Post-op Irritable Heart, Resting Heart Rate

[almost_hectic]

Okay, my surgery was like 11 weeks ago and in general I feel pretty good, wither exception of some lingering chest pain from time to time. Everyone had told me about the condition of irritable heart after surgery, and I've fully experienced some of that, no doubt. My question is how long to consider that normal?

I have to occasional palpitation here and there, but in general they are fewer than before my surgery and far more tolerable. When I was sent home I was on amiodarone and Lopressor, but my pressure was on the low side. Although my rate/rhythm was excellent. I had a very solid resting heart rate that ranged in the high 60's to low 70's, albeit that was after being home a couple of week. When I began recording it immediately after getting home it was low 90's. So you can see that thing calmed down quite a bit.

Well since then I've been taken of all meds except for warfarin. Plus I've since completed about 20 sessions of cardiac rehab. The thing that bugs me is my resting heart rate is now back up in the mid 90 to 100 range. Cardiac rehab tells me in still in the normal range. What I've begun to uncover though is what's really got me perplexed. That high end resting heart rate is typical for me in the morning. The afternoons it often settles down to high 70's or low 80's. Well I always attend rehab in the AM when it's higher, but looking back at my chart my very first session weeks ago was in the afternoon and my Resting HR was its lowest they have on record at 88 bpm.

Is there something to all of this or should I expect things are still settling down and that I should be more patient with this as a process. Otherwise I seem to be feeling good and have no trouble exercising. And even when exercising my HR is within the range where they want my target HR 120-145ish, not like it's way off the charts. I guess I'm worrying it may be a sign of some other issue...

 

[ALLBETTERNOW!]

Okay, my surgery was like 11 weeks ago and in general I feel pretty good, wither exception of some lingering chest pain from time to time. Everyone had told me about the condition of irritable heart after surgery, and I've fully experienced some of that, no doubt. My question is how long to consider that normal?

I have to occasional palpitation here and there, but in general they are fewer than before my surgery and far more tolerable. When I was sent home I was on amiodarone and Lopressor, but my pressure was on the low side. Although my rate/rhythm was excellent. I had a very solid resting heart rate that ranged in the high 60's to low 70's, albeit that was after being home a couple of week. When I began recording it immediately after getting home it was low 90's. So you can see that thing calmed down quite a bit.

Well since then I've been taken of all meds except for warfarin. Plus I've since completed about 20 sessions of cardiac rehab. The thing that bugs me is my resting heart rate is now back up in the mid 90 to 100 range. Cardiac rehab tells me in still in the normal range. What I've begun to uncover though is what's really got me perplexed. That high end resting heart rate is typical for me in the morning. The afternoons it often settles down to high 70's or low 80's. Well I always attend rehab in the AM when it's higher, but looking back at my chart my very first session weeks ago was in the afternoon and my Resting HR was its lowest they have on record at 88 bpm.

Is there something to all of this or should I expect things are still settling down and that I should be more patient with this as a process. Otherwise I seem to be feeling good and have no trouble exercising. And even when exercising my HR is within the range where they want my target HR 120-145ish, not like it's way off the charts. I guess I'm worrying it may be a sign of some other issue...

Does cardio rehab have you hooked up to a 3 lead EKG and take your bp and pulse. If they do I'd take comfort in that. I have a 55-60 resting heart rate bradycardia so I can't speak to you lucky people in the normal range though I understand your concerns.

 

[almost_hectic]

Does cardio rehab have you hooked up to a 3 lead EKG and take your bp and pulse. If they do I'd take comfort in that. I have a 55-60 resting heart rate bradycardia so I can't speak to you lucky people in the normal range though I understand your concerns.

Yup they do the full thing, 3 lead EKG going the whole time your working out. With BP taken before and during exercise. I dont know why, it just seems like my resting HR should be lower if everything is normal. Im in good health otherwise, I still consider myself young at 45. And I was in good shape prior to surgery exercising 4 or 5 days a week. I was no athlete, but I know my resting heart rate was lower, I just dont know what it was because I have no record or notes of it. But I can recall taking my blood pressure and the reading being in the 80 bpm range.

So what do they do for bradycardia?

 

[Paleowoman]

When I had an echo about six months post surgery my heart was apparently showing "mild paradoxical septal movement" which is something the heart can do post surgically because it doesn't like being handled in surgery. Takes a while to recover. I don't know if that is "irritated heart" but it is caused by the heart being irritated, that's how my cardio9logist explained it. It didn't cause me any symptoms, just showed on echo, and is not regarded as anything to be concerned about.

Your chest pain - I get mild costochondritis pain where one of my ribs joins my sternum, still get it, especially after weight training - again not serious.

