Test for Chronotropic Incompetence with a Pacer

I've had a slew of 'unrelated' problems develop or developing since getting a Medtronics Kappa 700 pacer installed 6 years ago.

Also, since I was young (I'm 51 now), I've felt behind the curve when exercising and would often end up dizzy after running. A number of times I felt like I would pass out. I made it through Marine bootcamp and even though I was relatively fit when I went in, I barely passed the fitness test coming out.

Since my implant, my ability to exercise has gone down to where even pulling a few weeds is tiring. Even though I seem to still have pretty good strength, I have absolutely no endurance. I get winded walking up a flight of stairs and sometimes have to rest for a bit at the top. I have problems reading and even after getting new eye glasses, nothing ever seems to look right.

One of my worst problems is that I used to love the subtropic climate but now I'm extremely heat sensitive (and live in Central Florida) and find it barely tolerable to even stand outside in the summer.

I have a variety of other symptoms that I've found online but the list gets long and boring.

When speaking with a rep at Medtronics today, she said something that got me Googling and I learned about Chronotropic Incompetence AND that Medtronics only have an accelerometer so my pacer doesn't compensate for it. The more I read, the brighter the light bulb in my head got and I feel pretty confident that that's my problem.

But the problem with my problem is that I go to the VA for medical care and there's only one cardiologist in East Central Florida. To get to him you have to just about fall over dead in front of your doctor and take a picture of it. So I want to know as much as I can before going in to my doctor and saying I think I have such-and-such.

Is there any kind of a test I can do or take myself to have a better idea if I'm right? My concern is the rate response feature of my pacer will interfere with any heart rate tests. I thought about getting an O2 sensor for my finger but I don't know what the levels should be or even if that will work. And I can't do or buy anything that's too expensive.

Any feedback would be greatly appreciated.

10 Comments

Central Florida

by ElectricFrank - 2012-05-23 02:05:03

I forgot to mention that I understand the Central Florida climate. I once attended a conference in Boca Raton in July. This was back when I was in the pink o health, and it was miserable. When my wife unpacked my suitcase she asked me if I had thrown it in the pool!!!

I live in the desert of California where it was 104 today, but that was at 12% humidity. Not bad at all.

frank

Chronotropic Incompetence

by ElectricFrank - 2012-05-23 02:05:30

All chronotropic incompetence means is that your heart rate isn't changing appropriately with activity. The problem is that the target rate at various activity levels varies widely between individuals. This makes it easy to justify one of the pacemakers that has a second type of sensing other than the accelerometer. Boston Scientific has a major marketing campaign for their pacer based on it.

For your symptoms of low exercise tolerance all that would need to be done is to change the RR settings on your current pacer to increase HR from the accelerometer. If CI is the problem you would see an immediate increase in energy. In fact just checking your HR and blood pressure during activity might show something. The O2 sensors are available at relatively inexpensive prices these days. at sea level expect something in the 96+% range. I have one and check it regularly.

The RR can be turned off easily during any test where it would interfere.

If you have any more questions feel free to ask here or drop me a Private Message.

frank

treadmill

by Tracey_E - 2012-05-23 07:05:27

Ask if they can put you on a treadmill with the pm computer hooked up. This has helped me several times to figure out why I have problems exercising.

With VA can you travel to see a specialist? I'm in South Florida, WPB has a massive VA facility.

Don't get much help from the VA

by Goose Goose - 2012-05-23 09:05:08

Thanks Frank and Tracy,

Frank - I've lived in Florida for 15 years and moved here because I enjoyed the heat and humidity some prefer dry but I never did. I loved that feeling when you walk out of the airport and you get hit with the warm, humid winds (ahhh... great memories) but now it feels more like seeing my wife with my best friend. It's too uncomfortable to want to stay around. I moved here from Calif because it got too cold at night for me. Also, arthritis doesn't seem to exist here and it was killing me in Calif.

I'm expect I'll go forward with buying the O2 sensor but I think I need to know what the levels should be while exercising(?)

Frank and Tracy - My options are limited. So far - with little checking - I haven't even found out what PM the VA uses. It's probably based on a current contract with one manufacturer or the other. Also, my appointments with a tech are on a strict schedule. I would have to get special approval to try to get my PM adjusted for testing short term. Every VA is different.

Currently, the Orlando area has a large clinic and no hospital. And one cardiologist who has turned down every request for anything that my doctor has ever made. I can walk into any VA hospital in the country if I have an emergency.

