Why is my HR 110 at rest and 70 on exertion ? I have HF many years and have a CRTD.

I notice that my BP is low when my pulse is high which makes it difficult to take beta blockers. Tried Ivabradine which didn't work. Awaiting Holter & Echo. Only noticed this particular problem last few weeks. CRTD settings not been changed. 10 min walk reduced HR by 40bpm but only lasts about 45 mins then it's back up to 110. Seems odd. Maybe a simple explanation ?


8 Comments

High resting heart rate

by AgentX86 - 2021-05-31 20:37:42

What did your EP tell you about your high heart rate, in February?

High resting heart rate

by sandoval - 2021-06-01 11:20:16

February ? I've only had high HR which goes down on exertion last few weeks. Last time I saw EP was on the operating table and next is November.

High resting heart rate

by AgentX86 - 2021-06-01 13:52:58

On Feb. 10, you started the thread "High pulse (110) before getting out of bed".  I was wondering what you found out about that and whether it would be meaningful here.

 

Heart rate drop

by ROBO Pop - 2021-06-01 18:04:47

You need to contact your Cardiologist ! A heart rate drop during exertion is not normal and is indication of a potentially serious problem with your heart and should be addressed immediately. 

High resting heart rate

by sandoval - 2021-06-01 21:10:37

AgentX86 - I didn't find out anything regarding 110 pulse in bed. I tried ivabradine but didn't make any difference. When I was up and about the HR seemed to normalise itself so I left it as seeing a cardiologist is so hard unless it is a scheduled appointment. Now it's basically over 100 all the time until I get active but it soon goes up again. I have normal BP but took a beta blocker anyway tonight and it didn't make a jot of difference to my HR. I phoned Hamm Hosp today and was told they would try and bring my cardiologist appointment in November forward "a little". There is no sense of urgency. There was me thinking a CRTD & an Ablation would make life easier

Tachycardia

by AgentX86 - 2021-06-02 00:36:46

Having permanent tachycardia, having to wait until November is nuts but you should have had it nailed down before.  Tachycardia is hard on the heart.

A pacemaker isn't going to help tachycardia at all.  A CRT should help with cardiomyopathy caused by tachycardia but not competely.  Long term tachycardia isn't good.  Ablations aren't always successful and, yes, they can cause more damage.  I had a Maze, which made things worse, then three unsuccessful ablations.  Some of us have no luck.

The bottom line is that you have to be seen by an EP.  A cardiologist isn't the right person to go to but it's better than nothing.

I agree, tachycardia needs to be controlled

by Gemita - 2021-06-02 03:53:47

Hello again Sandoval,

I suppose the question is, is your increased/decreased heart rate symptoms due primarily to an arrhythmia, due to another health condition or due to your heart failure - or due to a combination of all three?  The arrhythmia and any other health condition you might have may be more amenable to treatment and control than the heart failure.  Your doctors have clearly tried a good treatment regime:  ablation for your arrhythmia, CRT-D for synchronised pacing to try to improve your EF/heart failure symptoms, the defibrillator to protect you from a high heart rate/dangerous arrhythmia and potentially fatal cardiac event, Ivabradine and a beta blocker to control your heart rate.  I feel they have done their best but their best is clearly not working for you just yet and you need more help and care at this critical time in your treatment.  

I won’t go over what we have already covered in your earlier post since there were many questions asked.  I note that you have had some improvement with breathlessness on climbing stairs since getting your CRT-D which would appear to be a good sign, but clearly your breathlessness that continues seems to be happening during your increased heart rates and this needs to be controlled.  The earlier they can confirm the reason for your sudden changes in heart rate (?arrhythmia) the earlier they can try to more effectively manage the problem.

I too believe you should press to be seen quickly, or at least to have a tel consultation with your cardiologist/EP, and to have those investigations (echo/event monitor) carried out with some urgency to get a better picture of what is going on.  Getting your heart rate to stay down would be my top priority now and this should help to improve your LV ejection fraction, which after all is the goal of treatment of cardiac resynchronisation.  

When I was researching Ivabradine, I came across a few links.  Might be worth a read in case it has proved to be pro arrhythmic for you.  Something worth discussing possibly with your doctors, particularly as Ivabradine doesn't help to address your increased heart rate.  By the way, I presume you have home monitoring and you are able to send transmissions to your clinic to rule in or out an arrhythmia as the cause for your heart rate anomalies?

https://www.ncbi.nlm.nih.gov/books/NBK507783/

https://heart.bmj.com/content/heartjnl/100/19/1506.full.pdf

(Both links suggest Ivabradine increases the risk of atrial fibrillation. Discontinue ivabradine if atrial fibrillation occurs)

High pulse on rest

by sandoval - 2021-06-02 18:37:04

Thanks for all replies. I phoned today and there is no sense of urgency. "If you are worried go to A&E " is the response. I managed to get a Holter monitor (24 hrs) appointment on June 21st.

I can send transmission remotely - how they know I'm not making anything up but as they say the CRT doesn't control the HR.  The beta blockers & Ivabradine dont touch the HR, only exercise. It is ironic I can walk up stairs alot easier with the CRT D and on the flat I walk 30 mins without being out of breath, it's just the damn HR. I doubt a HR of 110 would get a cardiversion so I'm baffled what they can do. I'm trying several breathing techniques to see if anything helps.

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