symtoms still with exercise

i am 69-and  a 3 day a week cross fitter- i had the medtronic pm in october after beng dx with sick sinus syndrome. my hrt ratae was at 48 but relentless rapid heart beefs and dizziness. for thepast few months all has been good. hrt rate is stet at 60 and i was told pace setting is on.

i started having the same sx about a month ago and i had to do another heart monitor- which i recorded all symtoms- which occur mostly while exercising. rapid heart rate dizzy, cant catch my breathe.interesting i can run fine especially when its cold. i can get these rapid hrt rates sometimes just getting out of bed or walking up a simple flite of stairs- exact same sx as pre pm.

im going to ep in a few weeks- i am sure the heart monitor will not show any thing- but the sx are annoying.any advise as to how to handle this with the ep? do you think a beta blocker will help the pm kick in faster?






by Tracey_E - 2023-01-16 13:06:25

Turning on (or turning up) rate response can get your rate up higher faster.

Beta blockers do just the opposite, they hold your rate down and prevent racing. 

When it's cold, our rate stays lower.

Many of us-  no matter  how fit, how long we've been paced, how well adjusted our pacer is- struggle on the stairs. By the time our body figures out what we are doing and adjusts, we are already up at the top. Usually huffing and puffing.

The pacer is as gas pedal, not a brake. If your rate is too low, it will make it faster. If your rate doesn't go up enough on exertion, it can give you a boost. If your heart goes fast on its own, the pacer is going to watch. It won't prevent racing. 

Beta Blocker

by Lurker # 4375 - 2023-01-16 18:11:06

Tracey. It sounds weird, and I used to tell the doctors in the hospital which they denied. They give you a beta blocker to slow your heart rate down so the pacer can pick it up.



by AgentX86 - 2023-01-16 21:19:56

"struggle on the stairs"  It's more than just RR not ramping quickly enough, climbing stairs requires a lot more energy that walking (try a stair climber vs. a treadmill).  Pacemakers are set up for walking. Stairs can't be done without another dimension.  I have no idea why they don't do it.  Fitbits can count stairs but perhaps they can only count them after they find the top (too late for a pacer).

"blocker to slow your heart rate down so the pacer can pick it up."

Exactly.  My EP gave me the option for a pacemaker, before I needed one, to do exactly this.  I was on sotolol to control flutter but it's also a beta blocker ("olol") so the dosage was limited because my HR was already low and needed metoptolol for BP.  A pacemaker would keep the bottom up while he drugged the hell out of the flutter.  I didn't go for it, rather ablations (didn't work).  In the mean time, the sotolol gave me tachy/Brady and pauses so the decision was made for me.  It wasn't a long jump from there to the AV ablation.



by Tracey_E - 2023-01-16 21:41:07

It seems counter-intuitive, but some people need to be on a dose of beta blockers high enough  that it will bring their rate down dangeously low. My dad is in this situation. To get his arrhythmias under control, he needs a high dose and his resting rate is borderline now for needing to pace. He's doing ok as is, but he knows that if they have to up the dose again or his rate drops more, he's gonna be getting a pacer. 

It can be frustrating because the meds bring down the inappropriate fast rates, but they also make it harder to work out because it holds us down when we want to get our rate up. Finding a good balance can be time consuming and frustrating.

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