Cardiac Rehab Program

Hi all. I had my pacemaker implant about 9 weeks ago. I had some friends strongly recommend the local Cardiac Rehab program. So I talked to my GP who signed me up. When the Cardiac Rehab people phoned me I was only about 5 weeks post op and they wanted me to come in at 7 weeks post op. I told them I didn't really know if I was technically a cardiac patient. I'm still awaiting test results and my final post op visit with the cardiologist. But the Cardiac Rehab people wanted me in anyways.

Well I get there and I can do NOTHING. My heart rate is all over the map. My ECG was being taken at least two or three times during the one hour exercise program. At the end of the third day (each the same) the Cardiac Rehab staff insisted I see the PM technician about adjusting my PM. I did. Turns out the upper limit was set too low. And my diagnosis changed from AV block 1st degree, to a left bundle branch block.

But more of a concern to me was the technician (? he never did introduce himself) asked me twice why I was in a Cardiac Rehab program. Told me I didn't need to be! I just had "a loose wire" in my heart. I mean, he was a bit aggressive about it. I just refused to answer him, but I came back to the Cardiac Rehab program confused to say the least.

I asked the staff if I fit their criteria of a heart patient. They were quick to assure me I definitely was, as I had a pacemaker. BUT, I am still struggling with exercise. Now, instead of the brachycardia I am familiar with, I am having problems with too high heart beat. I am feeling symptoms at 120 bpm (not high in my books) that I should not be feeling. The PM technician told me I could safely go up to 140 bpm and tested me at that in the chair. I was fine. BUT when I exercise it is not fine. He said I could go back any time I needed it adjusted.

At this point I think I am better off waiting to see the cardiologist and going from there. He's done a couple of tests (MUGA Scan and Echocardiogram) that I have yet to see the results for. Does that seem logical? Or should I phone the PM Clinic again to see the technician.

12 Comments

Why Cardiac Rehab ??

by IAN MC - 2014-04-25 07:04:10

Hi hs2o I hope you get your problems sorted out and it sounds to me as though you have a settings issue.

It is possible that you have unique problems where Cardiac Rehab may help you but there is nothing in the info which you have given us which would confirm this.

In case any prospective PM patients read this and assume that having a PM implanted always requires subsequent Cardiac Rehab, I want to stress that it doesn't !!

Cardiac rehab is usually only needed after heart surgery or after a heart attack where it helps in your recovery and to make changes in your lifestyle to reduce the risk of further heart problems.

I think it either shows ignorance by the staff who suggested that you fit the criteria " because you have a pacemaker " or the criteria need re-writing.

The simple act of having a PM fitted does not usually justify any form of Cardiac Rehab

Ian



To clarify...

by hs2o - 2014-04-25 09:04:07

Ian, I think the concern with me is they do not seem to know yet if I had a 'cardiac episode' that led to the brachycardia, or if the brachycardia led to a cardiac episode. I had difficulty walking on Valentine's Day and chest pains, followed by dizziness the next day. When I was admitted five days later, I had a heart rate of 24 bpm.

Also, our Cardiac Rehab program has a couple levels. There's the level you mention - for survivors of heart surgery - and a Live for Life program for people who need to get healthy for other reasons. I definitely fit in the Live for Life program as obesity is one of the criteria and I am 50 lbs. overweight (thanks to medication not related to heart issues). But the staff think I'm better suited to the Cardiac Rehab program.

Dizzy, yeah, I'm thinking something's missing too...I want my test results before going back to the PM Clinic tech.

I have a PM - a Medtronic Advisa DR MRI Sure Scan. It was implanted by a Medtronic technician (?) under the supervision of a cardiologist (not mine).

The first day at Cardiac Rehab they made me wear a piece of equipment that constantly monitors my heart rate. They took a starting 3 lead ECG and BP. But I was having difficulties with my heart rate, so they ended up doing a 12 lead ECG on me. Ended up in the same situation the second day. The third day they decided not to do the 12 lead ECG, but told me to see the PM technician to find out what the upper limit was on my PM.

Cabg Patch: Yeah, the definition of Cardiac Patient seems to be up for discussion! I think it means different things to different professions/people. I have no doubt my cardiologist will let me know whether I should be there or not when I see him next week.




cardiac rehab

by judyblue - 2014-04-25 11:04:09

my primary doc said a pacemakei does not qualify me for cardiac rehab, end of story.

Thanks DonR and Grateful Heart

by hs2o - 2014-04-26 01:04:01

I'm in Canada...the land of "free" medicare... NOT! I don't know about the different levels they have for access to our program - other than they have the two programs Fit for Life and Cardiac Rehab. I left the decision of whether I belonged there up to my GP and the staff.

The program is run through the university. They have a stretcher they do the 12 lead ECG on. And EMS are handy. They often have a doctor present too.

When I was seeing the PM tech (?) in the PM Clinic his comment about my difficulties exercising was "well we didn't know you would be exercising!" And then proceeded to tell me they set the PM differently for young people and old people (he must have been in his 30s). It's the first time I've felt old! To give him credit, he did adjust several things once he looked at the data from the PM, not just heart rate. He commented my situation had changed since the PM was installed. Another reason to wait to talk to the cardiologist.

