heart rate too low during exercise

When we have a PM implant, is there a setting that could be in a constant position that would not allow the h/r to increase with exercise? If so, when rate response has been turned off, there would be problems . When I took my stress test it was with the r/r on, and with the good results I was cleared to turn off the r/r. I guess I'm thinking they should have checked me with it off during the test. Is it possible that any settings are off? Not that confident with Tech, and doc hard to get to.
Do all you runners who have turned off your rate response have any thoughts on this and was there any difference in your h/r pre PM. I don't remember having any difficulty before PM 3mos ago Currently on atenolol(25) and vasotec .. Side effects include shortness of breath, dizziness, fatigue. There is a new B/B called nebivolol which has far less side effects. It was approved last month with lots of good press. Anyone heard of it?
Thanks for the input and support...........this is truly a "good people" site
-Philman

4 Comments

rate response

by Tracey_E - 2008-10-01 11:10:41

I'm wondering why they didn't test you with r/r turned off if they were going to turn it off. Rate response will help get your rate up when you exercise if your heart doesn't go high enough on its own. If you did well on the stress test with it on, why did they mess with something that was working?

I'm not sure about those medications but in general beta blockers will keep your heart rate down which will make it more difficult to exercise and make you feel tired. Your heart wants to go faster but the medication keeps it slow.

If you are pacing atrial, then your heart will not drop below the number it's programmed for. Your heart can go as fast as it wants, the atrial lead is there to make sure it doesn't go too slow. 50 or 60 is a common lower limit.

If you're pacing ventricle, then your atria is beating more or less normally and your hr during exercise will only go up as high as the ventricle is programmed to keep up with the atria. So if your atria is doing 150 on its own but your ventricular lead is programmed for 130, then your hr will only go up as high as 130. This will cause fatigue, sob, dizziness. Been there, done that! They've got mine at 170 now, they crank it up a bit more each time I fuss that I'm getting sob at the gym :o)

My rate response is off because I pace mostly ventricle- my atria goes up high enough when I exercise on its own so I don't need the pm to boost it.

Hope that helps! I understand some of this stuff but am not so good at explaining it!

Rate Response

by hhowell - 2008-10-02 01:10:50

Hey Tracey and Philman --

I just went thru this ugly saga of getting my pacer reset too. My old electrophysiologist would never do anything to my pacer, I don't know why? But I switched docs and was sent for a stress test (which I had never had before.) Supposedly, paced the test fine. Didn't know anything about this r/r with the test though ?? that was all interesting info.

My Husband and I had just joined a health club after I was told by my former doc that I couldn't swim anymore (before pacer, I swam 1 mile 3x a week.). I had tried swimming twice, but was extremely out of breath. This doc explained (wrongly, I just discovered!!) that my pacer contained a pisoelectric crystal that needed direct impact to increase it to increase my heart rate. Well, he was full of you know what!! I called St. Jude's directly and found out that this was all wrong. At the health club, I was having the same problem with exercise classes, i.e. terribly out of breath - it was kinda scary! So, after new doc sent me for stress test and I did fine, Then I had a FREE evaluation with a personal trainer at the health club. One of the things she tested was my VO2 Max rate. She put me on a treadmill and within 4 minutes my rate should have been 138ish, but it only went to 99. Imagine that! No wonder I was feeling so out of breath and tire especially after working out.

Well, that FREE test was the clincher. The new doc finally adjusted my pacer. I don't understand these setting things and no one really wants to take the time to explain anything - after all it's their valuable time, but it's YOUR valuable LIFE. Imagine, I've TRIED to LIVE for three years with it like that and no one did anything but just try and make me feel like I'm crazy. Five years I've had this unexpected pacer and four operations three big, ugly scars and doctors don't want to give you the time of day to explain anything! Ugh!

I'll get off my high horse and just say to you philman, just keep plugging away till the problem can be solved. I'm on no meds, so I didn't have that factor to consider, but I do feel great now. Everything (just like what's going on in the economony) seems to be trickling down in my whole system. For instance, I used to drink iced tea constantly. It's been four weeks since this adjustment and I don't even want iced tea. I think my system wanted it for the caffine for the low/slow heartrate, but I'm feeling a little better everyday.

Thanks, Tracey for all the interesting info. I'm going to have to get back in the groove of looking at this site daily because its easy to feel like you're just floating along out here when you have a pacer. I don't know of anyone else who has one that I can just pick up a phone and talk. This is nice, but takes a little effort.

Hope my long, sad story helps you some, philman.

hhowell

by Tracey_E - 2008-10-02 04:10:27

rate response is a feature that newer pm's have where your pm will make your hr increase with motion. They can turn it on and off when they program your pm. If you primarily pace ventricle, you probably do not need rr because it affects atrial pacing only (the way I understand it)

I am a firm believer in pestering doctors and pm technicians! Ask a lot of questions, keep asking until you feel like you have a good understanding of your condition and treatment. Be polite, but make it clear to them that you are interested and you are taking charge of your own health. If they don't listen to what you're telling them or explain things when you ask, be more persistent. If the staff ignores you, mention it to the doctor. If you still don't get results, don't hesitate to change doctors. Some offices are better than others- the quality of the staff is as important as the doctors themselves. Too many are too rushed and treat us like cattle! But there are gems out there and it's well worth it to keep looking until you find one.

I have had nothing but wonderful experiences with the techs at St Judes. I've had the same main technician since I got my first pm in 1993. He has two gals under him now and they're all fantastic. I had a problem last spring that stumped all of them and they immediately faxed all my records to the engineers who made me a case study, they had a powwow and came back two days later with a solution.

oops rambling! My point is, they could have easily ignored me last spring because my pm was technically functioning but instead they went the extra mile and fixed the problems. Small problems, but annoying to me!

Hmmm...

by harrisonb - 2008-10-04 06:10:59

I don't think there is a setting like that. Usually the pacemaker has a high and a low setting. This means your heart rate cannot go above the high and below the low and your doctor does the setting on what he thinks is appropriate. If your BBM go above or below the settings you should contact your doctor.

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