Difficulty in getting heart rate up when excersising.

[Alphakiwi]

I have arrythmia and have a 2 wire pm. I take rivaroxaban blood thinner and diltiazem. I dont have high blood pressiure and never really been bothered with it either.When i excersise i dont seem to be able to get my hr up over 100 much which i think is causing me to be short breathed. I want to get cracking on my biking again if possible. Im 81 and in otherwise good shape. Ie i won silver at the world masters in 2017. Any thoughts please. I wont be able to talk to my gp about it for a few weeks. Maybe i can use a lower dose of diltiazem.

[Czech_Mate]

Good question; I have the same problem so I'm interested to see any answers to this. My anticoagulant is Apixaban and my beta blocker is Metaprolol. I have come to the conclusion I'll just have to live with it and I've contented myself with easier walking and cycling projects and keeping active in the garden, all at a slower tempo. Also I've found yoga has helped me physically and mentally.Cheers CM

[CDreamer in reply to Czech_Mate]

Exactly what you need to do, 👍

[JOY2THEWORLD49 in reply to Czech_Mate]

Hi

I was breathless with Metaprolol and pauses at night.

Changed to Bisoprolol no breathless, no pauses at night.

Diltiazem brings my h/rate down to control.

I take 120mg. But I think there is lower but stopped in NZ.

cheri JOY. 75. (NZ)

[beach_bum in reply to JOY2THEWORLD49]

Same issue with beta blocker Metaprolol, switched to channel blocker Diltiazem, and all good.

[JOY2THEWORLD49 in reply to beach_bum]

Hi

That's great.

Only that the hospital with stroke &AF Rapid & Persistent left me, and no follow up. 4 days in hospital diagnosed possible thyroid cancer (shadow on thyroid - papillary and I consented to a biopsy).

But from September 2019 - December 2021 although changed to Bisoprolol by hospital Heart Specialist left with H/Rate avge 154 from 186.

Damage done to my heart.

Research is ?ing whether BBs are best for those who have a stroke amd have AFib. They should hurry up about it that's two of us who was 'saved' by CCB Diltiazem.

cheri JOY 75 (NZ)

[bean_counter27 in reply to Czech_Mate]

That's your Metoprolol doing it's job unfortunately. It's job for AF sufferers is to prevent HR from going through the roof when you are in AF. However, it also makes it harder for your HR to increase when you actually need it to i.e. in response to exercise. That's why you're short-breathed - heart not pumping as fast as it would if not on Metoprolol.

[CDreamer]

What is your PM set to? Certainly mine was adjusted to allow my HR to increase so that I could go to a max of 120.

Hopefully you are taking something to lower your BP as Hypertension is not called the silent killer for nothing! Combination of doing nothing to control it, AF and going all out to exercise doesn’t bear thinking about.

Listen to your body - if you get breathless - slow down. Your body is your best monitor of your health.

If you are taking Beta Blockers they will subdue both HR & BP and also metabolism and make you breathless.

[Alphakiwi in reply to CDreamer]

CD i had no idea that the max hr could be set by the pacemaker. I do know it is set to kick in at 60 and below. I take only 120 diltiazrm and blood thinner. I dont seem to have high blood pressure problems. I woke up this morning st 3am nz time in af. Bp was 116 78 60Yester was 98 75 60. I felt awfull with thatone

[CDreamer in reply to Alphakiwi]

Sorry I misunderstood- your BP is low. Perhaps look at hydration & electrolyte intake?

Pacemakers come in all shapes & sizes and mine certainly restricted my HR as I couldn’t take meds but now my PM is working 100% of the time according to the pacing clinic, not just when HR drops below 60. It will depend on the type of PM and how it is programmed.

Maybe talk to your GP? I don’t take anything other than anticoagulant.

[Alphakiwi in reply to CDreamer]

Thanks CD. Ive been think for quite some time that maybe i should not be taking the diltiazem or at least a lower dose. Originally after the pacemaker wis inplanted i was taking 30mg diltazem as a pip and was fairly happy with that then30 became unavailable and my gp put me onto the 120 capsules.Like you i had pm put in with the intention to knock out the av node. That afterwards was not considered necessary. I have told the pm technician i would like to see my original cardiologist a middle aged lady i just have much confidence in. A letter has been written to her for me but goodness knows when that will take place. I can get to see my gp within 2 weeks.

[JOY2THEWORLD49 in reply to Alphakiwi]

Hi

Yes you are in NZ.

About 3 years ago the lower doses weren't available. Sounds like 30s was OK for you.

60sbpm is great for me and 47bpm avge Night.

When I asked Mr Chen he said drop the Bisoprolol 2.5 Night first. Then if necessary change your CCB.

cheri JOY. Fellow NZ

[Singwell in reply to Alphakiwi]

Find out if you can take 60mg Diltiazem in tablet form. We have then here in the UK. They're still a modified release but you can cut them in half if you prefer 30mg. Talk to your Dr about this. Dosage should change according to age and though you're normally very fit by the sounds of it, there should be an adjustment for age. I was on way too high a dose of Diltiazem and it caused me to have intermittent BP hypos with, as you've said, are horrible.

