 200, and nor do I nowadays, but I assure you (ime) trying to take an accurate "manual" reading counting over 3 beats a second on your own either radial or carotid is impossible (NB accurate within 10%).
Only the first 20 seconds matter (because HR drops quickly when stationary/effort off, so the max time of the count is 10 secs) and the other error induced is start finish counts.
Clearly a more accurate manual reading can be taken by a second party, but unlikely a competent person will be around, when the OP has their '220 moment'.
I would trust an HRM which has demonstrated reliability over months/years. Borrow someone else's (different make/frequency) for a second 'opinion' (wear both at the same time).
Having said that, 220 is top of the range, and I'd be very doubtful it's valid, for a 55 year old! My highest recorded (all at end of race sprints, I think in my 30s iirc) were 207, 206, 201, and 199 and on bi-annual testing (up a hill) I normally recorded 195.
Michal's comment seems excellent.

Sorry if I missed this, but to be clear - you are seeing these numbers on your watch/device/whatever but you feel fine (or at least normal race fine)? And this has been happening now for 3 years? Have you tried changing devices?

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Move on. Keep training. Be an adult.

When your HR spikes does it feel like it's spiking? What does actual effort feel like when it's supposedly 200+? Do some sort of hard running time trial (short something 800-3k range) & take manual heart rate at the end. Grab the 1st 10s & multiply by 6. Are you recording your HR data with a chest or arm strap? Wrist HR is much less reliable & spikes for no reason all the time. If you're using a strap then I'd be more concerned. Try switching out devices. If it's spiking like that then keep pursuing doctor help/advice.

I'm 31 & my HR "spiked" to 180 at the end of the last race I did. A decade ago I could get it to 200 but my max is now sub-190. 200+ @ 55 sounds impossible. Not perfect but 220-55 = 165. Your upper end should be somewhere around there. It does seem like you're something of an anomaly if even a couple years ago you were pushing well above that.

@monty, I appreciate you may never have gone over 200, and nor do I nowadays, but I assure you (ime) trying to take an accurate "manual" reading counting over 3 beats a second on your own either radial or carotid is impossible (NB accurate within 10%).
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Sure. But if the OP is expecting 160, that number is highly countable for a 6 second spell. Now the OP will know if his HR is indeed super spiked or if his technology is on the fritz. If his tech is malfunctioning, that is a very different pathway towards reconciliation than if his heart was on the fritz.

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Take a short break from ST and read my blog:
http://tri-banter.blogspot.com/

Thanks for all the recommendations. I did consider that it may be a faulty reading, and it was a wrist-based measurement from a Garmin Fenix 7. However, given that I'm consistently seeing it in races only on the first part of my run, I tend to think that it's something real. The advice on manually taking my HR is also helpful and I'll do that in the future. Also, I'm not experiencing any real symptoms during these episodes (i.e. no chest pain, shortness of breath, dizziness etc.) and am always surprised to see the high heart rates when reviewing my numbers. However, I do feel the need to slow down when this occurs and when I do my heart rate immediately comes down and stays down in a range that I would consider normal (even after I resume running). I'm doubtful that my HR is really as high as my Garmin is reporting (approaching 220), as I don't think I'm physically capable of going that high. Again, my concern is that my watch is being confused by an irregular heart rhythm, such as a-fib. As for what I plan to do, I've purchased a Frontier X2 heart rate strap. It provides a continuous EKG during workouts. I've used it and thus far haven't seen anything out of the ordinary. My plan is to try to recreate the conditions under which I've experienced the elevated heart rate and then share the EKG with my physician (who, as luck would have it, is also a triathlete). Thanks for being a supportive forum and listening to my issues.