re: stunted exercise ability

Hello all,
I am wondering if anyone can share their thoughts, advice and experience regarding an issue I had today whilst running.
I am 33 and had my medtronic mri proof battery implanted 7 weeks ago for sss, symptomatic brady (20bpm) escape bigeminy and sinus pauses.I am paced atrially with aai-ddd setting, and no av issues. I have been recovering well and have been running for the last week/ lifting weights, after a 6 week hiatus. Previous to my implantation, I was unable to train more than 1 day per week for several months due to fatigue, dizziness and sob, I was puffing and panting walking up and down the stairs.
Yesterday I went for my 4th run since implantation, and it all went dreadfully wrong. Within a 1/4 mile I was puffing and panting, my legs felt like lead and I had no energy, palaptations and chest discomfort. Stupidly I decided to push through, and subsequently 55 minutes later I had managed a meagre 3.5 miles (in comparison 3 days prior, I had run 6 miles in 41 mins comfortably). I had to stop multiple times and my pulse never hit above 130, which is the upper limit for my pm. When finally reaching work, my boss almost had a meltdown, as I looked and felt peri arrest, She tried to book me in and put me on a trolley in resus, but I refused as I was starting to feel better (i'm an ED charge nurse).
I have not been diagnosed as Chronotropic incompetent as my treadmill test was normal, however, one of my main problems was that I would be cracking normal activities such as rushing around a busy ED or taking a walk and when I felt symptomatic, my hr would be down in the very low 30's/high 20's.
My question is, does anyone know if chronotropic incompetence is paroxysmal, as it seems this way with me. it was the same with my escape bigem, sa pauses and brady, which was not identified on the ep study, due to me being in sinus the day of the procedure. My concern is that my exercise ability will be stunted. My cardiologist asked me if it had been a week ago at my check up and I said no as I felt great then, typical.
i'd appreciate your thoughts. with thanks
ian
per mare per terram

4 Comments

Hi ian

by IAN MC - 2014-03-30 03:03:32

Yes , chronotropic incompetence can be paroxysmal if you have sick sinus syndrome which is intermittent ; I know because mine is !

Like me, you may find that you have good days and bad days, or even good half hours and bad half hours.

This Friday I am having Rate Response turned back on and will be attempting to get the optimum fix for this intermittent condition . As always, Tracey is very optimistic ! Regrettably my experiences over nearly 3 years make it difficult for me to share that optimism, but who knows what Friday will bring !

Best of luck

Ian

fine tuning

by Tracey_E - 2014-03-30 08:03:48

It doesn't much matter at this point if you have CI or not, you already have the fix with the pm. Your rate response has a lot of settings that can be adjusted as needed. It can definitely be set to pace you higher than 130. That's a standard starting point but most of them can go to 180.

I have very different problems than you- av block- but we found out after I was paced that I also have CI sometimes with exercise. With the block, I failed every stress test so we didn't see the CI until after the block was fixed. One problem can mask another.

Pushing through is probably not a good idea at this point. Get your settings fine tuned. Heal a bit more. If we're deconditioned before getting our pm, it's not going to come back overnight. And don't be surprised it it takes a few tries to get the settings right. They like to do them in small increments rather than massive changes all at once. Don't doubt that you will get back to where you were! It's normal to take some time, but most of us get back not only to where we were, but better than that.

You didn't say

by Theknotguy - 2014-03-30 12:03:37

You didn't say what medications you had. It's not in your profile so we're working with incomplete information. But anyway....

As TraceyE said, you have your fix with the PM. They can tweak the settings and get you to where things work better.

I have the CI but I'm also on meds to control afib. While doing cardio rehab the nurses and I could see where the meds kicked in and when. If I took my meds early in the AM my CI was worse. If I took my meds later in the AM my CI was better. Knowing when they kick in and how they kick in has really helped me in my exercise. So instead of being a race car engine with a fast response, now I'm more of a diesel, slow and steady.

It always amazes me when people get a PM and they think they're instantaneously "cured". Sorry, it doesn't work that way. The body needs to take time to adjust. Just because we live in a world of fast food restaurants and instant rewards it doesn't mean the medical side of the body follows suit.

You might want to train on a treadmill where you can see your speed and your heart rate at the same time. You can watch your heart rate as you exercise and see how the CI is progressing.

For me, because of the medications sometimes it would take up to 15 minutes for my heart rate to build up to the rate I needed. Once I learned that I was able to adjust my exercise accordingly, not get frustrated, and not push until I would get dizzy and almost pass out. Now that I know that and I know how my body feels, I can do the exercise without all the monitors. I feel great.

Stress test on the treadmill was over 10 mets. So I'm at the level of the "typically fit" adult male. Then I went back to the charity woodshop where I'm a volunteer. That's where I found out you need to be better than the "typically fit" adult male to do the work. But I'm going to keep at it.

Hope I was of some help.

Theknotguy

Thanks

by Commando42 - 2014-04-02 06:04:46

Thanks for your kind replies and thoughts. I should know better as I work in ED, just impatient I guess. Popped into cardio resp dept at work and got the upper limit changed to 160, benefits to working in a large district general hospital and now everything's great again.
Am gonna take it easy and ease back into training, as opposed to my usual 100 mph. Good luck to you Ian hope you get your settings sorted, and thanks Tracey and the k not guy for your thoughts
Ian

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