Winded after exercise

You do sound better

by Gemita - 2020-12-07 04:26:08

Hello Alejandro,

So nice to hear things are somewhat better for you.  Can I just take you one step back first to your previous post before I give you my thoughts on your present post.  

On your last post, one contributor mentioned about checking your AV delay setting in case this needed adjusting to treat a possible change in your condition (from say intermittent block to a more persistent block) ?  Did you ask about this and did they make any changes to account for your improved symptoms since you do sound so much better ?  

Chest burning sounds inflammatory, respiratory or gastric in nature but they also need to rule out angina during/following exercise.  I think I can relate to your symptoms.  One doctor diagnosed me with angina triggered by my arrhythmias;  another said it was related to my ongoing gastric issues.  I believe the truth lies somewhere in between.  

When I push myself I can sometimes feel heat/discomfort sensation mid central chest and the more I try to push through it the more acute my symptoms.  For example on exiting the station near my hospital and while climbing stairs (but I was in AFib) not only did I feel winded (a bit breathless) but I experienced a burning sensation mid chest.  Angina can feel like burning pain too and is often described as a burning pain, although while climbing steps I also got the typical pressure type feeling too.  Clearly I was struggling with my arrhythmia and blood flow around my body was inadequate at the time.  When I got to the top of the steps I felt close to passing out.

I am glad you have got a Zio patch to check what your heart is doing.  You clearly felt a run of palpitations which correlated with your burning chest pain symptoms at the time.  I still wonder whether an arrhythmia, however benign, is causing symptoms for you and that like many you are extremely sensitive to any changes to your heart rhythm.  This is not because of anxiety alone, even though heart rhythm disturbances can cause anxious feelings.  I believe this is because when our hearts are beating irregularly the heart may not be able to pump enough blood to the body, or to pump blood efficiently, effectively and during exercise this will be even more noticeable as our requirements for energy increase.

I would consider getting an electrolyte check.  Ask about angina, a respiratory, gastric or inflammatory cause for your burning chest pain.  Bloods/other tests will help rule some of these out.  Get a medication review.  Consider asking for another stress echo to confirm what happens during exercise.  Then my friend we are back to querying intermittent heart rhythm problems either needing finer pacemaker adjustments or closer surveillance and/or treatment.  But we are breaking this down nicely now, aren’t we and leaving no stone unturned.  We will get answers won't we?

Gemita :-)

by arent80 - 2020-12-07 10:02:06

Thank you! I will definitely present this to my EP. I also wondered about the high side of my PM. It's currently set at 150. I notice that anytime I go over 150 this always seem to happen. The reason I ask is because when I had CLS activated or the Rate Response I felt similar in my chest. Now looking back, since this was turned off I feel so much better. I believe the PM and my natural rhythm may have been competing which in turn caused me these nasty side effects. Now when I go over 150 I feel something similar. 
 

What prompts the PM to do anything when you reach the upper limit? Does it automatically start to cut your heart rate? Is it looking for something first? I am just trying to cover all bases here. All I know is before PM whenever I would exercise no matter what shape I was in, I NEVER felt anything like this. 
 

On a side note. This is the second zio patch I've worn in a month. The first one was lost by the heart monitor company. The mail (USPS) delivered it, but the distribution center can't locate it. Good times! 

Winded after exercise

by Selwyn - 2020-12-07 12:27:34

A few extra beats is a normal finding after exercise. Anything that is in 'runs' lasting over 15 seconds I would be concerned and it would be worth having an exercise ECG.

Of course, strenuous exercise can leave your chest feeling raw as everything stretches on heavy breathing. Usually this is a lack of fitness. Chest pain certainly needs explaining and could be angina pectoris ( angina of effort). Even as a kid when doing cross-country I well remember the burning discomfort from prolonged strenuous running. Having said that, I would be thinking of angina especially at the start of exercise and during ( which is part of the exercise ECG test).

It may be worth looking at your rate response on your pacemaker, from what you have said in your post. The rate of onset is adjustable, as is the rate of offset. It you have built up an oxygen debt during prolonged exercise, this can take some time to clear ( you only have to see the TV interviews of atheletes still breathless after their excertions some time after the race has finished). A slower offset rate may be of benefit to you.  Believe me, the rest period after an exercise ECG is worse than running on a steadily inclining  tread-mill!

If you are able to get your heart rate above the upper rate limit set on your pacemaker, then congratulations. It may be that your intrinsic rate cannot cope with your demands. I expect you could ask for the upper rate limit to be lifted, however I would question why you want to push yourself to these extremes. Fitness is a balance between under doing it and overdoing it. Many folk have had fatal arrhythmias over doing exercise. The  risk of death from running a marathon is 0.8 per 100,000 people. Perhaps everything in moderation? 

UPPER LIMIT

by Gemita - 2020-12-07 13:19:43

Alejandro, I would make another post on Upper Limit.  You have a few unanswered questions.  There are a lot of knowledgeable people here who can really help you to understand it and to have that meaningful conversation with your EP.

I will try to answer your questions although I have limited knowledge in this complex area.  You ask what prompts the PM to do anything when we reach the upper limit?  For my particular condition - Sick Sinus Syndrome/rapid atrial tachyarrhythmias, when a rapid rate reaches my upper limit of 130 bpm, the pacemaker will prevent this rapid rate getting through the AV Node to affect my ventricles. My EP clearly does not want rapid atrial tachyarrhythmias to be tracked and allowed through my AV node, so he has put a strict upper limit (sensing/tracking) of 130 bpm to protect me.  

