Heart rate limitation

[spartangator]

Congrats on the nice echo and the removal of the restrictions. Sound like all's coming along nicely, and you'll be dancing on the pedals soon.

 

[dave1939]

I had AVR September 11 and started cardiac rehab about one month after. The nurse, a runner and triathlete, encouraged me to push myself, exercise wise. I entered a 5K six weeks after the operation and my time was about the same as my PR for a 10K. (Alright that was about 20 years ago). The following week I did another 5K and my time went from 40 minutes to 37.
I am a bit concerned (confused) about my heart rate. I never really monitored it previously, but since the operation I bought a heart rate monitor. In the races I decided to keep my HR below 140. In the first race I noted that it was 154 after a few minutes and in the second it was 164 the first time I looked. (I checked the monitor, both manually and with the gym monitors) I jog/walked after that to keep my HR below 140. The surprising thing is that my theoretical maximum, at age 74, is 146. As I said, I never paid much attention to my HR, but based on some measurements taken on exercise machines, I'm pretty sure I never got those numbers previously.
Also, my resting HR used to be 45-50 and now it is 70-80.
Any comments?
Thanks,
Dave

 

[AZ Don]

It's normal for HR to be higher following open heart surgery. Even with beta blockers mine was higher after the surgery. I'm still on a low dose of beta blockers so now my HR is lower than normal before surgery. Hard to tell but I think it would be about the same as before surgery if I was off the beta blockers, but my surgery was in May. I'm surprised your Dr let you run, let alone in a race so soon.

From Wikipedia:

The maximum heart rate (HRmax) is the highest heart rate an individual can achieve without severe problems through exercise stress,[7][8] and depends on age. The most accurate way of measuring HRmax is via a cardiac stress test.

If you are still going to Cardiac Rehab, perhaps you can have them measure to find your actual HRmax, rather than the general theoretical one.

 

[Rachel]

I am a bit concerned (confused) about my heart rate. I never really monitored it previously, but since the operation I bought a heart rate monitor. In the races I decided to keep my HR below 140. In the first race I noted that it was 154 after a few minutes and in the second it was 164 the first time I looked. (I checked the monitor, both manually and with the gym monitors) I jog/walked after that to keep my HR below 140. The surprising thing is that my theoretical maximum, at age 74, is 146. As I said, I never paid much attention to my HR, but based on some measurements taken on exercise machines, I'm pretty sure I never got those numbers previously.
Also, my resting HR used to be 45-50 and now it is 70-80.
Any comments?
Thanks,
Dave

I never kept up with my HR while running pre-surgery either - but after I did..... and it drove me crazy! I was super careful right after surgery to not go over 160 (my theoretical max based on age is 174 ish) - now I don't pay attention to it - I just run how I feel. My resting HR right after surgery was around 90 (I was not on any medication) but now it's 48-56 ish

Took me probably a couple months for the resting HR to go down to 70 and then another year to get to where I'm at now....everyone's different but I think the HR is higher for most people right after surgery.

 

[ottomurray]

Interesting reading... I'm new to the forum and post op 2 month today. I am a Cat 2 bike racer and have been trying to figure out my elevated HR as well. Prior to surgery Dec 20th, I had been racing pretty intensely and resting HR around 58. I've gotten back to some low level riding with a few long ride (50) miles but irritated with my elevated HR as well as the weakness on the bike going up hills. I was taken off meds (beta-blocker and Afib meds) after seeing docs in mid Jan. I know I need to be patient but it's spring soon and I want to get back to some decent training rides.
Wondering how long the meds stay in affect after discontinuing? :mad2:

Thanks for the read of folks here - Glad to be alive! :biggrin2:

 

[epstns]

Otto - You don't say much about yourself - age, other conditions, etc. (I checked your profile page), so it is hard to really predict your recovery. Some of us are a bit older or have other conditions (either pre-existing or induced/caused during surgery), while others just cruise on through and into the next race. I was a recreational runner/jogger for over 30 years pre-surgery. I had a few (?) complications from surgery and ended up with not only a new valve, but a bypass, a pacemaker, and eventually a hernia repair. I didn't get back to my pre-op times. In fact, I didn't get back to running per se. With advancing age, my knees refuse to accept the impact of running, so I do high-intensity treadmill work (fast pace on a heavy incline), as well as the stationary bike (but not quite at the spinners' pace). My heart rate used to go from rest at high 40's to the mid 160's under load. Now my resting rate is set to a minimum of 60 BPM, and I hit the upper 150's under load.

Why do I relate all this? Because no matter what the specifics, my life is still far better now than it would have been had I not had the surgery. My advice to you is not to dwell on what was. Focus instead on what is and what can be. Do all you can, then push a little more. Maybe you get back to where you were, maybe farther, maybe less. Just do the best you can and continue to enjoy your life to its fullest. That way you can continue to be a great example to the new folks who are still afraid of what is ahead.