The VA in Tenn is in Vanderbuilt hospital which is on the cutting edge of cardiology. I've thought about walking in the front door there and falling down clutching my chest but I think they'll know the difference between a fake heart attack and CI.

Seriously, this is why I'm trying to find out what I can do all by myself. I would like to walk into my doctor (which I can on short notice) with some indisputable, technical medical facts so the cardiologist can't turn down my appointment request.

Thank you again VERY much for your reply and any more info is also appreciated.

Make of Pacemaker

by ElectricFrank - 2012-05-24 01:05:08

You should have received an ID card when you had the implant. It identifies the maker, model, and serial number of the pacemaker, and the lead wires. If you don't have it request (or demand) it. They are required by law to provide it.

Oddly the O2 levels aren't affected much by exercise. They should stay in the 96% and up range. I'm leaving some room for measurement accuracy in this number. One thing I've found that affects the reading is the pressure of the clip that goes on your finger. Especially if BP is on the low side your finger can turn white which affects the reading.

Interesting your idea of faking an emergency. I considered doing just that when my AV Block first occurred. The hospital ER gave me a 3 hour waiting time even though I let them know my HR was down to 35 and dropping. I warned my wife that I might just roll my eyes back and slump to the floor so she wouldn't think I was really dying. After thinking about it I decided to go home and get some sleep. I set the alarm for every hour to check my pulse.

I still keep it in the back of my mind if I really need immediate attention.

frank

I had to do that

by Goose Goose - 2012-05-24 09:05:07

Thanks Frank,

I do have a card (although all the data wears off once a quarter and I need to get a new one)

I've had 4 partial A/V nodal oblations before my pacer. One time I couldn't get anyone to agree that I had a problem because it had to occur in the presence of a doctor. So I went around the corner of the hospital and had my father follow me in the car as I ran up the street. Usually it would take about 30 seconds for my SVTs to start. This time I had to run back-and-forth about 10 times before it would kick in. But it worked. I went in the ER and got my 3rd oblation. (Not that I really wanted one, but I knew I needed it.)

Thanks on the feedback on the O2. Anyone else have any ideas for a self-test?

Humidity and Hi Altidude

by ldebaugh - 2012-06-18 03:06:14

You are absolutely right--humidity has less O2 and at a higher altitude there is definitely less O2.

Thank you to all the athletes who have posted. It's helpful to me.

Much less O2 in humid air

by ldebaugh - 2012-06-18 09:06:23

You mentioned the difficulty you are having living in Central FL. The problem is the humidity. My husband and I researched it when our AC went out. Moist air is lighter than dry air and has significantly less oxygen in it. The molecules have significantly lower molecular weight. So humid air is the problem, less oxygen. Something I'm addicted to!

Humidity is the same as elevation for o2 levels

by Goose Goose - 2012-06-18 11:06:37

It looks like the practical effects of humidity are the same as elevation.

I found this thread that explains it pretty clearly (near the bottom). http://www.letsrun.com/forum/flat_read.php?thread=2604104

And a more scientific explanation here http://www.youtube.com/watch?v=KiyMlnAC098

Also, if you Google "relative humidity" and look for images, it provides a further understanding.

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BTW, I post a lot of what may be 'extra information' so people who Google similar problems can find answers easier. I've found this forum very unique and helpful.

Interesting about humid air

by Goose Goose - 2012-06-18 11:06:58

Thanks! I'm going to look into that more. I've thought more-and-more about moving but am stuck with my mortgage at the moment (and family consensus).

I had a stop-over in Denver about a year ago. (I used to travel a lot but don't think I ever flew through there before.) While at the airport I felt like I couldn't breath. It was kind of like breathing through a thick blanket. The feeling is part of what I feel when I exert myself now. I know that doesn't relate to the humidity, but possibly to my need for oxygen.

--- To update all readers...

I've also found some information that implies that maybe I should have been given an Exercise test to verify rate response (it's in the manual) but never got one.

Reading back my original post I see that I didn't say that during my last visit with the Medtronics rep that my RR was previously tuned off and he turned it on. This changed my feeling during minor exertion from just feeling exhausted to feeling exhausted and like I've just run nn miles.

I have now spoken with a nurse practitioner at the VA cardiology. The conversation went nowhere other than that she can put a note in my record to get my RR turned back off. That seems to be the option.

I also learned that the VA does use Medtronics and Boston Scientific. My battery has about another year on it so if this drags on without progress, I may be able to get a change then.

You know you're wired when...

Your heart beats like a teenager in love.

Member Quotes

I am just now 40 but have had these blackouts all my life. I am thrilled with the pacer and would do it all over again.