You ask, does pacemaker automatically start to cut heart rate?   Yes my pacemaker will enforce the upper limit when I reach it. 

How does it do this?  The pacemaker starts skipping beats apparently to lower the average rate which results in an irregular beat causing reduced blood flow and horrible symptoms.

Since you have heart block, you could ask whether you can safely raise upper tracking rate to see if you can reduce your symptoms?  Ask whether you can have a stress echo challenge to make sure that you will be safe and to see whether you are still symptomatic with a higher upper limit?  Some contributors here with block I believe have had their upper rate raised to 175 bpm or higher. 

What is happening I was told is that the atrium may go faster than our upper limit (in your case 150 bpm) during exercise but the pacemaker won't let the ventricles keep up and this can make us feel awful.  They should be able to tell from your pacemaker data whether you are hitting your upper limit regularly and if so, they should be able to recommend safe adjustments for you to give you a cushion over what you need.  

Upper rate

by PacedNRunning - 2020-12-07 22:35:06

I think the breathing after could just be post exercise feelings. hard to know.  I pace 100% and with exercise it does take time to get use to pacing and exercise. I use to feel similar after exercise and my rate decreases rapidly but I don't really feel symptomatic with it.  I only know because my watch said it went down 56bpm in 2 mins after exercise.  But I do feel the cold chest feeling  like running on a cold day except it's not cold. I'm use to it now.

 If you have heart block, your upper rate really matters.  It will cut your rate in half when you hit what is called the TARP rate. This is the heart rate in which the pacemaker will pace every other beat called 2:1 block.  Your TARP should not be your upper max rate. So if your max is 150bpm then your TARP or 2:1 block rate should be higher, usually by 20bpm so 170bpm.  I'm 49 years old, my max is 185bpm and my TARP rate is 220bpm. I never reach 220bpm for one and for two I can't go over my max of 185bpm because i have heart block. So the PM will cap at 185bpm anyways.  The point is you don't want your TARP rate the same as your max track rate or lower than your upper rate.  Hope that makes sense.  I was a runner before my PM so I can tell you it does feel different post implant.  It will never feel the same but definitely doable and manageable.  Ive learned you just have to know how the PM Is responding to you, what works and what doesn't.  For example, I know when my rate is 165-170bpm, I feel ok but my chest starts to hurt more and I get tired. So I found an app that monitors my HR during exercise and it will tell me if I go over my max rate that I set which is 160bpm. So when it tells me I'm over 160bpm, I slow down some to keep my under 165bpm.  Ive gotten so use to it now I don't even need it to tell me my rate. Ive learned what pace to maintain. Second, I know with hills I can't just spring up them.  I can run them but at a slow steady pace. Any sudden increase in rate, I'm out of breath and chest is pounding.  My theory is going from being paced at 120bpm to all of sudden 160bpm makes the PM worker faster and in turn makes your heart beat stronger to get up there quickly. So I just learn to do it slow and steady and allow my heart to adjust to the increase. Seems to work for me.  So things like that with exercise is what you will be learning to do.  It's a team work! Hope that helps!!!  Tweaking these things for exercise can be challenging.  

similar feelings

by Tracey_E - 2020-12-08 09:12:12

I had something similar recently, not burning so much as pressure.  Turned out it's not my heart, I developed exercise induced asthma. It was diagnosed on a combined pulmonary function and stress test. Not saying that's what is going on with you, but don't assume it's the pacer. Sometimes we get tunnel vision. I told my GP what was going on and he sent me straight to my EP, who ordered all the tests expecting to find something cardiac. 

PacedNRunning, when I had a similar problem hitting the upper limit, a very low dose beta blocker helped a lot, half of the smallest dose. When I got a replacement, they gave me a new pacer that goes to 220 so now my upper limit is 190 and I never hit it, however I find it difficult to sustain a workout if I stay over 160 too much so I still aim for that. But if I go over it, I don't hit the wall like I used to. 

Thank you ALL!

by arent80 - 2020-12-08 22:24:41

Your comments are truly appreciated! I will definitely look into this more. It's quite discouraging but I'm hopeful it will get resolved. Thanks again! 

Don’t get discouraged

by PacedNRunning - 2020-12-09 03:47:41

try and not get too discouraged. Or dwell on it too long. You will find a happy place. I took me 10 mos to program my PM for exercise.  I did a lot of reading and adjustments to get it feeling manageable.  You will get there. Take lots of notes. I had calendar that I took notes in after exerise. I would keep track of how far I ran, how long, my pace, my average heart rate and my max hr.  This is when I figured out over 165bpm is too much. I would give smiley faces or sad faces on how the overall workout felt.  It's really learning what feels good, what you need to adjust to work with the new paced heart. :). Hang in there!

T

Trying for sure!

by arent80 - 2020-12-11 00:05:39

Sometimes I can be ok for a day maybe two. Then something small will trigger it, like moving too fast. I walked up a small incline to the hospital and I could BARELY BREATHE I was so out of breath. Other times I can run up stairs and be fine. It's like it comes and goes. It never happened like this before the PM. I do not have anything set other than programmed AV DELAY HYSTERESIS. Low end is 50, high is 150. That's it. But I still struggle a lot mostly with activity. I'm also feeling these burning, prickling sensations all over my body at times when I'm moving around. It's been such a roller coaster for sure! Thanks for your comments. You guys are GREAT!