hoping I am not posting this more than once - seemed to loose the last one somehow
Recent diagnosis of svt (probs avnrt) probably rate related I’m told - treated with adenosine and prescribed metoprolol in ed. -tried daily - unsustainable and quite unwell - finally off it and will use as pip .
Gp says gentle level walks to regain some fitness - hesitant to send HR to high as it seems to be quite zippy.
70-80 sitting or lying down; 100 + as soon as I stand up; up to 120+ pottering around the house: 130-140 with a bit more effort (level ground walking/mowing etc)
I suspect I’ve become very unfit and am overthinking it all but your input/reassurance is welcome
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Glenlyon
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I’m not medically trained so this is totally above me, but your HR does sound a little high for what you’ve said you’re doing, which is obviously the reason why you’ve posted. At rest, you are still within normal limits, of 60-100, but 130-140 does sound a little too high for walking gently ( in my opinion only).
Does your GP know you’re off the metaprolol? Are you in the UK?
Again, I’m no expert, but it sounds like you may need perhaps another form of rate control, at least to help your heart rate get down a bit, which might be easier for you to tolerate daily, like another beta blocker, or a calcium channel blocker.
I think perhaps you need to have another chat with your GP. Does he know what your HR is doing, like you’ve told us? Also perhaps need to ask what the long term plan is for you?
How often do you have SVT episodes? How high does your HR go? What is their plan for you going forward? I’d probably be asking them that.
Thx Theresa - waiting to see how often it happens and whether the pip will be effective if I want a daily treatment moving forward verapimil er 240 a day might be a better option to metoprolol - I’m not leaping into that after my last experience but will wait and see how often it happens and whether things will settle if I can slowly increase my exercise tolerance- if was getting tired easily but hadn’t realised how zippy things were till I got an Apple Watch - so yeah - I’ll check in with my he Gp.
At our recent Patients Day we had a talk on exercise from one of the arrhythmia nurses who reiterated my usual advice to be able to walk and talk at the same time. She also talked about percieved effort, how you feel during exercise, as be important.
I do understand your problem as thanks to increased arthritis my long country walks are a thing of the past and even a short walk down my lane leaves me exhausted.
Yes - it’s true - I’m no spring chicken and I may not bounce back the way I’d wish to - I’m grateful to know it’s a reasonably strait forward ‘thing’ and that it’s manageable. Thanks for responding helps me think things through
Have a 24hr heart monitor. It showed that Metoprolol gave my heart pauses! Risky AF could cause a Stroke.
Metropolol is not the best Beta Blocker for AFers. Best is Bisoprolol.
But BBs don't settle my H/R - CCB Diltiazem 120mg was better. It's job is to bring down H/R. 180mg in 2 hours did, as H/R fell 105bpm. We tweaked it to 120mg. AM. Balanced Bisoprolol 2.5mg PM. 110-130 / 69. 60s H/R.
I'm happy with that. As I have an enlarged back chamber I now realise I cannot be cardioverted, no ablations, ot no anti-arrhymic drugs.
For a year on Diltiazem my H/R Day is 88-96 (Just under 100) but last November I felt better that my H/R had dropped day to 60s.
Anaesthetists will warn you if H/R over 100 they won't do an operation on you.
I can relax as I do not have this always ongoing threat.
I operation last year, another due on right shoulder on 30 October this year.
Sounds like you’ve landed in a good place after some trial and error + it’s great to know I’m not alone having issues with metoprolol - did you take a breather before taking something else or go straight from m to another?
Hi GlenlyonI can't comment on the meds regime or your starting point for improving fitness as you haven't shared enough basic information. That's not a criticism it's entirely understandable. However, you have been given a green light to increase exercise.
In the UK there are two good programmes Active 10 which is a walking get moving programme and Couch to 5k which is a beginning to run programme. They are supported with HU forums.
There are a couple of mantra's worth following
Always exercise at a conversational pace. And
No pain, no pain!!!!! As opposed to the old mantra of no pain no gain!
Here are my metrics for you to ponder and look at your starting point:
Male aged 71. Severe stroke 18 months ago but treated FAST and walked out of hospital.
Average level of fitness but just in obese weight category. Never run in my life since being forced to do cross country at school! At that time no identifiable causes of the stroke but this year Afib detected and now on DOAC and statins.
With no post stroke support on offer because I had mobility I found C25K which th GP have a cautious okay but take it steady!
