Minor Blip, but Nervous

On my usual 1 1/2 walk up and down a very steep hill (Ski Hill Circle)and two lesser hills (all paved streets) tonight for the first time I exceeded my PM setting of 60-120 with symptoms of being a bit out of breath, nervous, a bit light headed at times, and a higher heart rate throughout out the rest of the routine evening walk. I walk this route at least 3 times a week and usually get my heart rate up over 120 at the top, 108-111 on the next less steep rise, and in the 90's to 70's coming down. On the next hill, max 108, on the 3rd hill up to 115-122 if I push it and on flat stretches 70's and 80's-- even 60's. Tonight my heart rate stayed up much higher the whole time (max 124 , and over 120 many times, 111-117 where it used to be 80's & 90's) and I felt very nervous and slightly faint even on the flatter parts. I tried doorbells at three houses - no one home. Finally got a ride home near the top of the last hill. Also had no cell phone - my bad!

Boston Scientific PM installed Feb. 4, 1040 for SA node incompetence and bradycardia with no set back until now. Rate response is ON. Also I am 8 weeks post op from a multiple surgery session (vaginal hysterectomy, open hernia, , and 4 other procedures) from which I recovered very quickly and have been doing these walks for weeks. Laughably, It had been my intention to test the exercise limits before my next interrogation in one week, but it didn't seem so funny when it actually happened!

Does this seems to mean that if I intend to go on these walks alone (let alone driving by myself) I had better keep my heart rate under 120? OR does it mean that I can never go any place by myself, like it was before getting the PM? I also question the connection between those rates and the way I feel. Why did I feel "out of it" for the first time since the implant in Feb.? It will be interesting to see what my interrogation shows. I will take it earlier until then.

By the way I am a yr. old female, 5'5" 135 lb. and active, but not with the weight lifting, etc. of many members.

5 Comments

PM settings can take time to get right

by JerryG - 2014-09-07 07:09:14

I have sick sinus syndrome which is fixed by a dual chamber Medtronic A3DR01 with rate response ON. I work out daily on my treadmill and initially had similar problems to yours during workouts and it took my cardiologist + Medtronic tech 3 post-implant sessions to get my personal settings right.

Initially, my PM was set 60-130 with 'low' rate response. We are now settled on 60-150 with a higher rate response level and I am totally happy with the way my heart rate behaves. They start with 'average' settings when they implant a new PM and it then needs to be 'tweaked' periodically until the settings are right for the individual.

I suspect your sinus node isn't responding to the increased exertion of the hill climbing and needs the PM to step into the breach. The maximum HR set on the PM will not prevent your sinus node from taking your HR beyond the maximum set. That maximum is the highest the PM will pace you to if your sinus node doesn't do it for you.

You are close to your first PM interrogation so I would just take it easy until then. Tell the tech what your problems are and I am sure (with your cardio's approval) he can adjust your settings to take care of the problems.

Good luck!

Bushveld greetings from sunny South Africa

Jerry

5th interrogation

by flutetooter - 2014-09-07 10:09:57

I have had 4 previous interrogations because of being on a scientific study for an MRI compatible pacemaker. However, due to an obvious hernia and pending surgery for that and other things, and then for post surgery recovery, I had not tested my pacemaker's upper capabilities for those 7 months because I had other limits placed on my body's exercise by the surgeons. This is the first time the limits from the surgery were lifted and then I could test the pacemaker limits. Since I am 75, the upper limits were set lower than others on this site who are younger. We'll see how the interrogation goes. I have a good team at U. of Chicago.

A few random thoughts to .....

by donr - 2014-09-07 11:09:31

....help your mental state. Which is obviously affected, or you would NOT have rung three doorbells on the journey.

In May of 2013, I underwent unexpected belly surgery to remove half my colon because of a near cancerous lesion. It cost me about 3 weeks of near total inactivity. I was a wreck physically & mentally. I was also 76 YO at the time. My cardio saw me at an appt for my wife about 3 weeks post -op & told me that at my age, it took at least 4 days of recovery effort for every day spent immobile - & that was AFTER getting back to near normal activity capability. I found out that he was correct. He also told me that if you spent much time immobilized that you could sense the rapid deterioration in physical condition setting in. Boy, was he right!

This past May, I had to have a hernia repaired that resulted from the cancer procedure. Same thing happened again. I have just begun to feel really normal again recently.

I felt just the way you described on your walks - except that it hit me much sooner - like about ten minutes after starting to exert any effort. High HR,washed out, light headed, feared I'd pass out.

It always started as a physical thing & when it started, the mental part kicked in & made it feel worse. Knowing the situation as my cardio explained it helped a lot - I understood what was happening & it removed or at least decreased the mental aspect of feeling bad. Called anxiety, stress, fear. Remember what Napoleon said - "In Battle, the mental is to the physical as three is to one." True in these fights, also.

It is NOT all in your head, but when fear & uncertainty - out alone, no cell, no one knowing to become concerned take a toll it makes the situation even worse.

Donr

Thanks again

by flutetooter - 2014-09-07 12:09:36

I had just begun to think I was back to near normal (i.e. how I was feeling a year ago) or even better. My docs were all very pleased with my progress. I agree with you 100% about the stress irritating the situation. When I walk with my husband, I have aimed for a heartbeat slightly over 120 every time I climb that hill (mostly because most exercise besides walking was banned until 8 weeks post surgery) and I had no ill effects. The heart rate usually dropped down to 111 as soon as the hill ceased being so steep, and was 72 or so on the steep part going down. The dusk of night and the mosquitos didn't help either. I am much more relaxed now.

On another subject, I'll get back to you on the very interesting anesthetics/PM aspects of my 4 hours under the mask in July. I did very well with NO variations to my PM. It was felt that my previously normal heart rate was enough and that messing with the PM and a magnet, which would set it at a default of 100 beats a minute was too high for a long surgery. Of course, EPs were in the hospital at all times. I was responding to directions and talking coherently 15 minutes after the endo tube was removed.

My plan of action: Buy cellphones; stay relaxed; keep heart rate under 120 until my next interrogation; keep up a sensible exercise program; talk to the EP about raising my top "Rate Response" limit top to cover any exercise I would normally be doing if they felt it was safe for my age and lack of training. BTW - we have a Mississippi River paddlewheel steamboat "Fall Colors" cruise scheduled in 2 weeks. Plenty of low key exercise coming my way!









Typo - 2014

by flutetooter - 2014-09-07 12:09:45

Installed 2014

You know you're wired when...

Your signature looks like an EKG.

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