I paid

by hs2o - 2014-04-26 01:04:40

Our Cardiac Rehab program costs money. I paid $146 for 36 sessions (3 hour long sessions per week in my case).

My GP thought the program would be good for me and signed me up for it. The cardiologist might think otherwise though... I am going to this week's appointment with considerable trepidation...

I wondered...

by kmom - 2014-04-26 04:04:55

about Cardiac rehab myself since I haven't been active for so long--yah I went to work took care of my family etc but never really had any sort of exercise program except for walking occasionally but hadn't been able to do that for a long time either. Received my PM first part of April and am exercising at a gym I joined. At the first check they basically said to wait another week then go for it at least bike and treadmill, still being careful of raising my arm and not lifting too much. no weights! I feel great!! the only problem i'm having is when my heart rate goes above the set limit I can't catch my breath, I called the PM gal about that and she said when I see them next time in May they will adjust the settings to allow my heart rate to go higher.

It's good for your confidence

by Porkypig - 2014-04-26 07:04:37

I think it's great you have been given the chance to do this. Great to get your confidence in a safe environment. Hope it helps you out. X

IT DEPENDS ON WHERE YOU LIVE!

by donr - 2014-04-26 08:04:54

AND ,,,who your Dr is. AND, in the US, what kind of insurance you have.

Let's talk MEDICARE: there are 7 diagnoses that qualify a person over 65 who has Medicare for PAID cardiac Rehab. Based on the post by Grateful Heart a week or so ago, I walked into the office where I am doing my Cardiac Rehab & ASKED the nurse who handles that part of the process. The SEVEN are:
1) Heart Attack
2) Stents or angioplasty
3) Valve Job
4) CABG
5) Current Stable Angina
6) Current stable CHF
7) Heart or heart - Lung transplant

Note that nowhere in the list is a PM/ICD! You may have one in addition to the above, but it has no apparent bearing on your qualifications. Here is an article discussing the three (or 4) Stages (Phases) of Rehab. All of them are tailored to the patient's needs.

Generally speaking, Stages 3 (&4) are NOT covered under most insurances - YOU pay for that.

Now, since it is a self pay program, ANY Dr. who says it is NOT authorized spent several days in the cattle fed lot across from our college housing in Las Cruces, New Mexico, gorging him/her self on the paving material found there.(For those old enough to recall him, can you imagine how President Truman would have described that!?)

The "Where you live" part determines whether or not the local hosp or PT facility wants to run a stage 3/4 program. My local hosp, in Cumming, Georgia, does. I described the program in a comment entitled "I dunno who paid....."
Which I have pasted below for the interested.

Begin Paste:
Comment posted by donr on 2014-04-20 09:44.
"I dunno who paid....."
..... for my Cardiac Rehab about 1-1/2 yrs ago, but it wasn't me. I did it at the hosp where our ER Doc Daughter works in Mississippi,

What I had was a modified Stage 2 - no ECG monitoring. The hosp assigned a therapist to me who watched me like a hawk, checking BP & HR frequently. They had no VISIBLE crash cart. The facility belonged to the hosp, but was in a bldg about 1-1/2 blocks away. They also had an indoor pool that hosted rehab patients all day long. I was working out w/ all the folks w/ all the other ailments requiring PT.

For the current session, it's Stage 3 & all they do is check BP before I start, once while exercising & after I stop & HR & respiration return to normal. This hosp has a large room dedicated to Cardiac & pulmonary rehab, w/ probably 45 -50 machines in it. Operated by a supervisory RN & at least half a dozen LPN's/techs who do BP's. All the Stage 2 clients wear ECG Telemetry units & one LPN monitors them on a computer continuously. They very wisely switch out the computer monitoring person about every 15 minutes.

The supervisory RN is a former USMC Drill Instructor - or at least acts like one straight out of the lore as to what they are like. She watches everyone like a hawk ready to dive & take her dinner. That includes all the other staff personnel. Every one of the staff wanders around the room chatting briefly w/ people like they were long-lost siblings & they can put a name to every one of us by the time we've been there 5 minutes. Once per month, ALL of us get a rhythm strip at least 12 beats long.

Amazingly, the Supervisory RN Knows something about PM's & can read an ECG. I asked her to measure out my AV Paced & sensed times & she whipped out a pair of sharp-tipped dividers & straight edge & measured them out like a HS student in a Plane Geometry class.

The other RN is a former member of my cardio's staff, so she also knows PM's. Both of them have years of experience as cardiac nurses.

Crash Cart is tucked into a small room & has a wheeled bed so they can whip any people who collapse onto the bed & hustle them off to the ER, which is in the same Bldg.
Lots of O2 bottles on wheels available.

A First Cass Outfit & operation.

The billing charge is $252 per month for a Stage 3 client, but they discount it 75% for those of us who self-pay. MOF - that's ALL of us, since Medicare will not touch a dime's worth of State 3 therapy. Dunno what any pvt Ins will cover. There have to be a BUNCH of us Medicare eligible (65+ Yrs old) just from the small sample of folks I've asked the ages of. Couple of WW-II vets - in their 90's; Korean War Vets - in their 80's & a smattering of 70's types.

