Trouble going up stairs

I have a medtronic pacemaker for complete AV block. Probably caused by Covid. I feel completely fine and walk 8-10 kilometres several days a week. I have difficulty going up stairs. My pacemaker was set to go to 130. They increased it to 150. I feel like it's still not enough. Ideas?


Rate response

by doublehorn48 - 2023-01-23 15:15:44

I believe it's the rate responce that needs to be changed. A medtronic tech can help you with the stairs. But even with my pm set correctly I still can't go up stairs like I did before needing a pm.

Good luck

m scott


by AgentX86 - 2023-01-23 15:41:53

Welcome to the club, in more ways than one.

If you're also cronotropically incompetent (your heart rate doesn't increase on demand), you'll have a feature called "Rate Response" turned on. If this is the case, the pacemaker has to make a guess at an appropriate heart rate to pump enough blood to feed oxygen to the muscles and heart.  Normally the heart's sinus node (SI node) controls the rate by measuring the CO2 in the blood).  If the CO2 is high the heart rate goes up.

The Medtronic pacemaker uses an accelerometer to measure body movement, rather like a FitBit and it guesses at an appropriate heart rate for that motion.  This is normally simple motions and walking on level surface.  Walking up stairs takes a lot more energy (think stair climber vs. treadmill), so more oxygen is needed.  However, the pacemaker thinks you're just walking.  The bottom line is that you're not getting enough oxygen when climbing stairs.  You can try having settings changed but it's really a fundamental flaw in most (all Medtronics) pacemakers. I've had my pacemaker tweaked every which way and now with the RR setting set as sensive and as fast to respond as possible.  It's not enough.

Thank you AgentX

by Penguin - 2023-01-23 16:05:35

That was a really helpful explanation of RR and Medtronic devices AgentX. 


Thank you

by Lisa Michelle - 2023-01-23 16:19:27

Thank you all for your helpful and supportive responses. 

One more question

by Lisa Michelle - 2023-01-23 16:27:13

Assuming that the problem is just a limitation of the medtronic pm or a response setting issue, has anyone been told it can be dangerous to continue to exert by walking up stairs when it feels like the heart isn't keeping up with the activity level? I am going to cardio therapy to check it so don't worry, but I am just curious about what others have been told or experienced.

One more...

by AgentX86 - 2023-01-23 16:46:22

 I suspect that the safety of pushing past what the PM will easily handle varies from person to person.  If all else is well, it's no different than running.  If there are structural problems, it's probably not a good idea to run marathons.  It's a good point and one that should be answered by your cardiologist. I've complained about it since day one and it's just been shrugged off so I assume he's not worried. It's self-limiting.


Good Question

by Penguin - 2023-01-23 18:25:50

I've experienced the following: 

RR Issue

Example: Walking along a flat street then finding a steep hill or flight of stairs at the end of it. Poor RR wouldn't kick in effectively and would struggle to adjust heart rate to cope with the gradient.  Good RR would allow the heart rate to adjust smoothly and quickly. 

Underlying Cardiac Concern

In my case, symptoms would come on with longer term or more strenuous activities which outstrip what I can comfortably manage.  E.g. Digging the garden on a hot day or an activity which really tires me out.  I know when I've done too much because I start to feel shaky and have a worn feeling in my chest. I feel overwhelmingly exhausted. 

This isn't due to ineffective RR (although RR might contribute to how much I have been able to manage). 

Everyone is different but that's how I differentiate between something which has an underlying 'issue' as the cause and the pacemaker failing to help me when I need it due to unresponsive RR. 

I hope that helps a bit. 

So helpful

by Lisa Michelle - 2023-01-24 04:00:42

This forum is so helpful. I really appreciate all of you taking the time to share your knowledge and experiences. It has given me more peace of mind, more acceptance of my situation, and direction in terms of what to discuss with medical professionals.


by Tracey_E - 2023-01-24 09:10:13

Many of us struggle with stairs. My rate response setting are very aggressive at set to increase my rate on the sightest exertion, and I breezed through my last stress test so my conditioning is pretty good, but am huffing and puffing at the top of the stairs. Always. We are moving our whole bodies against gravity, by the time the pacer catches on we are at the top. 


by RogerK - 2023-01-24 14:43:32

I have not had a problem with stairs at all.  I recently had my Boston Scientific Accolade adjusted to respond up to a 165bpm heart rate.  My PM was originally set to pace me when my BPM was between 50 and 130. 

I swim competitively and in my post-implant return to training saw that my bpm was regularly above the upper pacing limit of 130bpm  I wasn't having arrythmia above the 130, but I was concerned that I might and that the PM would not respond, so I had the adjustment made.  I know my cardiologist selected Boston Scientific for me because it was be best option to accommodate an athlete during training and competitions. 

You might want to try wearing an HRM/running watch/apple watch, etc. when you are going up steps to see what level your BPM is reaching.  With this info, the upper limit on your PM can be set to reflect the physiological demands on your heart during this exertion

Stair climbing

by zr1john - 2023-01-26 23:56:11

I have a Boston Scientific pm and a Garmin fitness watch with an led heart rate monitor. If I jog in place for 5to 10 seconds and see my rate go up to the 80's or 90's then go up the stairs, I don't get light headed. Try it if your pm primarily paces using an accelerometer.

Rate Response

by Lisa Michelle - 2023-01-29 11:30:54

I went to the pacemaker techs again. They seem to have no awareness that people with pacemakers can have trouble with going up stairs. I asked about rate response and they called the medtronic rep who said it's not possible with my situation to open rate response, so it's not on. I have a complete AV Block, no other issues. They tried to draw me a picture of heart to explain why it wasn't relevant to me, but I really couldn't get it. They told me my PM is set as good as it can be and I shouldn't come back until my regular appointment in May. They said too much checking will wear down my battery. 

Forgot to mention

by Lisa Michelle - 2023-01-29 11:40:32

I took the idea someone shared here of checking my pulse as I walk normally and up stairs.

I found that it increases nicely when walking on a flat surface, but as I go up an incline, it doesn't seem to increase relative to exertion and in fact, I slow down because its hard. This actually causes my pulse to drop instead of increasing. If I stop to rest after a flight, even for literally 2 seconds, my pulse already drops from 120 approx. to 80 so I am essentially starting all over when I approach the next flight.

I am a 52 year old female. I am a tour guide and it's frustrating when I can't keep up with my clients. I can adjust the routes to some extent to include fewer stairs, but it's generally the inevitable part of most routes. I guess I just have to try to get them to be a little patient and wait a few seconds here and there. It's hard with families with teens...

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