Sounds like you're doing well. Please accept my best wishes for continued progress. It sounds like you have the attitude it takes to make the most of it.

 

[MtBiker]

Otto,

I was riding 4 or 5 times a week prior to my surgery last June. In August I rode 25 miles slowly and by October was up to about 40 miles in a single ride. I was on Metoprolol (100 mg) until early December and it took about a month or so for my heart rate to stabilize after I stopped taking it. Now I'm skate skiing and riding when it's warm enough and my HR is comfortably reaching 160+ during the peak of a workout and resting in the 60's. That's not far off my pre-surgery numbers. It took longer than I thought it would for the effects of the beta blocker to wear off, in fact, the effect it had on my peripheral circulation took a couple of months to wear off so skiing during January was really cold on my hands and feet.

I'm impatient, but I'm catching onto the idea that full recovery takes a long time. Most people I talk to congratulate me on my great recovery since I'm up and walking around, working full time and going up and down stairs without gasping for air, but my pre-op state was a high level of physical activity, and it's taking a good long time to get back to it. That said, I feel really good in general, so if this is as good as it gets, I can't complain!

 

[Paleowoman]

Interesting reading... I'm new to the forum and post op 2 month today…..<snip>…..I was taken off meds (beta-blocker and Afib meds) after seeing docs in mid Jan.

Interesting to read that you were taken off your meds about a month after surgery. I am trying to find out the usual time to come off those meds, assuming there's no AF. There seems to be no definite answer, it seems to be what the individual cardiologist or surgeon is used to.

 

[MtBiker]

I think there can be a benefit to the heart by staying on BBs while it's reverse remodeling. My cardiologist explained to me that it's common to have high blood pressure just after valve replacement because the ventricle is still pumping hard as if the valve were still stenotic. I think part of the purpose of the BB is to artificially back the ventricle off so it gets used to the new normal.

 

[Paleowoman]

I think there can be a benefit to the heart by staying on BBs while it's reverse remodeling. My cardiologist explained to me that it's common to have high blood pressure just after valve replacement because the ventricle is still pumping hard as if the valve were still stenotic. I think part of the purpose of the BB is to artificially back the ventricle off so it gets used to the new normal.

I think it has to be looked at individually, and it's that which I don't think cardio thoracic surgeons and maybe cardiologists, do. I discovered that the reason everyone is put on BBs immediately after cardiac surgey is because they protect the heart from atrial fibrillation. That makes sense as the heart can easily get AF after surgery. The question then comes up - for how long ? I looked and looked on the internet for reasearch on this - there's plenty on BBs at the time of surgery (perioperatively), plenty on BBs and hypertension, AF and anxiety - nothing on BBs given for any length of time post operatively. I checked with a cardiac thoracic surgeon at the Society of Cardio Thoracic Surgery and he said, assuming no AF, six weeks is what he keeps his pateints on BBs. Another surgeon might say stay on them for a few weeks, another for a few months, your surgeon says while your heart is remodelling - how will he know when it's remodelled ? How does a cardiologist/surgeon know if a heart needs remodelling ? Sorry, I feel very sceptical about all this since everyone's surgeon has their own timeline which is not based on any consensus nor appears to be based on individual patients' needs !

I'm on Atenolol 12.5mg per day - looking forward to coming off this !

 

[MtBiker]

An echo can tell to what extent your heart is remodeling. It shows how hypertrophic your ventricle is and can determine ejection fraction. It seems that there are no simple standards for use of BBs post operatively but it also seems that the decision of how long to stay on them depends on tolerance for them, tendency toward afib and need for reverse remodeling among other things.

 

[Paleowoman]

An echo can tell to what extent your heart is remodeling. It shows how hypertrophic your ventricle is and can determine ejection fraction. It seems that there are no simple standards for use of BBs post operatively but it also seems that the decision of how long to stay on them depends on tolerance for them, tendency toward afib and need for reverse remodeling among other things.

Before my surgery my ventricle did not have any hypertrophy and was very strong (echo technician remarked on that) - my Ejection Fraction was 79% despite my pressure gradient being 68 mm/Hg (pressure gradient always good, it was 77% seven years previously when pressure gradient 35 mm/Hg). A week after surgery echo showed there was still no hypertrophy and my Ejection Fraction was 75%. I had no AF but I had been put on BBs as per standard. Six weeks after surgery, still on BBs, echo showed I had mild left ventricular hypertrophy and my Ejection Fraction had dropped to 67%

So my heart, which showed no signs of hypertrophy at all before or immediately following surgery, now has hypertrophy and the EJ has dropped. BBs are supposed to slow down the heart rate and not let it work so hard...looks like doing that has caused hypertrophy to me

 

[MarkU]

Otto,



I'm impatient, but I'm catching onto the idea that full recovery takes a long time. Most people I talk to congratulate me on my great recovery since I'm up and walking around, working full time and going up and down stairs without gasping for air, but my pre-op state was a high level of physical activity, and it's taking a good long time to get back to it. That said, I feel really good in general, so if this is as good as it gets, I can't complain!

