Question about Heart Rate

[Ras1151]

Hi Everyone,

I am about 4-1/2 months post surgery. I graduated from cardio rehab on May 2, 2011. Now I am in the cardio rehab maintenance part.

I bought a new road bicycle, and can get to work (2.2miles) in under 9 minutes with pedal power. I have given up driving almost entirely, and ride my bike everywhere. I have had my new bike 1 1/2 weeks and have put on over 150 miles.

Now my question, Cardio rehab said I can safely get my HR up to 157.
Is it dangerous to go much above that?
This morning on the ride in to work it hit the 170's.

I got the new Garmin 610 forerunner heartrate watch. It is the newest release from garmin. It has everything you could want in a GPS heartrate watch.

It has virtual partner, virtual racer, HR alarms, Training effect ( it rates your workout on a scale of 1-5, 5 being very intense. on my bike ride yesterday it gave me a 5.)

one of the girls at cardio rehab thinks that I shouldn't work that hard, without a stress test. with the new bike I can easily push the HR into the 160's, but my average is about 140-150ish.

Is it dangerous to go above 85% Max HR? I am 51 so max 220-51 = 169; 169 x 85% = 144.

I have had it up to 178 a couple days ago. I felt fine, but when I noticed (HR@178) I stopped until it came down.
I hate having to slow down because my HR is getting too high.

I take 25 mg of metoprolol once a day, and have a carbomedics mechanical aortic valve.

Should I call the Cardio doctor tomorrow and ask them about a stress test? Just wondering.
There are two guys that work in the cardio rehab, that do triathlons. They average about 20 mph on their bike rides. I average about 15 mph on my rides.
I hate the idea of having to slow down because of HR issues. a month ago my average was only 9 to 10 mph on my mountain bike. So I am making progress.

Thank-you for any suggestions

Ron S

 

[Jason]

Ron, I can't answer your question with any authority, but if I were in your shoes I would definitely call the doc and talk it over with them. I would at least touch base with the cardio rehab personnel and ask them, as they set your 'safe' zone originally. I find it amazing though how differently drugs affect each of us; I take 50mg of metoprolol, twice daily, and I can't get my heart rate above about 115-120. Previously, I was on 75mg twice daily, and I was lucky if I broke 100 bpm. Sounds like you don't have an upper limit with the metoprolol onboard, though. Keep on biking and exercising, but if I were you I would give someone a call tomorrow and discuss the safe upper limits.

 

[Ras1151]

Jason

I can be sitting and have HR of low 70's and stand-up and it will go to high 90's. When I sit it come back to 70's. Walking it is around 120's.

I have noticed that it is begining to get lower as with time.

 

[Jason]

Mine is typically in the 50's and 60's at rest, depending on the time of day. It will go up to 75-85 walking around, and 90-110's with excercise. I had to lower my metoprolol dose as I said earlier because my heart rate was dropping into the 40's, which just felt too low to me. I was getting lightheaded when it was that low, so they changed up the metoprolol dose. Are you on the extended release pills, since you only take it once a day? By the way, my valve is also a carbomedics. So far, so good for me!

 

[ALCapshaw2]

DEFINITELY a Good Question for your Cardiologist, or perhaps even better, a Cardiologist who has an interest in athletic performance and may actually have more experience treating / monitoring patients who desire to 'push their limits'.

While the Cardiac Rehab Nurses have some relevant experience, they are most likely merely adhering to guidelines set by their supervising Cardiologist(s). It's best to go to the Source.

'AL Capshaw'

 

[tprice54]

HR of 170 on BB is impressive! I would say that is quite a workout. It is a good diea to talk this over with a cardiologist, and better if they are into athletic performance.

 

[ChicagoMammy]

I saw my cardiologist today. My resting HR is 48 on 150mg metoprolol daily. It leaves me sluggish, but the A-Fib is gone for now so on we go. I had a stress echo and my heart rate reached 146. She said that was high for me and that 120-130 should be my max.

Everyone is different though. If you are cured (as opposed to being improved) post surgery then you may well be fine, but if like me you still have other cardiac issues then probably not. I would talk to both your rehab person and your cardiologist.

 

[Ras1151]

I called the cardiologist today. They said, 170's was way too high, and I needed to go to the ER, because they had no openings, and they wanted me to be seen today.
The first ER doctor had no idea what to do for me and passed it off to another doctor who had to call up to cardiology to get the plan of action.
They kind of said if your HR goes up when you exercise then don't exercise. But they took care of me, after the call to cardio.
I had Chest x-ray's, blood sample for complete blood count,and a couple of off duty ER doctors practiced doing echo's with the ultrasound on me. They said not looking for anything, but just to practice. That was kind of fun because they were pointing everything out. "there's the aortic Root, there's the tricuspid, mitral valve etc...
I have an Echo appointment for june 2, and they put a holter monitor on me for 48 hours. I need to keep a log of my exercise, times etc...

