Low exertion, high heart rates.

Hi all,

I'm 24 now, had my pacemkaer implanted in october 2018 for congenital complete heart block.

I've been getting back into exercise for the past 6 weeks and have noticed whenever i do minimal exercise my heart rate is shooting up. For example, my heart rate will go from 70-80 resting to 110-120 after standing up and going to the loo or to go get food. It will recover nicely though. 

My LRL is set at 70 and my HRL is set at 170, im pretty sure rate response is being overlys ensitive but wasnt sure.

My walking heart rate at a pace of 12 mintues per km is 130bpm, this is way too high, my friend is sitting at 100bpm (no pacemaker) should i get used tot he fact i wont be normal. It doesnt feel like exercise can bring this rate down.
I've also noticed i have very low Heart rate variability accoridng to my apple watch <10ms and also my VO2 max is extremley poor, in the 30s.


14 Comments

Increased heart rate with exercise

by Selwyn - 2022-06-16 08:19:49

Hi,

 I would be asking to have my pacemaker exercise rate response settings looked at in your position and with your difficulties.  It would seem that your settings may be rather harsh!  There are different sensitivities and speed of onset/offset for rate response settings. 

I see you are in the UK. You don't mention the make/model  of PM you are fitted with.  Just phone the pacemaker electrophysiologists directly for an appointment  and get yourself back to the department ( If you don't have the number go through the hospital switch board).   Here in Liverpool they will usually see me within that week.

 

settings for CCHB

by Tracey_E - 2022-06-16 08:44:46

As Selwyn said,  sounds like rate response settings. With CCHB, this can be turned off. Rate response artificially raises our rate when it senses movement. For us, our sinus rate is often normal so we don't need this boost, we just need the pacer to keep the ventricles in sync with the atria. Ask if you are pacing atrial. If you are, it's likely rate response and a very easy fix.

 

Low exertion

by AgentX86 - 2022-06-16 11:02:54

It seems to me that if CHB is the only issue, RR should be turned off.  If it is on, the pacemaker and SI node would be fighting each other and weird things could happen. CHB means that the AV node (or His) is defective.  Then the pacemaker just replaces the AV node.  It says nothing about the SI node, which can be assumed is still intact (or they'd mentions something like SSS). The sinus node is the pacemaker the artificial pacemaker isn't needed so RR shouldn't be used.

Again, this is conjecture because we don't know anything else. The high rates may be becoming from an SVT, like flutter, or other. This could have been masked by the CHB but could be showing its ugly head now that the ventricles are connected to the atria.

Again, my guess.  We don't know the whole story.  This is why we have to communicate with our EPs. We have to be able to understand, sometimes complicated, issues so we know what to expect.  If we notice something unexpected we have to tell them about it.  If the EP knows about it, they damn well should have told us what to expect and if they didn't, they do now. This is really important.

Appointment

by Grantbibby98 - 2022-06-16 12:25:34

Got an appointment instantly. They gave me some checks, they said my rate response is more for tracking and won't exert my heart, they said that the heart dictates the speed, they lowered it to a 9 from a 12 but I'm not sure what even means. Apparently it will cause my heart rate to rise slower but has no effect on how high. 
 

im not sure what my pacemaker company is, all I know is I got given a heart monitor from Boston clinic, latitude so I can have monitoring from home. They also reduced my power output and now my battery life is 3.5 years, up from 2. 
 

the pacemaker is dual chamber and is on 100%. Not sure what other information to provide. Other than I live in Essex, England. 

Rate Response

by AgentX86 - 2022-06-16 12:55:45

This doesn't make any sense to me.  Rate response is used to adjust the heart rate for various oxygen demands.  SI node normally senses oxygen demand by measuring the oxygen (actually CO2) content of the blood and adjust the rate accordingly.  Those of us with a defective SI node (chronotropic incompetent) need some way of adjusting heart rate.  RR is used to estimate oxygen demand and set the rate accordingly. Since your problem is a heart block not sick sinus syndrome (SSS), I don't see the need for atrial pacing at all, much less RR.  Again I'm not a doctor.

Tracking means that the pacemaker's ventricle lead is used to excite the ventricles when it senses a contraction of the atria.  This simulates the operation of the AV node. So... I don't see RR used here.

I'm sure there is a logical explination in here somewhere but if it were me, I'd want to understand it.  In any case, something is driving your heart rate up.  Since you have a bedside box, I'd initiate a transmission when I felt the problem. This will give them more information. 

There is something in here but I certainly don't understand the problem and their explanation doesn't make sense to me.  If it were me, I'd want my EP to give me more information.

Since you have a Boston Sci bedside monitor, you'll have a Boston Sci pacemaker.  They should have given you a card with all of the information on it: manufacturer, model, and serial numbers of not only the pacemaker but also the leads.

 

Rate response

by Grantbibby98 - 2022-06-16 13:26:26

I don't have an EP, I just have pacemaker technicians. I do however have a cardiologist who is doing a stress test and an echo to asses the situation as he think it could be the pacemaker inducing it, that won't be discussed until next month. I did try and say that I wanted rate response switched off but the pacemker technicians made me feel like I had no clue what I was on about. 
 