If you're concerned about any of your pain or other symptoms you should probably see your cardiologist.

 

[MethodAir]

I have a 55-60 resting heart rate bradycardia so I can't speak to you lucky people in the normal range though I understand your concerns.

There's nothing wrong with that heart rate if you don't have any underlying issues. Resting heart rate in the 40s is common among athletes (a competitive cyclist had a resting heart rate of 28).

 

[MethodAir]

Okay, my surgery was like 11 weeks ago and in general I feel pretty good, wither exception of some lingering chest pain from time to time. Everyone had told me about the condition of irritable heart after surgery, and I've fully experienced some of that, no doubt. My question is how long to consider that normal?

I have to occasional palpitation here and there, but in general they are fewer than before my surgery and far more tolerable. When I was sent home I was on amiodarone and Lopressor, but my pressure was on the low side. Although my rate/rhythm was excellent. I had a very solid resting heart rate that ranged in the high 60's to low 70's, albeit that was after being home a couple of week. When I began recording it immediately after getting home it was low 90's. So you can see that thing calmed down quite a bit.

Well since then I've been taken of all meds except for warfarin. Plus I've since completed about 20 sessions of cardiac rehab. The thing that bugs me is my resting heart rate is now back up in the mid 90 to 100 range. Cardiac rehab tells me in still in the normal range. What I've begun to uncover though is what's really got me perplexed. That high end resting heart rate is typical for me in the morning. The afternoons it often settles down to high 70's or low 80's. Well I always attend rehab in the AM when it's higher, but looking back at my chart my very first session weeks ago was in the afternoon and my Resting HR was its lowest they have on record at 88 bpm.

Is there something to all of this or should I expect things are still settling down and that I should be more patient with this as a process. Otherwise I seem to be feeling good and have no trouble exercising. And even when exercising my HR is within the range where they want my target HR 120-145ish, not like it's way off the charts. I guess I'm worrying it may be a sign of some other issue...

For what duration were you typically exercising at a heart rate of between 120-145, almost_hectic? If it was anything more than a couple of minutes, that sounds needlessly taxing at that early stage after surgery. Palpitations and an elevated heart rate are sometimes cues that you may have been overdoing it. In my experience, exercise is generally not a specialty of a cardiologist (it's mostly about pushing pills). It requires a whole other subset of knowledge which I've found is usually non existent in the medical community.

 

[almost_hectic]

For what duration were you typically exercising at a heart rate of between 120-145, almost_hectic? If it was anything more than a couple of minutes, that sounds needlessly taxing at that early stage after surgery. Palpitations and an elevated heart rate are sometimes cues that you may have been overdoing it. In my experience, exercise is generally not a specialty of a cardiologist (it's mostly about pushing pills). It requires a whole other subset of knowledge which I've found is usually non existent in the medical community.

Well believe me I've questioned all this myself. My cardiologist isn't really all that involved at this stage, I just go to the cardiac rehab center three days a week. Really wonder sometimes though what the expertise level of the folks there is, but I have zero, so my only course of action was to assume they know what they're doing... I do a number of things like treadmill, bike, arm ergometer, and elliptical. Each with a duration of about ten minutes, so pretty much for an hour they've got my heart rated elevated in that 120-145 range. They set my max bpm at 150 but have also said its okay if I go a little over that briefly. What threw me for a loop was how they determined my max heart rate at 150, they just take 220 minus your age and then ultiply by .7 . Isn't that how you determine target heart rate for someone healthy?! This is supposed to be cardiac "rehab" because I just had open heart surgery! I don't know, I mean I feel okay while doing it all. But I do question the method. On days when I don't have rehab I've been walking at a brisk pace with bpm of 125-135 for anywhere from half hour to an hour, sometimes twice a day. I keep thinking exercise is the only way to bring down my resting heart rate, by getting stronger. But I'm just following their example and really don't know if it's right or not... I mean it's been almost 3 months since surgery but I don't know (obviously)

 

[MethodAir]

Well believe me I've questioned all this myself. My cardiologist isn't really all that involved at this stage, I just go to the cardiac rehab center three days a week. Really wonder sometimes though what the expertise level of the folks there is, but I have zero, so my only course of action was to assume they know what they're doing... I do a number of things like treadmill, bike, arm ergometer, and elliptical. Each with a duration of about ten minutes, so pretty much for an hour they've got my heart rated elevated in that 120-145 range. They set my max bpm at 150 but have also said its okay if I go a little over that briefly. What threw me for a loop was how they determined my max heart rate at 150, they just take 220 minus your age and then round it down. Isn't that how you determine target heart rate for someone healthy?! This is supposed to be cardiac "rehab" because I just had open heart surgery! I don't know, I mean I feel okay while doing it all. But I do question the method. On days when I don't have rehab I've been walking at a brisk pace with bpm of 125-135 for anywhere from half hour to an hour, sometimes twice a day. I keep thinking exercise is the only way to bring down my resting heart rate, by getting stronger. But I'm just following their example and really don't know if it's right or not... I mean it's been almost 3 months since surgery but I don't know (obviously)