My HR average this moring was 156 and the max was 171. my watch gave me the alarm and I slowed down. It didn't feel like I was working hard.
I believe I have to try to keep it under 160 while wearing the holter monitor. I guess i am going to have to slow down for awhile. But they did say to do cardio at rehab like normal.
Thanks for the input

 

[johnp]

I would think that the HR you state is also way too high. I have to be honest, it doesn't add up. If you are on a road bike, unless your ride to work is totally uphill, I do not see how you could be only going 15 mph but have such a high level of exertion and a HR that high. If you told me you were going 28 mph, then that might make sense.

I suspect before you went to cardiac rehab you had a stress test, and then during cardiac rehab you had a sense of your heart rate during various levels. Were they that high?

I would also point out that, depending on the nature of your condition, the HR monitor may not be counting your beats properly. I have had episodes with my own Garmin 310 XT where it tells me my HR is 180, but I know my HR was only about 110. Sometimes I had to re-positition the chest band in order to get a better readout.

 

[Ras1151]

John
I have never had a stress test. The doctor did not want to risk it before surgery. As for The work intensity of the ride, that is the question. I am not working all that hard when the HR goes high.
As for the Accuracy of the watch, I have the new soft strap and and the garmin 610 forerunner, when I have been hooked up at cardio rehab to the ecg, my watch has always Mirrored the HR numbers. I also have a bike computer with HR monitor and they always have agreed, it also mirrored the hospital HR yesterday, so I believe the watch is accurate.
My HR has been consistently going high. I am wearing the Holter monitor now. They told me to keep doing what I have been doing, but don't let it go over 160. My average ride to work this morning was only 13.7mpg ( I had to slow down during ride, My HR av was 149 and HR Max was 160). I actually saw it climb to 160. so it wasn't a spike. The watch alarms at 148, so I can start slowing down in time.

Ron

 

[Ras1151]

PS. The ride to work is mostly flat, with slightly more down-hill than up, but over all is mostly level ground. Winds in the morning are usually 0 mph.
My HR has been high since surgery. When I do squats at rehab, HR goes to high 160's. I would have to sit untill it came down to continue. So always somewhat of an issue.


Ron

 

[johnp]

I have the opposite problem, my HR is often on the low side.

When I signed up for rehab I had to have a stress test, they would not accept me into rehab unless they had that as a baseline.

I would vote that you try to push for one. It might be quite good to confirm the HR at various levels. my 2 cents anyway. They take your blood pressure the entire time as well.

 

[Ras1151]

Funny how everyone can react differently. During a work-out on the elliptical my BP would often be 160/90 or so. One of the cardio rehab staff suggested that I not get my HR up without a stress test, or talk to the cardio doctors about it.
It seems most people on BB have low HR. I don't really know, but my guess is I need higher dose of Metoprolol or something.

I have not seen any doctors since two weeks after my surgery, except for yesterday.

When I first started cardio rehab. I would slowly be going with HR at 120. as soon as I started talking HR would go up to 150's almost immediately. I wasn't allowed to talk much during exercise.

On wednesday this week When I rode at 23mph, HR hit 178. I still believe that to be accurate.:confused2:

 

[normofthenorth]

I'll add to the chorus of WOWs, that you can get your HR that high while taking Metoprolol! And also the chorus that's suggesting you get a stress-EKG, with or without an Echo. At "my" Cardiac Rehab place, they start every patient with a stress-EKG, and do another one eventually, occasionally with "telemetry" in-between. Telemetry is when they strap a Holter-like 12-lead gizmo on you just before you power-walk on their track, and the gizmo transmits your EKG signals to the overhead antennas. (I assume they monitor them in real time.)

When I was on Metoprolol (mostly 25mg x 2/day), my resting HR was much higher than I'm used to, but I only glimpsed 150 BPM HR a couple of times, while downhill skiing aggressively in Whistler (and I rested until it was down to 110-ish before I started down again). On my pre-Rehab stress test, they stopped my bicycling at 137 BPM, because my heart rhythm was starting to get erratic, like two weird (inverted?) beats in a row. (I was also working WAY too hard, pedalling hard for 10 minutes around 11 weeks post-op.) So they recommended that I stay under 127 BPM, which sounded pretty wimpy even when they told me. But when I came off the Metoprolol a few weeks later -- and before the actual Cardio Rehab classes started -- it sounded absolutely ridiculous, so I started asking for a new stress test, without the Metoprolol.

