Marathon Runner Bradycardia

3/27/2011

I had a 2-wire pacemaker installed two months ago. My history may be of use to others.

I am a 79-year-old who has run eight marathons, my last at age 50 being my personal best of 3 hours 23 minutes. Since marathoning I have had a very low pulse rate. In those days a doctor once measured it in the 20s. I was proud of that as it is typical of marathon runners and generally a sign of heart health.

I have also had labile hypertension. Sometimes my pressure would be a normal 130/80 but other times 160/110. I was on medication for this; Diovan or equivalent. My doctor did not want me to use a Beta Blocker because of my low heart rate and the fact that beta blockers lower it further. My dose had been doubled about a year ago and I was also taking a diuretic to keep the pressure safe.

I have continued running though at greatly reduced mileage. In December 2010 I took a four-mile run and finished it uneventfully though, as I have gotten older, it is harder and harder to run the way I used to. This seems normal.

That night I got up to go to the bathroom, felt a little lightheaded, and fainted for the first time. I then wore a Halter monitor and my doctor was alarmed that my pulse while asleep was 35. I laughed it off as normal for me.

I then took an electrophysiology test at the St. Francis Arrhythmia center in Long Island. The doctor told me that I had several problems and required a pacemaker. First, the interval between my aortic and ventricular pulses, 280 milliseconds, was too great. It should bbe closer to 200. Second, I had a sick sinus node. Third, the nerves running from heart top to bottom had a problem; he did not specify what.

The pacemaker minimum rate was set at 60. After the month of recuperation I have resumed running. It may be due to the layoff but I find that my heart rate goes up much more rapidly than it used to and I get winded easily.

When I asked if hypertension had anything to do with it the doctor replied in the negative and said my problems were a result of aging.

As one of my hiking friends always says, aging is tough but better than the alternative.

According to WebMD: http://www.webmd.com/heart-disease/tc/bradycardia-slow-heart-rate-overview

Bradycardia can be caused by changes in the heart that are the result of aging.
A very slow heart rate may cause you to:
• Feel dizzy or lightheaded.
• Feel short of breath and find it harder to exercise.
• Feel tired.
• Faint, if a slow heart rate causes a drop in blood pressure.

People older than 65 are most likely to have a type of bradycardia that requires a pacemaker.

The goal of treatment is to raise your heart rate so your body gets the blood it needs. If severe bradycardia is not treated, it can lead to serious problems. These may include fainting and injuries from fainting, as well as seizures or even death.

End quotes!

In retrospect I may have contributed to my heart disease by spending too much time sitting in front of my computer since retirement 19 years ago. The American Heart Association says that excessive sitting can be deadly even if one exercises regularly and, according to one researcher, runs 35 miles a week.

I hope this essay helps.

Be well.
Len

8 Comments

P.S.

by len613 - 2011-03-27 09:03:56

My PM upper limit is set for 120.
This is 85% of 220 minus my age and seems low. I have reached 120 a couple of times and it feels tough; like I can't go any higher.

One of my friends had one installed 14 years ago.
First question he asked right after: "Can I have sex?"

"Wait till we get out of the operating room," replid a nurse.

Upper limit? WHY?

by COBradyBunch - 2011-04-12 07:04:02

When they put mine in (age 50) I ran into a battle that luckily I have a good heart doc to work with. They wanted me set at 60 / 120 also. I am a cyclist (knees don't like running anymore) and my RHR was in the low 60's to begin with. Pacer tech said no way they would lower it and that for the upper limit they didn't want to do much there either (at 52 my MaxHR is in the 180's somewhere, hit 179 the other day hammering up an 11% grade). Talked to my doc and he told the pacer tech to drop me to 50 on the low end and basically to 'turn off' the high end. Since my issue was heart naps due to sick sinus (I would flatline for several seconds at a time, which would then make be go flat, usually on my back) there was no reason to have the high end set to anything. The pacer was there to keep my heart from slowing down and stopping (or going into low single digits in bpm). One other thing they turned off was the little diag that unit put itself through every night at about 3:00 in the morning that would wake me up. If you have a good doc they will work with you. It is your body after all.

Upper limit? WHY?

by COBradyBunch - 2011-04-12 07:04:03

When they put mine in (age 50) I ran into a battle that luckily I have a good heart doc to work with. They wanted me set at 60 / 120 also. I am a cyclist (knees don't like running anymore) and my RHR was in the low 60's to begin with. Pacer tech said no way they would lower it and that for the upper limit they didn't want to do much there either (at 52 my MaxHR is in the 180's somewhere, hit 179 the other day hammering up an 11% grade). Talked to my doc and he told the pacer tech to drop me to 50 on the low end and basically to 'turn off' the high end. Since my issue was heart naps due to sick sinus (I would flatline for several seconds at a time, which would then make be go flat, usually on my back) there was no reason to have the high end set to anything. The pacer was there to keep my heart from slowing down and stopping (or going into low single digits in bpm). One other thing they turned off was the little diag that unit put itself through every night at about 3:00 in the morning that would wake me up. If you have a good doc they will work with you. It is your body after all.

Thanks COB

by len613 - 2011-04-12 09:04:01

You're an inspiration.
Are you 50 or 52 (not that it makes much difference)? At 52 your max is 168 so you are pushing it at 179. It doesn't even seem possible. Frommy running knowledge I would guess it is harmful to be at your max much of thetime. A good aerobic workout is at 80 to 85 % for long periods. That would be 134 to 143. It is OK to go higher for intervals but not all the time.
Lucky you did not flatline while biking.

With my max at 141 I am going to request my doc to adjust the range to 50/140. As it is, I get very short-winded over 115 and it was not that way before the installation. I used to hit 135 regularly. Part of the problem is my hypertension med change to a beta-blocker which lowers heart rate. My pressure today was 130/84 so that is encoraging.