I would need to contact them to ask regarding the model, but I will press when have those problems. In all honesty I don't have symptoms it just seems like too much for the little activity I'm doing and I'd rather it wasn't that high. Having rate response off wouldn't cause any problems then is what your saying, only if the SI node is not doing its job?

 

thanks for all the helpful comments, it helps to discuss this in future appointments. 

Ecg

by Grantbibby98 - 2022-06-16 13:29:38

During the appointment today they took ecgs whilst setting my heart rate to 70 and 100. They also then took someone when I pressed my hands together and when I pressed into the technicians hands. They said twos seperate words but can't remember what they were. 

Exercise settings.

by Selwyn - 2022-06-16 13:59:13

Dear Grantbibb98,

I am pleased to hear that you have access to a pacemaker clinic with ease ( thank the NHS!).

You should have details of your pacemaker model on your European Pacemaker Card which is issued to you when you have your pacemaker fitted. It is worth looking at the card.

If it is a Boston Scientific, then they may have lowered the sensitivity for rate response from 9 to 12. Clearly, rate response, if switched on, this is meant to increase your heart rate with the  movement of exercise. There is also a setting for response factor range which sets the upper rate limit for pacing. If you have a model that measures ventilation response to exercise, that response  is set differently, and then can be combined with the movement response for best exercise response.

It may be worth having someone accompany you to your check ups as it is difficult to remember everything that is said. Some departments will give you a printout of your check ups if you ask.  This is always worth having, you can then look things up yourself. You should get a copy of the letter from the department to your GP. Again, if you don't get this I would ask for a copy to be sent as it is always a learning process, and you will have a pacemaker for all your life.  All NHS hospital patients are entitled to receive a copy of the letter that goes out to their general practitioner from their hospital visit. 

Pacemaker and lead model

by Grantbibby98 - 2022-06-16 17:58:50

Hi so I found my pacemaker model to be:

pacemaker - Essentio MRI DR Pacemaker L111

leads - Ingevity MRI 

Mode - DDDR

BPM?

by MinimeJer05 - 2022-06-17 16:04:30

Hello,

I might be chiming in here with useless information, but I guess I am confused on the confusion or concern with the raising of the heart rate?

I have a pacemaker and a mechanical valve and generally when sitting down and not doing much, am around 70-90BPM. When I get up and walk around, it can go up to 100-120BPM and when I am exercising I can get it as high as 170BPM. That higher side usually requires an exchausting run, otherwise if I go for an intense walk, I can get it to around 130-150BPM.

I haven't been alarmed by these numbers because I have been told that these are normal (I will admit, I am a little out of shape and overweight right now, because my exercise has been more sporadic than consistent), but I generally just lean into how I FEEL.

I feel like I am getting a good workout in when I am working out and I feel fine otherwise.

Are you feeling uncomfortable while walking and working out? Out of breath or just exhausted? If not, then are you just concerned because your heart rate is usually much lower?

Take care

Jer

Bpm response

by Grantbibby98 - 2022-06-17 19:45:21

Hey,

 

so the heart rate before was usually much lower, it seems like it's pushing me too high for no reason. I shouldn't be going that fast, most of my friends sit at 100, I know they don't have a pacemaker but my partners dad does and he sits there too comfortably. 

BPM Response

by MinimeJer05 - 2022-06-17 21:37:51

Hello again,

Understood -- so you are use to it being much lower and the increase is causing concern? Note that a PM will naturally increase that rate (read many of posts from people that were living with 30BPM and thought it was foreign when the PM adjusted them to a more "normal" rate).

You should also not try to compare to others as everyone (PM or not) is different. I have a friend that can't get his rate past 100 when doing INTENSE cardio and he sleeps around 50BPM -- personally, if I saw those numbers, I'd be freaking out as that's way too low. 
 

I guess all I'm trying to pass on here is to simply focus more on how you FEEL and less on numbers for the sake of numbers. There isn't a "perfect" or "right" BPM that you should shoot for. Your "new normal" could be resting at 90 and working out at 170 or it could be 70 and 100 -- neither of these are a concern unless you're feeling tired, dizzy, exhausted or not how you'd normally feel after whatever type of exercise/workout you've completed. 
 

Again, I hope you feel better and get the answers you seek! Just trying to offer some advice and learn more about your situation as I've spent too much of my own time worrying about "high" heart rates that I later found out aren't of any concern. 
 

Take care

Jer

BPM response 2

by Grantbibby98 - 2022-06-18 18:57:41

Hi, 

I really appreciate the messages. I believe you are right, once I've had my echo and treadmill test come back clear I'll probably relax a little about the rates. I've also got Boston scientific involved to help assist on my next appointment to really perfect the programming of the pacemaker seetings, I don't feel any symptoms other than constant fatigue as I truly believe I'm running to high for too long, I just want to protect my heart structure before it's too late.

thanks again for your comments.

 

Grant 

Makes Sense!

by MinimeJer05 - 2022-06-30 10:47:55

Grant,

That makes perfect sense and I hope everything comes back normal for you! Nothing wrong with wanting to be pro-active and to keep an eye on things.

I wish you the best of luck and I hope the fatigue goes away or can be identifed as an effect to something.

Take care

Jer

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