Dude, that sounds ridiculous. They got you training for the Olympics? If the left ventricle is taxed too much at the early stages, it can cause some stretching which can disrupt the hearts electrical signals, resulting in palpitations (I was told this by a progressive medical doctor with an exercise background).

There is a target heart rate calculation called Karvonen that factors in your max and resting heart rates (resting in the mid 90s being pretty high):

HR = ((HR[SUB]max[/SUB] − HR[SUB]rest[/SUB]) × % intensity) + HR[SUB]rest[/SUB]

Max heart rate: 180 Resting heart rate: 70, intensity: 50%:
((180 − 70) × 0.50) + 70 = 125 bpm

 

[almost_hectic]

Well my left ventricle is already slightly enlarged, so how does that factor?... Which I'll blame on the cardiologist for not being watchful enough and letting my condition progress. I used to see him at this same hospital. Thank goodness my new cardiologist sent me elsewhere for my surgery! I wish I had went there for my rehab also. But that would have meant a 40 minute drive each way three times a week. Who knew that where I'm at could screw up something as easy as exercise.

 

[MethodAir]

The left ventricle should come down in size. Nothing to worry about. Give it time. I now use a stationary bike for 30 minutes as opposed to an hour of cardio. 30 minutes with some fast intervals at a higher pedal tension...job done.

 

[almost_hectic]

So you think 30 minutes is about all I should be going for (at correct target) for now? I of course want to increase that, just not before I'm ready. I've been googling this morning heart rate thing and did find something about athletes over training, but it wasn't by anyone with credentials, just some random person.

Just for my own education, where did you learn about that stretching and disrupting electrical signals? It would be great if I could read more on the subject. So does the stretching create stretch marks like scarring, and that's what can interrupt electrical pathways of the heart?

 

[McCbon]

Here is my theory. The medical community sees way more elederly or atherosclerotic pts who need new valves, (frequently with a CABG, ) than BAVrs who are otherwise healthy and active. I have found that they try to use the same paradigms for both. So most of what they tell me I try to temper with my own common sense. The rehab staff may be used to pts who can't manage an hour at higher BPMs. It is only my opinion but I think at your stage of healing that it sounds excessive. I wonder if your surgeon or cardio made an actual specific recommendation for where they wanted your heart range? In any case, I would think you want the heart muscle to be pretty well healed before you stress it. I would think you'd stay low, around 125 , steadily until healing has progressed. I mean really: is your incision all healed? Then your heart tissue isn't either. I am generally a pretty gung ho kinda gal, but I would take it easy for awhile if I were you. Trust your gut. McCbon

 

[almost_hectic]

Dude, that sounds ridiculous. They got you training for the Olympics? If the left ventricle is taxed too much at the early stages, it can cause some stretching which can disrupt the hearts electrical signals, resulting in palpitations (I was told this by a progressive medical doctor with an exercise background).

There is a target heart rate calculation called Karvonen that factors in your max and resting heart rates (resting in the mid 90s being pretty high):

HR = ((HR[SUB]max[/SUB] − HR[SUB]rest[/SUB]) × % intensity) + HR[SUB]rest[/SUB]

Max heart rate: 180 Resting heart rate: 70, intensity: 50%:
((180 − 70) × 0.50) + 70 = 125 bpm

I'm sorta confused by this formula. According to this the higher your resting heart rate the higher your tagprget heart rate... Is that correct? Seems like a higher rest rate would indicate lower fitness ability and a lower target, to build up from. No?

 

[almost_hectic]

I actually had another working theory of my own I was brewing, but haven't shared it with anyone yet. Tell me if I'm crazy or if I may be on to something. I was suspecting that maybe it was related to some parasympathetic nerve pathway interference, if that even makes sense. I have osteoarthritis in my neck and upper back. Surgery got that all sorts of cranky on me and I was having considerable referred pain. A couple of times while moving or extending my arms I experienced a considerable joint pop and had a brief vasovagal moment, feeling faint and dizzy, BP sank. I've had a couple times in the past that's happened as a result of neck stiffness and briefly immobile/stuck cervical joints. My theory was that while laying in bed overnight I'm trapping or pinching on the parasympathetic nerve somehow and the next morning it's behaving badly because it's been pinched off or compromised in some way while sleeping. Because in addition the the elevated heart rate, I also have morning gut issues and just feel overall sorta cruddy. Or are those other symptoms a result of the elevated heart rate? Moving around throughout the day then relaxes and stimulates the nerve and it goes back to behaving normal was my thinking. So how crazy am I? Or have I stumbled onto something?