I was in good shape prior to my AVR and my surgery was textbook, but it still took me 9-12 months to feel 100% again. Although I was "functional" and back to most normal activities within 8-12 weeks, I found I had very little stamina and wore out easily. My cardiac function was great, but the trauma associated with the surgery hit me hard.

It was very frustrating at times. But looking back I feel very lucky about the way things turned out for me. In fact I am probably more active in many ways than I would have been if I had not gone through my AVR. Makes me appreciative of every day of good health that I now enjoy.

My biggest concerns these days are orthopedic injuries (some related to age) as opposed to cardiac issues.

Good luck,
Mark

 

[MtBiker]

Before my surgery my ventricle did not have any hypertrophy and was very strong (echo technician remarked on that) - my Ejection Fraction was 79% despite my pressure gradient being 68 mm/Hg (pressure gradient always good, it was 77% seven years previously when pressure gradient 35 mm/Hg). A week after surgery echo showed there was still no hypertrophy and my Ejection Fraction was 75%. I had no AF but I had been put on BBs as per standard. Six weeks after surgery, still on BBs, echo showed I had mild left ventricular hypertrophy and my Ejection Fraction had dropped to 67%

So my heart, which showed no signs of hypertrophy at all before or immediately following surgery, now has hypertrophy and the EJ has dropped. BBs are supposed to slow down the heart rate and not let it work so hard...looks like doing that has caused hypertrophy to me

That's similar to what happened with my heart, though I had some hypertrophy. Also, my lv was dilated at 6.8cm. It went down to 5.6cm a month and a half after surgery, but that caused my hypertrophy to worsen. It's like you have a balloon that's blown up to its limit. The walls of the balloon will be thin. Then when you lessen the pressure inside the balloon, the walls thicken. In the case of the heart, my cardiologist explained that it will take a while (possibly several years) for the hypertrophy to lessen. It will probably never go away completely, but he said it shouldn't affect function at all.

 

[ottomurray]

Thanks for all the advice. Glad to hear similar stories. I Just hit the 3 month mark on Friday. I am slowly improving my fitness each week but I think my brain still remembers the pace I used to go with the groups I trained with. Arghhh!

I've been able to do regular 50 and 60 mile rides but I have noticed I have no top end to endure hills at all. HR monitor shows me going from around 150 to 170 and just like that the legs turn to jello... I really need to rethink trying to ride with my fast team mates. But I will echo that recovery is taking longer than expected. I am a stubborn SOB and learning that I have to sustain from the notion that I should suffer more to get my fitness back up to racing level. My friends tell me "patience young grasshopper". Fortunately bike racing is not my day job to earn a paycheck so the pressure is off - HA :biggrin2:

I'm not really trying to break any recovery records but riding is part of my soul. I guess it doesn't help that I'm turning 50 in few months. Reality's a bitch.... :eek2:
I'll keep checking in every so often.
Otto

Otto,

I was riding 4 or 5 times a week prior to my surgery last June. In August I rode 25 miles slowly and by October was up to about 40 miles in a single ride. I was on Metoprolol (100 mg) until early December and it took about a month or so for my heart rate to stabilize after I stopped taking it. Now I'm skate skiing and riding when it's warm enough and my HR is comfortably reaching 160+ during the peak of a workout and resting in the 60's. That's not far off my pre-surgery numbers. It took longer than I thought it would for the effects of the beta blocker to wear off, in fact, the effect it had on my peripheral circulation took a couple of months to wear off so skiing during January was really cold on my hands and feet.

I'm impatient, but I'm catching onto the idea that full recovery takes a long time. Most people I talk to congratulate me on my great recovery since I'm up and walking around, working full time and going up and down stairs without gasping for air, but my pre-op state was a high level of physical activity, and it's taking a good long time to get back to it. That said, I feel really good in general, so if this is as good as it gets, I can't complain!

 

[RunMartin]

Sounds very familiar to me. It took me a while to get used to my new ability profile. I ended up training with a beginners group which stopped me overdoing things eventhough my head would say "push harder" etc.

 

[pnarciso]

34 months after surgery and I'm still experiencing a higher heart rate than I used to while exercising. I do not feel like I am pushing extremely hard, and still my HR will go above 180; realistically I do not think it will go back to normal, ever. Glad to be alive, for sure, but a little bit frustrated too. Ran a 1/2 marathon in 1:50' before surgery, now I can't get lower than 2:15', because I need to slow down to keep HR at a reasonable level.
Oh, well, I guess you can't always get what you want...