jossikins

I have been advised to have my upper setting ot 155 reduced to 120, without any explanation as to why, I have had my pm for just over one year. Initially, they did not turn on the rate response and the result was awful - I couldn't hurry across a busy road, no energy - the pm was then adjusted to 60/130 which was ok. A month later, because I swim and cycle and generally lead a fairly active life, the upper rate was increased to 155. That has been fine. Two months ago, I had an ECG, then an echocardiogram a month later; As a result of the ECG, I was put onto 1.25mg bisoprilol daily. I have just received a letter from the cardiac specialist that I should have the upper rate of my pm reprogrammed to 120 (which horrifies me) and withdrawal of Bisoprilol. Apparently I have "palpitations" although I certainly haven't felt that. I don't want to compromise my cycling and anything physical that I choose to do. I have been signed off the cardiac clinic and want to go to my pm reading on the 27th as fully informed as I can. Would I be justified in asking the technician to reprogram to 130, rather than 120? I worries me that I will not be able to ride my bike to the demands that I am used to if they put me back to 120. How does that upper limit work? What happens if my hr goes to 130 or more when the upper limit is only 120? What is the advantage to me to be programmed to 120 instead of 155? Is it to save the life of the pm battery or my life? I am confused. I am 77 (as of yesterday) but have an active lifestyle and I don't want to lose that unnecessarily.

6 Comments

jossikins

by IAN MC - 2016-01-02 01:01:44

You need collect information when you see the PM guru on Jan 27th :-

- what do they mean by "palpitations" ? Palpitations usually means that heartbeats become more noticeable to the patient i.e. it is something which the patient feels and is a symptom of something else. I find it odd that they are accusing you of having palpitations and yet you haven't felt them.

- let us assume that your palpitations were caused by a tachycardia in your upper chamber . This is the reason that we have upper tracking limits . If for example your upper chamber started beating at 300bpm it would be dangerous if that message was passed down to the ventricle and the ventricle in turn tried to pump blood out at 300bpm ! That becomes life-threatening and the safe maximum reduces with age

- because Drs are scared stiff of your ventricles beating too fast they make assumptions about what is a safe maximum for you. You then get into formulae for your maximum safe HR such as 220 minus your age.

But you sound as though you are a very fit 77 yr old so the normal age-related formulas would not apply to you

I had a helluva battle persuading them to increase my maximum from 130 to 165 ( I am the same age as you, dammit ! ) . I won in the end but , unlike you, I haven't been experiencing palpitations

Just to complicate matters there is a different maximum sensing rate for the rate response function.

Best of luck on the 27th . You didn't say why you needed an ECG and Echo if everything was fine ? You really need to know exactly what those tests showed and why you were prescribed the beta-blocker.

Ian

Risk/Reward

by BillH - 2016-01-02 03:01:46

First of all you need to talk with the doctor and not the tech. And find out details of what and why they want to make this change.

And what other options that there are for treating this? And what is the risk if you don't.

Risk/reward. For every activity there is a risk & reward. For activity in life there is a risk/reward. For most things reward is high and risk low. Even something as simple as eating. The reward is high, but there is a very small risk of choking or food borne illness.

Other things the risk is so high compared with the reward that we don't even consider it.

Other things the risk/rewards are not as clear. And they vary by the individual's values.

Biking is one of those. Many, uninformed, person think that it is dangerous. And it is more dangerous and setting on the couch, for the Short Term.

But others are the find the joy and health benefits of are MUCH, MUCH, more than the risk of an accident.

I am 72 and bike with a group that range from 55 to 82.

I have brady/tachy and the only symptoms that I have is noticing a fast HR or missing beats, ONLY when calming resting Nothing that I notice during activities.

My EP want to put me on a beta blocker to control the tachy and the PVC's. But with the brady it will slow my HR too much and they want to install a PM.

I will see my EP next week and discuss this. But so far, at least to me, the risk of doing this is higher than the reward. Although I would not be surprised that if this changes in a few years if things continue.

Remember it is your risk/reward to make and any treatment that is do or do not do.

jossikins

by josmascarenhas@mail.com - 2016-01-02 05:01:26

I have received your responses with huge thanks. I have printed out your answers and will read them and go to my GP before my pacemaker appointment on the 27th, hopefully armed with intelligent questions and the benefit will thus be mine.
I feel that a diagnosis has been made without any holistic approach, particularly as I have been signed off from the cardiac clinic so they are kind of dismissing me.
BillH, I am very interested that you, like me, are cycling..
IAN MC I have only been told that I have had palpitations. I haven't been aware of them. And 220 minus my age (which is what I have also always been told was my hr limit) makes it around 140, and I am more active than many people half my age.
TRACEYE I will stand my ground.
Thank you, all of you, for your feedback. I will now act accordingly. You are the grist to my mill!!
Jos.

PS - here are the test.

by BillH - 2016-01-02 06:01:06

Here are the tests;

http://www.cycling-inform.com/how-to-test-for-your-cycling-max-heart-rate

http://www.howtobefit.com/determine-maximum-heart-rate.htm

http://www.bikeradar.com/us/gear/article/heart-rate-monitor-training-for-cyclists-28838/

Max HR

by BillH - 2016-01-02 06:01:45

"And 220 minus my age (which is what I have also always been told was my hr limit) makes it around 140,"

All of the doctors know that is bogus formula, but everyone still uses it. It was done based on way too few of persons and not enough older ones. It tends to under estimate in older persons and over in younger.

There are several ones that that have been statistical backgrounds and will give 8-15 points higher for me.

But even then and individuals max HR can vary 10-20 less or more than given by the formula. And it vary somewhat depending on the type of exercise.

The best way to find it is with a maximum exercise test. Two many will stop you at 85% of predicted. But if you aren't having symptoms, bad EKG, etc and arrange it before hand you can go until you can't. That gives the best estimate of max HR.

But even then it will vary somewhat in real life from day to day and type of exercise.

For example my max HR is around 167-170 @ 72.

I have a short, but steep hill that I climb from time to time both as an exercise and also as a test of fitness.

The summer, while doing a 30 day holter test climbed it at max effort and peaked out at 167. Then went down and after a few short recovery tried it again. But my legs where just too tired and could only get up to 155.

Here are some cycling (&running) test that you can do yourself. Some are sub-maximal test. But others are maximum. And you want to be careful about doing those depending on past history and over all health.

pacing

by Tracey_E - 2016-01-02 12:01:05

What was your original diagnosis? It would help us answe3r your questions if you filled in your profile information so we have a bit of history.

Your heart can go as fast as it wants on its own, the pacer won't stop it. The upper limit is how high it can pace. So if your rate goes up on its own with activity, it doesn't matter what the pacer's upper limit is because you aren't pacing when you get high. If you are depending on rate response to get your rate up, you will only go as high as it will pace you.

When they lower the rate, it sounds like they don't want you getting high for some reason. Usually that would be because the heart isn't healthy, myopathy or heart failure, stuff like that. I would certainly question them, both the need for the meds and reducing the upper limit. Palpitations are generally harmless and not a reason for medication, and it sounds like you not only didn't feel bad but felt good enough to be very active. That's a good thing so unless there is a risk, I would stand my ground and insist on leaving the settings alone so you can continue to be active.

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