I`m puzzled

I`ve posted before and this is a follow up.
To recap, 67years always sports active. CRTD fitted 18months ago following valve repairs and maze procedure. Happy with exercise but would still like to be 30 again !
I`ve always had a problem with `odd feelings` when relaxing and after trying various permutations of settings I`m ok when active. However no one seems to be able to answer my question. I`m quite happy with that part of the setting that helps me with activity but that part at the lower end seems to be giving me these `odd feelings`
I have a gentle 25min warm up routine . When my resting HR is set at 60 it increases to 63/4, when set at 65 it increases to 67/68, when set at 70 it increases to 73/4 and when set at 80 increases to 83/4. The Techs have tried altering the RHR to see if it stops the problem. I can only presume that something must be wrong as because if I need 83/4 why for the same amount of effort do I only need 63/4 ? Is the rate response linked to base setting? I`ve noticed that on the lower settings my immediate get up and go is lagging compared to the higher settings. I can only liken it to having a stone in my shoe but the experts are just changing the size of the stone.
all comments welcome. I need to know how this thing works!
thanks mg

4 Comments

I`m puzzeled

by mg - 2015-05-06 01:05:11

Thank you both for your comments.
Prior to being ill some 4years ago my resting HR would have been 50. Flat out and really pushing it perhaps 180. Now if I really push it I try and limit it to 120/5 just in case and I`m happy I`m not over doing it. Exercise is not a problem it is just at tick over.
My day job(I`m still working full time+some) is involved with motorsport and I have a knowledge of engine management systems and I suppose I look at my self as an engine that needs a map to run correctly. I`m sure that the capacity of the later PM devices are not used to maximum potential to sort our problems out with the fine tuning. The manufacturers fully know but unfortunately there are not enough people who understand the device 100% at hospital level. I`m sure if one of my engines had the problems I have it could be sorted with time but time is the big problem to get our fine tuning sorted and unless you are lucky and hit on something close straight away. I know there is something not right and how I get there I`m not sure but trying to understand how things work is just me.
I`m sure that with people like me who are active in old age is a relatively new problem with in the last 5/10 years as previously older people were not as active and the fitting of a PM with basic setting made a huge difference to their lives and what few odd symptoms occurred were probably ignored as they felt better anyway.
For me the addition of 3/4 beats at whatever resting HR I`m set at does not make sense for the same input of activity be it just light activity. I do not think the device is not clever enough to sort it , I`m sure it can if it is told how.
thanks mg

It's not an engine

by Theknotguy - 2015-05-06 02:05:48

I don't think they have the ability to control the heart rate to within 3 - 4 beats at this time in medical science. When you add the screwed up natural pacemaker to the mix, all sorts of stuff can happen.

My natural beat was beat, pause, pause, beat pause, beat,beat. Not a good rhythm. After the PM I was amazed to find out what a good heartbeat felt like. Hadn't felt that in years.

Most of the time now I get the 60 BPM because of the PM. But occasionally the heart kicks in and I get some crazy thumping. The real good ones are when the ventricles decide to take time off and the PM steps in. At those times it feels like I've got several things going on all at the same time. Then everything goes back to normal. Doctor said it was because my grandparents swam in the wrong gene pool. i.e. heredity and nothing we can do about it.

You were saying there still isn't something right? Have you asked about chronotropic incompetence? That's where the heartbeat doesn't come up fast enough because of interference with meds. I have that due to medications I take for afib. Spent the first six months learning how long it would take for the heart rate to come up to speed. Don't think about it now but people have a tendency to walk away from me until I can get my heart rate up and walk at their speed. My other option is the heart not beating at all so I have to live with the incompetence.

Hope you've gotten some insight and have some more questions to ask your doctor.

Over analysis

by Theknotguy - 2015-05-06 09:05:16

I've commented on your posts before. And you'll get pretty much the same answer as before.

1) You may be one of those people who are more sensitive to electrical stimulation and feel more than others. Nothing much you can do about it. Ignore it and go on with your life.

2) Why the resting heart rate and exercising heart rate don't consistently go up and down is one of those things not defined yet. They weren't even able to measure the heart rate response with that accuracy until recently. You could contact The Ohio State University heart research hospital and see if you could get a more definitive answer from one of the research doctors there. Chances are they'll tell you they don't know. Too many variables with which to contend.

3) All heart problems are the same. All heart problems are different. Each person is unique so your heart problems will be unique too. Fortunately there is enough similarity they can research, find commonality, then find some kind of solution.

4) Odd feelings. Yeah, I get them too. Some I can chalk up to having a PM. Others I can chalk up to heart problems. Still others are from what has happened to my body over the years. That includes the sore ribs just before a storm front moves in. After they break your rib and crack ribs from CPR you don't come back 100%.

5) Your body isn't Mickey D's. You can't just walk into the fast food restaurant, order what you want, tap your foot three times and walk out with exactly what you ordered. Your body will have bumps, thumps, twinges, and itches that can't be explained. For me, I'm too busy living life to do and over analysis. It's a big world out there and I want to enjoy it. With my PM I now have the second chance to enjoy it.

Hi mg

by IAN MC - 2015-05-06 12:05:46

I'm curious ; what was your resting heart rate before you had a PM ? I think that the base-rate should be set as near to your normal resting HR as possible; and we are all different !!

All of my life ,my resting HR was 60 bpm ( I could use my HR as a watch which was quite useful ! )

After having a PM fitted they,the PM gurus in their infinite wisdom, set my base-rate at 50 bpm and I soon tired when not exercising; I believe that I wasn't getting the levels of oxygen that my body needs. Last year I had the base-rate increased to 55 bpm and the difference in my energy levels was incredible ! Maybe it should be 60 and I would be able to fly ??

Your exercise routine must be VERY gentle if you are only increasing your HR by 3 or 4 bpm . What happens if you really go for it and get your HR up to 140 or 150 ; is the max still related to the base-rate ?

It sounds as though you do need a higher base setting !
but the question you raise regarding the relationship between Rate -response driven HRs and base-rate is an interesting one and is not over-analysis I.M.H.O.

Ian

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