Heart rate limitation

[Sten Osis]

I'm now about 5 weeks post-surgery and saw my cardiologist yesterday. He wants me to stay on the Metropolol
and not exceed 145bpm for 3 more months. I thought wow, how am I going to ride my bike and keep it under 145?
I was really getting excited to be able to get out riding again once I pass the magic 8 week mark, but now it looks like I'm not going to be able to open the throttle or even ride up a hill.

I'm going to follow his instructions but I wonder what others have had to do with their heart rate during and after recovery?
I haven't had any complications yet, but I think he was worried about to high an HR bringing on A-fib.


Mike

 

[dwhist]

I am not sure the metoprolol will let you get your heart rate over 145. I started riding at about 12 weeks, due to winter conditions and was on metorprolol at that time. I had a had time getting my heart rate over 120. Weeks later when I was off the med I was able to get it to 150 -155 which was as high as I felt I could go.

I usually ride limestone path at 13 to 14 mph average with a few small hills.

I think they want you to keep rate down in order to allow the heart to go through its remodeling as it resizes. I know I was told my left ventricle had gotten enlarged but came back to normal size a few months after surgery.

 

[Cooker]

Slow and steady. You still have healing to do. I was able to reduce mine dose after a while and everything is back to normal. It takes time.

 

[Rachel]

I agree with the others, it takes time! I was not on any BB’s and so I didn’t have any drug related restrictions on my HR – I’m a runner so you know my HR gets up there. During the first 6 months after OHS I would only run for a minute if mine got up to 160BPM – I didn’t go far to say the least and it was SOOOOO frustrating… but easing into was worth it for me.

Now I don’t even pay attention to it.

It does take time…..

 

[Sten Osis]

Thanks for the help! I really needed some perspective on this because I feel so good I just want to get back to my normal activity level.

 

[TheGymGuy]

At 5 weeks, you can do some serious speed walking and a little bit of jogging if your sternum or body lets you. I, personally, see no issues with stationary biking if your body lets you. Not sure you can do real biking yet as bones in your sternum still have 3-5 weeks of healing to do.

 

[Ryan CA]

I have not had my valve replaced yet, and hopefully still have a while to go, but for what its worth, I do a good amount of mountain biking on 25 mg of Metoprolol a day. In order for me to reach 140, I really need to push hard....which I try not to do.

I ride 3 times a week or so and in some pretty hilly terrain. I can stay between 115 and 130 pretty easily. I believe its the combination of fitness and medication that allows it.

May not be the same situation as you but you might find that the meds will really keep you under your limit.

 

[clay_from_nj]

In my case, I've asked doctors and nurses about using heart rate as a guide for working out, and all have told me that I cannot use that as any kind of a measure because of the meds I'm on, probably the carvedilol (6.25mg 2x day, plus lisinopril, 2.5mg 1x). I have noticed that when doing cardio like walking (5mph+) or biking, I have to sort of "warm up" at the beginning and slowly rev my heart up to speed, like I'm fighting against the effect of the meds, then I can tick along at full tilt.

ASD repair at age 10
AVR on 9/21/12 (age 46)
Medtonics OpenPivot supra-annular 24mm.

 

[AZ Don]

Well at 8 weeks I think "opening the throttle" or serious hills would not be a great idea. At 8-12 weeks I would think that you would be able to start with easy rides and I'm surprised that the Dr. has given you a limitation for 3 months. Course different doctors say different things. When talking to Dr's about limitations after recovery I have been told everything from no limitations to keep my heart rate below 120 (always). At 8 weeks (just this week) my Cardiologist said I have no limitations within reason and no competitive sports. I took that to mean I wouldn't be doing the steep hills in my area for a while, if ever. I'll see how my heart rate responds to smaller hills after I've been riding a while first. FYI, I am still on Metoprolol 25mg twice a day and expect to be for at least a few months.

