Upper limit for PM

Long time no post here but glad to be back, reading and hearing of success stories. It's been 2 years since I had my Medtronic ADDRL1 implanted for bradycardia problems occurring during any effort. Have not had to have any attention since the implant. I am taking 80 mg of Propranalol a day (when I remember) to help with junctional tachycardia that was observed before my PM was fitted but to tell the truth I need to get off of it altogether to see if it makes a difference.

My question is about my upper limit setting. The doc prescribed settings of 60/140. I know my natural conduction works sometimes but it is pretty certain that the PM kicks in within minutes after I start to do anything that requires effort. I am trying to get back into running. I can't seem to go more than a quarter mile @ 10+ mt pace, my legs get weak, I'm breathing hard and I have to stop and walk a lap or two. Now it's been more than 8 years since I've been able to run more than what I can do now and for the 5 years before my PM (2 years ago) I was limited by my bradycardia.

After my PM was fitted I wondered whether 140 was limiting and the doc said that a higher HR for exercising was not really needed and said that he would also have to adjust the slope and I might have too high a rate when I stopped exercising. He also said that 140 for my age (65) was high enough! At the time I did not press the matter since I thought I should first go back and start working out regularly and more seriously and then go back to the doc after I felt that I was getting nowhere. Now I haven't been doing that thanks to long work days and I'm overweight about 10-15 lbs. Is this still the best approach or is it possible that changing the upper rate will help me improve fitness in that it would let me improve. I know some people here have their PM without an upper limit. How does that PM behave when load is increased, will it just keep ramping up as effort increases?

Any advice/info on the upper limit setting will be appreciated.

9 Comments

Proprananol

by annaelliott76 - 2009-12-16 10:12:34

I'm not going to be much help here, but I do know about Proprananol. I'm in my 30s and just got my PM 4 weeks ago. Mine is set with a range of 70-140 and I have been wondering the same about exercise as I recover. I have a few extra pounds that have to go. I have been on wonderful Inderal LA for a year. I'm at 120mg BID and still we are tweaking. I take my meds religiously, because I pay for it if I do not. Discuss this with your doctor first, but since you don't always take it on a regular basis, try skipping a dose on purpose monitor yourself and see how you feel. We've done this a few times with me just to check. Or you can even have them do a holter monitor without to see how high your rate is going on its own.You can always jump back on. I plan on starting of my exercise in a cardiac rehab setting for two reasons; to build my stamina up again and to see exactly how my rates should be set. We had tried this prior to my PM. They gave me a upper limit for rehab without PM of 170, however I went brady instead. That's when we decided on the PM.

Rate Respose Slope

by ppt - 2009-12-16 10:12:46

Is your Rate Response On or Off? If it is "On" there is another setting associated with the Rate Response, slope. My PM (Medtronic Versa dual chamber) has slope settings of Low/Medium/Medium High/High. This setting is related to how fast the heart responds to the body's need for more metabolic support (e.g. while exercising). We had to "play" with my settings - starting first at Low - and am now set at Medium High and I seem to do "OK" - certainly better but not perfect. Try discussing this with your Dr. I also just learned last week that there may be a setting as well for the rate at which the heart "responds" after heavy exercise. .. i.e. the rate at which the heart returns to normal. Am going to discuss this with the EP at next appointment. Cheers and Good Luck and Happy Holidays !!

Limits

by ElectricFrank - 2009-12-17 01:12:12

It's fairly easy to check if the upper limit is affecting your exercise. Make several stops during your exercise and take your pulse. If it is getting near 140 then trying to push on will hit the limit. The problem is in the way the pacer enforces the limit. When you exceed 140 the pacer starts skipping beats to lower the average rate. This results in an irregular beat and reduced blood flow right at the time you need it.

Of course it may be nothing more than your trying to increase your exercise level too fast when you have been inactive for a while.

frank

My response

by axg9504 - 2009-12-17 07:12:38

Annaelliott: The doc prescribed Inderal for 2 reasons. My BP during my visits was nearly always high (like 1160/90). I thought it was 'white coat' syndrome but he disagreed. Also before the PM, when I started exercising I would get this clutching sensation in my throat (now that could also be PCV's which I have on and off and am used to and don't cause me any real discomfort) which seemed to lead to my bradycardia.This sensation was always the precursor. They also found that I also had an accelerated junctional rhythm which I think means that another node is taking over the propagation of the beat (from the sinus node) and that its rate is faster than the upper chamber rate so if this happens he was afraid that the PM would not be able to provide the needed rate. So the med was supposed to help that. Actually I don't know what point he was making, because I took my rate repeatedly while walking fast during my exercise routine, while I supposedly was having this tachy. and it was @ 90 bpm which was barely enough to let me walk at 4 mph. My PM would certainly override that rate. I have noticed that when I skip my Inderal for a few days there seem to be more PVC's during exercise and at rest, but I haven't actually tested this rigorously by experimenting with Inderal off and on. But it's not causing me problems except maybe I think it is slowing my metabolism and making it very hard to lose weight. I'm taking the slow release non-generic version which is $50 for 3 months. There is a much cheaper non-generic version available from Walmart but it's not slow release. This is something I will check with the doc.