Best wishes and keep in touch.
Len

I'm 52

by COBradyBunch - 2011-04-13 12:04:21

Got the pacer at 50 but I am now 52... Most people don't understand that a MaxHR is different for everyone. The basic rule (220 - your age) is only a very, very general number. Mountaineers often have MaxHR's that go well above 200 even into their 40s. At 40 my Max was in the 190s so I have always run high with my max. To find your MaxHR you really have to have a MaxHR test done (you can do your own, although I am sure most cardiologists would freak if we were to post the DIY instructions here and it isn't as accurate as one done by a doctor or sports physiologist) and from there you have the baseline to work with.

As for my workouts... I normally run an average of about 140-145 through my workouts and will run low 150's for long periods of time, 2 hours or more (90% for me is about 162, 85% about 154).

While I don't recommend people who haven't been training regularly and in excellent cardiac health or who have other issues even try and get near their MaxHR for me to hammer up a hill and get close to it is not all that unusual. I will say I rarely see much about 170 but that is only because to push that hard right now is not what I am trying to get out of my training. However in another three months when we start hitting the mountains HARD it won't be that unusual.

BTW, this mornings Spin class numbers:

1:15:31 duration
834 cals burned 35% fat
Max HR 167 (2 minute sprint)
Ave HR 142


Still have questions

by Stefani - 2011-04-14 10:04:20

Hello there, I wrote once before and get some really great info. Hoping to get some more. I got my pm Dec. 23rd., I am 44 and had a low heart rate. I always shrugged this off because I am a runner. I was diagnosed with bradycardia (always feeling tired) and when I got my pm the dr. said it may not alleviate my symptoms (mostly being tired). Well, 3 1/2 months later and I am still feeling tired, but what is even more frustrating is my running is so hard! I have been to the tech three times to get "tweaked" and the last time my low was turned back down to 60 (the last tech set it at 70 without dr. approval), not sure what the max is. My heart rate sky rockets so quickly (10th. mile) and at 1-2 miles I get a feeling of weakness in my arms and legs that passes if I slow down. I am not set to go back to the tech for 2 months but am really getting discouraged with my running, any suggestions would be appreciated. As an aside, I have not seen a dr. since my pm was put in, is this normal?? Thank you for any help, advice you can share :) I have really relied on everyones posts since I have had my pm put in, thank you for all of your help...

Problems Gom With the Territory

by len613 - 2011-04-14 11:04:48

Your problems sound like mine except that I am 79 so I feel for you. You did not say what your running was like, or what your pulse rate was, before the pm other than feeling tired.

A low pulse rate alone should not be a sufficient reason for a runner to get a pm. My triggering even was fainting. Upon EP examinatiionthree problems were found aside from the low pulse rate; an excessive time between the atrial and ventricular pulses, a sick sinus node and some unspecified problem with the nerves running between the atrial and ventrical chambers.

Did you have symptoms besides tiredness and a low pulse rate? When I was in my late 40s my resting rate waas in the high twenties and I never have been healthier.

I was frequently tired too but I attribute that to lack of sleep; getting 5-6 hours. A low pulse rate may also cause tiredness because of lack of blood to the brain but I discount this because I feel the same before and after my minimum was raised from 35 to 60.

While I am happy to have a pm that will save me from fainting I am not happy with my poorer reaction to running since the pm. My pulse rate rises faster than it used to and I feel winded at a rate about 10-15 lower than before. This may be partly due to switching my blood-presssure medication to a beta blocker which has te side effect of slowing thhe heart rate.

I had a checkup one month after installation and also was given a Merlin @home transmitter that is beside my bed. Every night, between 2 and 4 AM it transmits my pm operation to a hospital recorder but is unmonitored. On May 26, about four months after installtion, the transmission will be monitored. My next doctor's appointment is Aug. 22, almost seven months after my Feb. 1 installation.

I cannot solve your problem but I hope my experience provides you with helpful insight.

I wish you a complete and speedy recovery.
Len

Problems Gom With the Territory

by len613 - 2011-04-14 11:04:49

Your problems sound like mine except that I am 79 so I feel for you. You did not say what your running was like, or what your pulse rate was, before the pm other than feeling tired.

A low pulse rate alone should not be a sufficient reason for a runner to get a pm. My triggering even was fainting. Upon EP examinatiionthree problems were found aside from the low pulse rate; an excessive time between the atrial and ventricular pulses, a sick sinus node and some unspecified problem with the nerves running between the atrial and ventrical chambers.

Did you have symptoms besides tiredness and a low pulse rate? When I was in my late 40s my resting rate waas in the high twenties and I never have been healthier.

I was frequently tired too but I attribute that to lack of sleep; getting 5-6 hours. A low pulse rate may also cause tiredness because of lack of blood to the brain but I discount this because I feel the same before and after my minimum was raised from 35 to 60.

While I am happy to have a pm that will save me from fainting I am not happy with my poorer reaction to running since the pm. My pulse rate rises faster than it used to and I feel winded at a rate about 10-15 lower than before. This may be partly due to switching my blood-presssure medication to a beta blocker which has te side effect of slowing thhe heart rate.

I had a checkup one month after installation and also was given a Merlin @home transmitter that is beside my bed. Every night, between 2 and 4 AM it transmits my pm operation to a hospital recorder but is unmonitored. On May 26, about four months after installtion, the transmission will be monitored. My next doctor's appointment is Aug. 22, almost seven months after my Feb. 1 installation.

I cannot solve your problem but I hope my experience provides you with helpful insight.

I wish you a complete and speedy recovery.
Len

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Today I explained everything to my doctor, he set my lower rate back to 80 and I felt an immediate improvement.