 

[epstns]

Mike - I understand your wanting to get out there and push it to the limits, but it may be just a bit too soon. They usually use heavier doses of metoprolol initially to make sure your heart beats fully each cycle as it is healing and remodeling. In my case, over time, we reduced my metoprolol dosage from 100 mg/day to 50 and ultimately to 25 mg/day (of the timed release version of the drug). With each reduction, I felt better and better. This didn't come quickly for me, as the reductions took place from about 12 to 20 months post-op. Now at 2.5 years out, I feel better than I did over the couple of years prior to surgery. During exercise, though, my heart rate doesn't need to go as high as it once did, I think because my heart works so much more effectively after valve replacement. Where my max HR used to go up to the 150's, it now usually doesn't need to go over mid-140's to do the same effort. It is difficult to figure it out exactly, as I can no longer run as I used to (knees won't hear of it) but I go much harder on the bike (15-16 mph).

I tried to get my cardio to reduce my metoprolol dosage by telling him that it was causing bloating and weight gain. That didn't bother him (I guess many of his older patients just accept this, but at 64 years old, I wasn't going to accept it). Finally, when I told him that the metoprolol made me feel like I was towing a sled full of rocks he got the idea. With each reduction in dosage, the sled got lighter until now it seems to be gone. Score!

So, maybe give it a little more time, then at one of your regular cardio chedk-ups you can open the discussion about reducing your dosage gradually. You can watch for problems like rhythm issues, palpitations, etc. after each dose change, and if none appear maybe he will allow another reduction the next visit. Some cardio's may want to wait until after an echo to discuss reducing metoprolol, as they want to know what your ejection fraction is prior to discussing dose changes.

 

[Classtime Sailer]

Unless your Cardiologist "Exercises", he won't understand. My guy told me to keep it under 150. And even at 150, I shouldn't maintain an effort like that for long. I stayed on the trainer for 6 weeks and then rode easy. I ramped it up a little each weekend while commuting 3 times per week 36 mi. round trip. At my 6 month check up, he said there were no restrictions. Really? I told him what I was doing and he freaked out. They don't get it. (sent you a PM)

 

[Rachel]

Unless your Cardiologist "Exercises", he won't understand. My guy told me to keep it under 150. And even at 150, I shouldn't maintain an effort like that for long. I stayed on the trainer for 6 weeks and then rode easy. I ramped it up a little each weekend while commuting 3 times per week 36 mi. round trip. At my 6 month check up, he said there were no restrictions. Really? I told him what I was doing and he freaked out. They don't get it. (sent you a PM)

You and I must have the same cardiologist! LOL

Even after two years, mine tells me not to run (she does not exercise at all).....while my surgeon gave me the green light to run half marathons... and I really believe (because I was a runner before all this) that if I didn't run, my heart wouldn't feel right.

I have adjusted my running a bit so I'm a little more conservative than I used to be, but still.....exercise in moderation (whatever that means for you) after a certain time away from surgery is helpful to get things back to "normal" - IMHO - of course you should ALWAYS follow your doctor's advice - if both my doctors told me not to run (and gave me good solid reason why I shouldn't ) then I wouldn't run.

 

[MarkU]

My cardiologist had me undergo lactic threshold heart rate (LTHR) and VO2 lab testing before he turned me loose to start triathlon training. After we determined all that, he asked me to wear a HR monitor when cycling and running, and to check my HR manually between sets when swimming. He didn't give me any hard limits, but asked me to not spend too much time in zone 4 & above (+95% of LTHR). Since most endurance training is done in zone 2&3 (roughly 75% of LTHR), that wasn't too big a deal. A big part of his concern at the time was my post-op left ventricular hypertrophy (LVH). Fortunately the LVH reversed itself within about 18 post-op and I have no current HR limitations.

Interestingly, I had done a lot of weight training pre-op, and my cardiologist asked me to limit that post-op and focus more on my aerobic exercise, i.e., my triathlon swimming, cycling and running. Now twelve years after my AVR he is suggesting that I add more weight training back into my regimen to offset muscle loss due to age (I recently turned 60).

Mark

 

[MtBiker]

My resting pulse has always been in the 50s, but before the operation it was in the 80s (maybe some anxiety there). Working out I generally max out at about 160, but now I'm having trouble getting it above 110 due to my metoprolol. My resting pulse is in the 50s again now.

I had AVR and hemiarch replacement about 8 weeks ago and just saw my cardiologist. He cut my metoprolol dose from 150 mg/day to 100 mg/day and my amiodarone from 400 mg/day to 200 mg/day. He also started me on lisinopril since my bp has been going up the last few weeks. He said the rise in bp is common after avr since the left ventricle is now pushing against a competent valve instead of a narrowed and calcified one.