The discounted cost is indicative of the whacko, unrealistic, artificial billing accounting going on. It is obvious to even the most casual observer that about $60 per month is too low a charge. For that we get 3 visits per week. Just the cost of the building & equipment has to exceed that income stream. But it does entice a lot of LOW demand patients to come in & add to the revenue. Revenue that pays for a significant part of the overhead of running the place. They have enough Stage 2 patients that the marginal increase in staff to cover the Stage 3 types is insignificant - so we are fitted in between the demands of the stage 2's just like sand fits in between the gravel in concrete.
End Paste

According to what I read this AM, Stages 1 & 2 require a Dr's Order. Stages 3/4 do not - though it sure helps! We must have a big bunch of imaginative Cardios in this area coupled w/ an imaginative Hosp, 'cause there sure are a bunch of us in stage 3/4.

So - if'n Y'all's having trouble where you live, C'mon down to Cumming, GA - about 35 miles nawth of Etlanner & I'll find you a cooperating Cardio - y'hear, now, Honeychile?

Sorry if I botched my Southern accent, but it's the best a transplanted 'Yankee from New Jersey can do. Trust me, WE take a lot of crap from our true RedNeck neighbors because we talk "Funny," but they are the salt of this earth when we need some kind of emergency help.

Donr

hs2o

by Grateful Heart - 2014-04-26 11:04:11

If your Cardio says you can do Cardiac Rehab once your settings are sorted out, definitely stay with it. Since you already paid for it, see if they will "freeze your membership" so the clock does not run down on your 36 sessions while you wait to see your Cardio.

As far as the PM tech, it's not his heart and most of the techs I have dealt with when surgery was needed are magnet happy. I call it "magnet and go" because that's what they want to do.....around here anyway.

I also do not think it is the techs place to tell you whether or not you are a candidate for Cardiac Rehab. That is for your Cardio Doctor to decide.

I agree with Patch, learning to exercise (meaning how hard you can push your heart now) is very important for heart patients and WE ARE HEART PATIENTS albeit the lowest rung on the ladder in many eyes.

Often times it is not "just electrical" but a combination as Don said. So a heart out of sync, an enlarged heart or an overweight patient can all benefit from exercise and Cardiac Rehab is the best place to start. If something is going to go wrong during exercise for a heart patient, that is the place to be......as you already experienced.

Judy: Your Primary Doctor may well be right in that you do not "qualify" for Cardiac Rehab but that does not mean you would not benefit from it. I would check with your Cardio if it is safe for you to exercise and let him know you want to try it. That's what I did and he agreed to let me try it. He wrote the prescription and it was one of the best decisions I ever made, medically. So much so, that after my 36 sessions, my insurance would not cover it further and I also went on self-pay and continued with it for over a year. At that point I was confident enough to go to a gym on my own.....with my trusty heart rate monitor of course!

I still see some of the guys and women that were in my "class" and they still self pay. Some have been there for well over 7 years now. I was just ready to expand my exercise routine at that point.

Another benefit for me.....I lost 70 lbs. since my ICD implant 5 years ago. If I did not go to Cardiac Rehab I would have never lost that weight nor strengthened my heart by just sitting around being afraid to increase my heart rate. I'm still a work in progress.

So don't let someone tell you that you don't belong in Cardiac Rehab....unless it's your Cardio because they may not want you to exercise due to your particular condition.

Grateful Heart

my experience

by highdesert - 2014-04-26 12:04:39

I had a heart attack a few months back and ended up with 2 stents and a pacemaker. For whatever reason i was contacted by the cardiac rehab staff before leaving the hospital to get me into the program. When signing up they used a insurance code for stents... didn't seem to interested that i had a pm.

ETA: also...

by hs2o - 2014-05-06 08:05:03

MUGA scan and echocardiogram showed no problems. Apparently I am 100% paced, and I've been told all my heartbeat issues need to go to the PM Clinic from now on.

Thought I'd update

by hs2o - 2014-05-06 08:05:27

I did talk to my cardiologist. He did not say anything negative about me being in the Cardiac Rehab program at all. Thanks to my ECGs there, we discovered my problem switched from being a total AV block to being a left Bundle Branch Block. It was the staff at Cardiac Rehab who suggested I go to the PM Clinic. And it's a good thing in the end. Because I was not able to do hardly any exercise due to the changed diagnosis, without adjustments to my PM. If I waited till the original appointment I wouldn't have seen them until the end of August!

The only concern the cardiologist had was if I had high blood pressure. I told him "no", but then realized twice since my episode that led me to the hospital, I've had nursing staff comment on my high BP. Most of the time it is a nice normal 120/80. But a couple of times it's been more like 135/90 or 95. Hmm...my friend is going to loan me her BP machine so I can track my BP for two weeks. Another friend in the medical field suggested taking it morning and night, as it can vary. So I'll do that and report back to my cardiologist if I see it is consistently high.

So much to learn!

You know you're wired when...

You fondly named your implanted buddy.

Member Quotes

I am an avid scuba diver.