Frank:I'm trying to understand your response. If my rate exceeds 140 (and right after PM I did notice brief peaks to 160) isn't that because my natural conduction works and therefore the PM does not do anything?

I do have rate response, and it works fine as far as I can tell. I can walk at 4 mph for quite a long time (I haven't really checked because I'd rather go faster) and my rate will stay around 120 and I will feel fine. Try to run and maybe after about 1/8 mile of 10 mt pace I will be at 140 and I can't run much longer with my rate at this level. I can lower my pace (and my rate goes lower) and I soon get comfortable.

It might be lack of training, I just need to keep plugging. It's hard at 65 to do this, especially when you also have a full time job (lucky to be). I will discuss this at length at my next annual review,coming up in about 8 weeks.

Ronaldo:

by axg9504 - 2009-12-17 07:12:59

I think you are right in everything you said, except I don't know why Frank mentioned that the PM could lower rates. Frank knows more about these devices than most here so I'll wait to see what he says.

I walked/ran many times monitoring my rate with my Timex HR monitor before I got my PM (I even took the graphs from my data store to the doctor). When I started running my rate would go up smoothly to about 120 and then whoosh it would plummet. If I kept walking it would stay around 90 and I could get by, very much out of breath but get some exercise. When I stopped I couldn't predict what would happen, it would go down as low as 50 (and that is not normal for me). It would recover to a normal 80 (which is what apparently I needed during normal activity) after an hour. At night after that exercise I could wake up at night with 30 bpm, with my heart pounding (no doc could explain why I had this delayed response after my exercise)

Effect of limits

by ElectricFrank - 2009-12-18 11:12:08

I should have said my suggestion would only work if your natural conduction doesn't work. It is true that the pacemaker can't slow your heart rate below its natural rate if that is working.

I was assuming you didn't have consistent natural conduction so the pacemaker could limit the rate by skipping pacing cycles. This is what I have and experienced the effects of hitting the limit during exercise.

Does this make sense. If not keep after me and I will!!!

frank

Thanks Frank

by axg9504 - 2009-12-24 12:12:14

I can be pretty sure that my PM is pacing me once I start running or walking. I strapped on the heart monitor last week after a long hiatus from personal monitoring. After an 1/8 mile of running at 10mt pace I would reach 120 beats and I would feel OK. Then the next 1/16th I would get to 140 and one more lap after that is all that I can take, I have to stop, I'm breathing too hard. I used to see my rate spike up once in a while to 160, but I did not see it this time. I have a data storage device that I probably need to use that would give me more frequent data, but I kept looking at my watch and it went to 139 and then after awhile to 140. As long as I was running it stayed there so if the PM backed off any beats it's not more than 1 per minute.

So what do you think Frank, do I just do what 120 beats per mt will let me, do I keep at it and maybe I'll get fit enough to do more at 140 or do I push the doc to increase my limit so I can maybe train more. My doc thinks it's a fallacy that increasing the upper limit will help, or at least that's what he said 2 yrs ago and I didn't push the point.

(Sorry late in replying, hope you see this, thans for your advice)

Also need more data

by FirstDuely - 2009-12-31 03:12:54

Thanks axg9504. I am an avid cyclist (roadie) and have hit the wall many times. I have been holding off buying a HR monitor for the bike until now. This is the first hour I have been on this site and I've already found some answers to my questions. Your posting has pushed me toward making the HR monitor decision because I, too, want to know what my heart is doing while riding/exercising and want a record of the event that I can show to my pacer doctor at Loma Linda Heart Institute. He says come in and we can change things but I get there and have very little feedback to give him....and this has been true for over 23 years of pacing!! We've tried lots of settings with some success at times but then things change and so does the pacing issues I have. I have always been active and I will now be paying attention to this site. I'm having trouble now with the heart and pacemaker skipping beats while at, or near, rest. Don't like the thumping chest and have always attributed this to my having the flu or flu-like symptoms. Thanks.

Hi FirstDuely

by axg9504 - 2009-12-31 06:12:47

Glad you found answers here. I too found others here for the first time who had similar problems as I did before I got my PM 2 years ago. My problem was exercise induced bradycardia (my rate would go down when I exerted and I suffered afterwards). Actually the HR monitor helped clarify this to me and that I needed a PM. Post-PM it hasn't been of much use. You know the heart skip you mentioned could be PVC's or PAC (premature atrial or ventricular contractions). You'll have to look it up, but it's a delayed beat and you feel it in your throat. I have them often and they are harmless. The PM should be recording those. I send my PM data over the phone every quarter to the hospital from home. So far everything is working fine, my only question is whether it would help me to have my upper limit raised. All the best to you, you do no need to bring up the heart thumping with the doc. I had that before my PM. When my rate went down to 30 I could feel my heart thumping (they said that was natural because each beat is accentuated) and I could not sleep.

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