I was hoping he would tell me my left ventricle was starting to remodel, but although it is about 15% smaller in circumference it is still hypertrophic and my ejection fraction has not improved from what it was pre-surgery (50-55%). He said to expect reverse remodeling to take 3 months to a year and that sometimes it doesn't happen at all. I'm hoping I don't fall in the latter category, but I'm curious to know how long others' reverse remodeling took.

I'm back on my bike and riding very easy (about 8 to 12 miles at 12 mph) but it feels good to be riding at all. I'm hoping to be able to ramp up the pace and the distance over the next several months, but I want to make sure I'm not setting back the remodeling effort.

 

[TheGymGuy]

Great progress update. Your heart is remodeling all the time. Whether you are resting, sleeping, walking, or riding its doing its job. Its a big muscle after all, so let it do its thing as you take it through its paces. I'd say that you are resting a lot more than you are exercising to there is lots of remodeling and happening at rest.

 

[Sten Osis]

Now, after 8 weeks, all the lifting restrictions are off and I can ride the bike. I've been out a couple of times to see what I can do with the HR max. of 145. It isn't much, but it sure is fun being back on the bike. I have to go super-slow up the hills, but can keep a pretty good pace of about 18-20 mph on the flats and not go over the max. Yesterday I did a 20 mile road ride with my wife. She said that I should have heart surgery more often...........so that she can keep up with me, hehehe.

 

[Classtime Sailer]

VERY COOL.
I'm smiling for you big time. I remember my early post surgery group rides where I could start with the group and drop off on the first incline. One time, the rider next to me looked over at my HR monitor and told me, "OK. That's it for you. See you next week." Don't be in a hurry to regain pre-surgery form. Unless your due to renegotiate your contract.

 

[Debbrn]

I have a very different defect than most of the people here. I was born in 1965 with tetralogy of fallot. My exercise tolerance is decreased. I am on atenolol which is a beta blocker. I use heart rate reserve to determine target heart rate. Also I have been monitoring my heart rate during exercise for years so I know how I feel at different heart rates. Being on a beta blocker does not mean that heart rate can not be used to determine exercise intensity. When I was in cardiac rehab after my last OHS they figured out my heart rate reserve and decided that there was no way that I could exercise in the narrow range. They would not listen to me that I did it all the time.

I do agree that being on beta blockers hinders exercise ability. The other day I took my beta blocker and then an hour later I tried to ride my stationary bicycle. I accomplished what I wanted to, but I was miserable the whole time. I felt like I was riding in mud or sand. I try and arrange my exercise so my beta blocker is not at its peak.

Debbie

 

[clay_from_nj]

Debbie,
Did the rehab figure out your reserve using a stress test? It's probably a more precise measure than the "talk test", although that works OK for me. I take carvedilol, 6.2mg 2x, (as well as lisinopril 2.5x1) and find that the only real hindrance to my exercising is that I need a "warmup" time (first half mile or so when biking) to get going before I can effectively go all out.

From the AHA website:

Concerns About Exercising While on Beta Blockers
“It’s important to remember that your heart rate is being slowed, and to adjust accordingly if before you took these drugs you monitored your exercise using heart rate,” said Dr. Fletcher, who is also a volunteer with the American Heart Association.

“Don’t overdo it trying to get your heart rate up to previous levels,” he said.

There are a couple of ways to monitor your exercise intensity.

1. If you have been using a target heart rate to get to the right intensity, Dr. Fletcher recommends a brief exercise stress test with your healthcare provider to determine your new target heart rate. This test is important because beta blockers affect everyone differently, so there is no other way accurate way to calculate your target rate without it.
2. The second way to monitor your intensity is simpler: making sure you’re not too exhausted.

“Exercise hard – to the point of being tired – but not excessively hard,” Dr. Fletcher said. “If you reach a point where it is hard to talk, that is probably too much.”

The advice from all my doctors (surgeon, cardio, gp, etc) has been #2. Kaiser practitioners around here, in my experience, seem to be very big on "listen to your body" and rely on numbers as little as possible.

 

[Sten Osis]

Re: Heart rate limitation

Well, I just had a three month Echo and consultation with my cardiologist. He wants me to keep taking the metoprolol as long as it doesn't bother me, but he also lifted the heart rate restriction. That's good.