Motorcycle racing Harescrambles-enduro's upper limit setting

Advocate for yourself.

by Gotrhythm - 2017-09-04 18:06:00

Tracey who is very knowledgeable and very fit can give a better answer than I, but here is an answer based on my limited experience.

It's true that a pacemaker won't prevent your heart from speeding up on its own--if it can. But 130 isn't high at all for someone who's active and fit. It seems to me that you need to talk to your EP. You need to ask, if you don't already know, whether you have chronotropic incompetence, meaning "can your heart speed up on it's own." You also need to understand if your heart is healthy enough to handle the stress of faster heart rate.

Cardiology practices aren't used to dealing with healthy, fit, relatively young people who are still putting heavy demands on their hearts. They're used to old, sedentary types like me for whom 120 is an overload.

It's neccessary for people like you who need for their pacemaker to do more than chug away steadily, to advocate for themselves, and educate their pacemaker team about how they need for their pacemaker to repsond.

Left to make the decision, medical people will choose whatever conserves battery life, and that means the lowest tolerable settings. They won't know what quality of life is for us, unless we tell them.

Picture in gallery

by smitty141 - 2017-09-04 19:02:20

Thanks for your thoughts...

I did post a pic of the monitor in the gallery. It did not show the complete picture, so the BPM scale is not showing. The race was over a 5 hour slot, with some 30 minute breaks. There were 5 tests (races within the race) if that makes sense.

The top of the yellow line is 130 BPM. the top of the green line is 146 BPM.  As you can see, most of the day I was right around 130...

Smitty

limits

by Tracey_E - 2017-09-04 21:01:39

If you are staying at your upper limit, that's a good sign the upper limit should be raised, if in can be done safely.  Why did you get it, av block or sinus issues?

Yes, the heart can go as fast as it wants on its own. The pacer is a gas pedal, not a brake. However, if you have av block, then the atria will go faster on its ow but the ventricles aren't getting the signal so are dependent on the pacer to keep up. If your atria is getting over 130, then the upper limit needs to be raised so you stay in sync. The pacer should record every time this happens.

If you have sinus issues and are dependent on the pacer to raise your rate some/all of the time, it can only get you up to 130.

Talk to the doctor, not the technician.  Settings are a prescription so techs are limited what they can do on their own. The technician seems unwilling to go higher so get the doctor involved. That may be all you need. In my case the doctor said I was fine to go faster, my upper limit is 190 now. I regularly hit 160-170 so 190 that gives me a cushion.

That said, CRT suggests issues with heart function, not just your rate going up enough. A two lead pacer raises your rate. The third lead can help with function by forcing the ventricles to be in sync. If your stamina is dropping, it might be time for an echo to take a look at the  numbers. The pacer can send the signal to beat, but it's up to the heart muscle to contract and make the blood circulate. It can pace faster all day long, but if it's not pumping hard enough, your stamina will drop. 

A treadmill is also a great tool to help fine tune settings. Get on and exert while they are watching real time to see when you are  going up on your own, when you are pacing, how you are handling the overall exertion. Before my doc let me go to 190, we did this. I was able to keep chattting with them while I hit the target rate and easily stayed there for a few minutes. My latest echo showed my EF is good, so he's ok with me pushing hard enough to have my rate over 150. 

Pacers can confuse monitors. They can pick up pacing spikes as extra beats, or the pacer can interfere and keep it from picking up beats. My polar said my rate was 0. My phone always tells me I'm 200+ and I should call 911 lol. Don't depend on them too much, when in doubt count manually or use a pulse oximeter. What  you can do is write down day/time that you have episodes and tell them next time they check so they can see what was going. 

Final note, if you are left feeling exhausted, don't push it until you know why. It is very hard on the body if your rate needs to be higher than it is or for the atria to be higher than the ventricles. I'm all for living life to the fullest and forgetting that little hunk of metal is in my chest... but sometimes we need to pull back a bit til we get the whole story. 

Echo

by smitty141 - 2017-09-05 21:16:13

I had a echo a few weeks back and all was good. I think the biggest problem is my Dr. and device tech have way to many patients. And always feel rushed when talking with them.. In two years I have never seen my Dr. since the morning of my implant. I see my tech or a Nurse practitioner.

I do have a call in and I hope to get a return call tomorrow. I really hate to change Dr's, I feel they went way above when it came to my job. I work in a Electrical power plant, and had so many hoops to jump through to go back to work. So I feel a sense of loyalty.. But will nip this in the bud...

I will keep my fingers crossed, and really hope I can get my heart up the speed. :)

Smitty

PM Tuneup!!

by smitty141 - 2017-09-12 21:43:34

Spent some time with my PM programmer along with the Rep from Boston Scientific today. The rep was with me when I had the device implanted, and did the progamming. She was also there when they did tha cardiovertion..I had a list of question's for them...

Here are some of the issues I deal with and the reason for my PM.

Heart block

Pace 100% of the time.

LV disfuntion (Ejection factor)

Sick sinus syndrome..

I did have some improvement with my last Echo and had a 54 Ejection factor. (Good news).

Good new is that the rep feels it was safe to up the upper limit to 160, along with some other adjustments.. They did warn me, if I felt any discomfort to let them know. They said adjustments in small steps...  Round 7 AMA Kenda National enduro this Sunday... I will wear my monitor and see how things look..

Thanks for input everyone, 

Smitty