 

[ALLBETTERNOW!]

There's nothing wrong with that heart rate if you don't have any underlying issues. Resting heart rate in the 40s is common among athletes (a competitive cyclist had a resting heart rate of 28).

Yeah the doctors kept looking at me and asking if I was a marathoner or cyclist. At 6'2" 215 at the time it was bewildering to all of us. As long as I can avoid a pacemaker I'm ok with it. My stress test demonstrated appropriate response whatever that is

 

[ALLBETTERNOW!]

Yup they do the full thing, 3 lead EKG going the whole time your working out. With BP taken before and during exercise. I dont know why, it just seems like my resting HR should be lower if everything is normal. Im in good health otherwise, I still consider myself young at 45. And I was in good shape prior to surgery exercising 4 or 5 days a week. I was no athlete, but I know my resting heart rate was lower, I just dont know what it was because I have no record or notes of it. But I can recall taking my blood pressure and the reading being in the 80 bpm range.

So what do they do for bradycardia?

They don't do anything for now. The Coreg probably isn't helping but 55-60 is flow but not a major problem, ver title people, not me, often have very low resting rates

 

[ALLBETTERNOW!]

Well believe me I've questioned all this myself. My cardiologist isn't really all that involved at this stage, I just go to the cardiac rehab center three days a week. Really wonder sometimes though what the expertise level of the folks there is, but I have zero, so my only course of action was to assume they know what they're doing... I do a number of things like treadmill, bike, arm ergometer, and elliptical. Each with a duration of about ten minutes, so pretty much for an hour they've got my heart rated elevated in that 120-145 range. They set my max bpm at 150 but have also said its okay if I go a little over that briefly. What threw me for a loop was how they determined my max heart rate at 150, they just take 220 minus your age and then ultiply by .7 . Isn't that how you determine target heart rate for someone healthy?! This is supposed to be cardiac "rehab" because I just had open heart surgery! I don't know, I mean I feel okay while doing it all. But I do question the method. On days when I don't have rehab I've been walking at a brisk pace with bpm of 125-135 for anywhere from half hour to an hour, sometimes twice a day. I keep thinking exercise is the only way to bring down my resting heart rate, by getting stronger. But I'm just following their example and really don't know if it's right or not... I mean it's been almost 3 months since surgery but I don't know (obviously)

Your prescribed workouts are much more vigorous than anyone in my class. The whole class is an hour including warm up stretching and cool down. Exercise takes 30-45 minutes, tops and maybe 10-15 at upper limits maximum.

 

[almost_hectic]

Well I said an hour but it actually total 45 minutes workout time, the rest with stretching and BP and such. I've only got one more week of class. The total program is 36 sessions but I'm only getting in 24, because I have to return to work. As it is my boss practically threatened to fire me while on medical leave if I didn't get back to work when I initially told her way back prior to surgery, when all I was doing was taking a guess at the timeframe I'd be out.

 

[DachsieMom]

I think it depends on the person. I started cardiac rehab at 5 weeks, jogged at 6 (slowly!) and increased my speed by about .3 mph each time. I don't recall exactly, but by 11 weeks I think my exercising hr might have been in the 140s. They set me at a max of 152ish I think (it was an odd number based on a complicated formula) - but I was running at about 7 mph at that point. At 11 weeks, I would be on the treadmill about 40 minutes and the bike for 10 or 15 minutes. That decreased to about 30 minutes when work became too crazy. I was continually monitored.

 

[almost_hectic]

I think it depends on the person. I started cardiac rehab at 5 weeks, jogged at 6 (slowly!) and increased my speed by about .3 mph each time. I don't recall exactly, but by 11 weeks I think my exercising hr might have been in the 140s. They set me at a max of 152ish I think (it was an odd number based on a complicated formula) - but I was running at about 7 mph at that point. At 11 weeks, I would be on the treadmill about 40 minutes and the bike for 10 or 15 minutes. That decreased to about 30 minutes when work became too crazy. I was continually monitored.

Sounds like you did great! Even more intense than I've been doing probably. I can do everything they push me to. But is it too much, I don't honestly know. It doesn't feel like too much when I'm doing it. But it seems my elevated resting heart rate may possibly be a result of exercising too intensely, as has been suggested, the result being my heart is struggling to recover from workouts.