I struggled to do week 1/1 and could have given up. Mainly walking with a short 1 minute jogs to attempt. 9 weeks on I could run the thirty minutes albeit very slowly. Some people can walk faster! But the improvement for my cardiovascular was clearly obvious and measurable. Rest days are very important as are warm up exercises which are all available on the C25K app . Stretching, strength and conditioning are all things to do maybe first but alongside short walks. Build up slowly and even more slowly than that ! You want to be able to give yourself a positive stroke for achieving the bite sized progress and achievements.
The big gain is your mental well being. You will see the same people out who will say hello and ask you how you are.
The big part in the back was passing a group of teenage kids waiting for the school bus on a new route for me in the village. They clapped as I went past and it was genuine and not ironic. It was lovely moment.
You've gone public here with your ambition. Yes do try, have some passion for making your own contribution to improving your health to complement the work of the health practitioners.
I'm still running and did my 30 minutes this morning, drinking my reward coffee as I write to you. Good luck and go for it. Remember the mantra's. You have had some other good advice too it seems.
Thanks for this Chinkoflight! I’m 61 female and had lower than average fitness beforehand - your response makes me happy and hopeful. You are right, it is a powerful thing to ‘go public’ with one’s intentions- it hadn’t occurred to me I’d done that but it’s true. After writing it occurred to me that my heart rate doesn’t escalate when I’m horizontal so I started doing some exercises on the floor - no rapid increase in heart rate and today I’m a bit sore, counting that as a win! I’m in Australia but will have a look at both the programs. Yours is a wonderful story thanks for sharing it here.
Hi! Not a doctor, but some things I’ve come across for myself. You mention that your heart rate changes based on your position, perhaps check out the CHOP protocol for exercise created for POTS patients. Consider letting your doctor know you have this issue of position dependent HR as well.
I’m not sure how to include an active link but here’s a copy and paste of the location:
I’d also recommend exercising with a friend that has an understanding of your situation (for me this helps ease anxiety I have about something going wrong while I’m exercising and conversation takes my mind off of my heart), bonus points for meeting a buddy out in nature! And maybe explore some meditation or a gentle yoga class with an experienced instructor. Good luck!
Hello Glenlyon; Just had the paramedics and fire dept at my house last night due to fast HR and nausea discomfort in upper stomach blood pressure was 158/111, HR 107. They arrived and did an EKG, showed what I knew, was in afib, had been all day and checked BP again, was 144/96 and conclusion was gastro-intestinal cause, I have gastritis and just had a cup of bran flakes but I really thought I was having a heart attack but thank GOD it wasn't. I was told they felt comfortable leaving me home alone (I live by myself) to just ride it out and it shortly calmed down after I took 5mg Lisinopril and blood pressure dropped to 117/86. In conclusion unless HR is extremely high I've been told to not worry and ride it out. Isn't afib wonderful? Hope this eases your worries a little, Best of Luck to You.
Oh Kocoach what a night you’ve had! Thank you for responding and yes it’s all a learning curve and a fib does remain a possibility, though so far the assumption is one of its sibling svts -time will tell I guess. I’m hoping you’ll be able to do something you love for yourself today or find time for a good catch up sleep.
Can only speak in generalities in how to improve cardiac fitness, as fitness programs should be tailored to the individual.
That said, in most cases, "moderate" exercise is most often cited as being beneficial. That's where you can talk a little, but have trouble with long sentences. Some say that's when you can talk, but not sing If you can talk and sing quite easily, then that would be light intensity and if you can't do much of either, that would be high intensity. Sometimes a combination of the three is advised, again depending on the person.
Some also talk of perceived exertion scale and then there's working out using a heart rate monitor, using it to keep your heart rate in whatever zone is applicable. I've been using a Polar Heart Rate Monitor for fitness since it came out, I believe in the 80's.
Lastly, if you qualify, a medically supervised cardiac rehab program may be something to explore.
Thanks Jim! That’s a great recipe for gauging intensity before checking in on the new watch (which I feel is amazing but can become a bit too much of a distraction from staying in the flow of life). You’ve nailed it with question for the Gp, re: relevant local cardiac programs. So easy to overlook these things in an appointment.
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If you can talk and sing quite easily, then that would be light intensity and if you can't do much of either, that would be high intensity. Sometimes a combination of the three is advised, again depending on the person.
what is a good resting heart rate 
A-Flutter and heart rate
Has anyone else had a steady heart rhythm but changing rate?