I finally got the re-stress-test this past Monday, and it went very differently from the first: More bicycling (12 minutes vs. 10, while the resistance keeps increasing), much lower BP, and no two-weird-beats-in-a-row stuff, until they got tired of hanging around (last appt. of the day!) at 143 BPM. Now I'm cleared for ~145 BPM, which is pretty close to a normal target for a 66-yr-old guy, so I'd say that's more like it.

I think stress cardiograms are often prescribed when they're useless and dangerous -- e.g., somebody posted here that their CHD-infirm aged mother was scheduled for one! But for somebody who's actually exercising, and monitoring their HR, and wondering where their "red line" HR is, it seems like the Gold Standard, IMHO. In your case, bicycling and doing your Cardio Rehab while wearing the Holter may be a lot like doing a very long (48-hour!) Stress Test!

BTW, the chest-strap HR monitor I used on my ski trips -- a cheap Chinese non-Garmin that I've described here before -- displays each individual heart-beat, as well as my HR in bpm. It does occasionally go irrational -- usually when the pads aren't contacting my chest properly, or when the battery is fading, but sometimes "for nothing" -- but I can always tell because it shows a crazy number but no heart-beat "flashes". But it sounds as if yours is telling the truth, and that your HR is really way up there, despite the Metoprolol.

 

[Ras1151]

I talked a staff person at the cardio rehab gym this week about my HR hitting 170's. She suggested a stress test, and a call to doctor.
I have been exercising almost everyday since a couple weeks after my OHS. Started out walking, then on to the bike, usually 60 to 90 min a day. The intensity has been increasing each day. It is frustrating that now after 4 months HR can reach 170 +.
I climbed a ladder at work yesterday and HR hit 167, (a very tall ladder) and at cardio during squats it reached 165.

1) How common is it for HR to get to high levels after OHS? and With moderate excerise?

2)What about on BB? How long before the need of BB diminishes?

3) They say to exercise, but now I am being told I have to slow down?

 

[normofthenorth]

Ras, I think we all share your frustration, but I'm not sure we've got many answers. Your exercise HR is higher than most of us experienced. The BB is supposed to hold it down, though even the same exact drug seems to work somewhat differently for different people.

Are you really taking "Metoprolol", but only once per day? I know they make an extended-dose version of it, but I thought it had a slightly different name. Most of us who got Metoprolol took two pills a day, at ~12-hour intervals. If the answer's YES, when do you take it? If it's the normal (12-hr) pill and you take it at bed-time, you may not be getting much effect when you exercise, because there might not be much BB left in your bloodstream.

I'm also surprised you feel pretty good at 170 bpm, BTW. . . That's probably one of the hopeful signs in your experience. . .

As for your Q #1, I think the vast majority of us experienced faster (and louder and more forceful) heartbeats after our HVRs, and also sharper elevations in HR from relatively trivial exercises than we ever noticed pre-HVR -- not that many of us monitored our HRs very closely pre-HVR!!

I've recommended here that HVR patients start monitoring things like HR & BP BEFORE their surgery, so they'll have some baseline to compare to, later. BAV-ers who are still asymptomatic but looking at surgery down the road should get some baseline readings while they're still asymptomatic, IMHO. I sometimes measured my resting HR first thing in the morning, starting as maybe a teenager. But I've no clue if my HR increased by 5 bpm, or 10, or 25 when I ran up a flight of stairs. Now I kind of wish I knew. . .

Mind you, many HVR patients don't "fixate" on these measures the way I still like to. . . and that's OK, too!

 

[Country]

ras,

i am on 200mg of metropolal a day! and i am lucky if my hr dips into the 70's!! usually it stays in the 90's and i dont even know what it does when i am exercising or working!

my bp will usually be around 120/70ish! my doc is in aww that my hr can be at those high levels! i think that he hopes it will come down over time! it kinda worries me since it has almost been a year!!

i am guessing that he will up your bb and see how things go!!

good luck! make sure you let us know!

 

[Ras1151]

I finished with my holter today, and turn it in on Monday 5/23; I have an Echo on june 2, and an appointment with cardio on June 8.

 

[Country]

Ras,

i noticed that you are a bav'er so make sure you pay special attention to your blood presure. it is important to keep your bp low to keep your risk of anyerisms low.

hope things go well for you today!