[Alphakiwi in reply to CDreamer]

My pm technician wrote to my cardiologist reporting that I am in aflutter or tachycardia most of the time. Says he is rate controlled and appropriatly anticoagulated. Recomends reassurance.I guess this report means they wont ne rocomending me going off diltiazem or reducing dosage any time soon. They never menyioned anything about my breathlessness when excersising. I want to find a way of returning much closer to my athletic condition than i am now. It just seems the public health system is only interested in getting us just good enough to stay alive

[CDreamer in reply to Alphakiwi]

Sorry to hear that. I found that AFlutter far more restrictive than AF because of course the HR will be much higher. But AFlutter is much easier to ablate than AF. AFl is often far more symptomatic. Has that ever been suggested?

I don’t know enough about the NZ public health system but I do know that several people in Canada sought ablations in other countries simply because their public health system doesn’t allow private health clinics.

You might find this of interest, from a study in 2020:-

A total of 7695 EP cases was performed, including 5929 (77%) in the public sector. Atrial fibrillation (AF) ablation was the most common procedure at 29%. EP procedure rates increased by 21% (to 353 per million in 2018), predominantly due to AF ablation rates increasing by 46%. Ventricular tachycardia ablation rates increased by 41% but only comprised 8% of procedures. There was a striking difference in the growth of EP procedure rates in the public compared to the private sector (4% vs 106%), as well as considerable differences in EP procedure and AF ablation rates across the public EP centres. NZ had lower ablation rates compared to countries with similar healthcare expenditure.

Recent trends in cardiac electrophysiology and catheter ablation in New Zealand

Fang Shawn Foo, Martin K. Stiles, Geoffrey C. Clare, Nigel Lever, Darren Hooks, David Heaven, Dean Boddington, Heart Rhythm New Zealand (HRNZ)

I suspect that successful ablation for the Flutter might be your only hope but know that there is no guarantee of success. The CCB’s with the AFl will always cause that sense of oxygen starvation thus limiting your physicality so you may need to work within those parameters if you want to stay well. It’s your body’s way of saying - sorry, not up to this any more. Very hard to accept.

Best wishes

[Nomis21]

Im 100% paced, two lead PM and recently had a exercise stress test (Cpex test) during the test (I was on a exercise bike) my heart rate never went above 70bpm.Suffer daily from being out of breath and was diagnosed with heart failure 3 months ago, tbh never felt great since my pace n ablate carried out July 22.

I have a heart rate monitor and it never goes above 70 bpm find it really difficult to do anything under exertion, get really dizzy when I stand up from sitting or kneeling.

I was paced at 70bpm but my understanding at the time in the pacing clinic was that my HR wouldn't fall below 70 but would go higher when exercising but seems it just doesn't go above 70bpm.

52 yrs old on ramipril & Bisoprolol for HF and expecting more meds this week when I go see HF nurse.

[beach_bum]

I also am in the same boat. I live to cycle, but gave up racing a while back, as I have only so many hrs in a day lol Having said that, whenever I see someone coming up on me, I feel the need for speed 😏 I have *trained* my heart to accept the new parameters, and can hit 70% of my max (150bpm) with no issues. I’m only 69 so yours will be slightly lower. It was disconcerting at first, but now my new normal.

[Alphakiwi in reply to beach_bum]

Thanks for your encouraging reply Beach bum. Yes I have theoretical max hr of around 140 so i go down to the club gym every day and use the stationary cycle at about 98 bpm at level 8 for half hr. Been doing this for 3wks now. Started off at lower levels. The idea being to start low and build slow, discipline eh. I had a an all out yesterday after a warm up time and managed to 127 bpm. First time ive done this for a long time . Couldnt hold the 127 for long and soon dropped to 116. I then let it drop back to 94 etc. So pleased with that and i am looking forward to getting in to a decent walk and see how the huffing and puffing goes. I hope to get out and around our domain slowly this afternoon. I will make an appt to see my gp as soon as with the view of stopping the diltiazem and just having a PIP to cover me for the bad time when it comes or if hopefully but i am a realist .... i hope.

Are you on Strava. Maybe we could keep track on the bike ?

[Sweetmelody]

From my experience, I’d say the diltiazem is suppressing your HR. Like you, I’ve never had high blood pressure, am in good shape for 82. When I’m in SR, beta-blockers, calcium channel blockers, and anti arrhythmics all can keep me in bradycardia, unable to raise my HR to the number I’d like even when exercising.

When I stop taking any of these drugs (metoprolol, diltiazem, amiodarone), my HR returns to normal if I stay in SR. I only titrate with my EP’s okay, but I’m proactive in seeking as fast a titration off these drugs and my EP has been agreeable. I don’t do it on my own.

Right now I’m titrating off amiodarone, started almost 4 weeks ago and prescribed for the immediate post-ablation heart chaos my poor, assaulted heart experienced. My heart is calmly in SR now; the amiodarone has done its job. I’m eager to stop it so my heart rate, now in the 40’s and 50’s, returns to normal, which it will.

I’m following my EP’s guidance on titration—but if I had my way, I’d stop taking the darn stuff this very day! I understand your impatience and desire to “get back to normal” ASAP. Just keep biking, as I just keep walking, and let your heart do what it does until you and your doc decide on lowering your dose. “Ride it out” until you talk to your gp.

Also, all these drugs cause breathlessness at the top of my stairs or walking up hills—which goes completely away when I stop the drugs. A light at the end of the tunnel.

[Alphakiwi in reply to Sweetmelody]

Thanks for your very welcome info Sweet melody. It is so settling for me to know that others have such similar experience. Your advice is great. I will ride through all this as you say and wait for the gp before i start doing anything else.l would like to know what titration is. Its great that you see a light at the end of the tunnel. Same here. Thankyou.

[Sweetmelody in reply to Alphakiwi]

Titration is another way of saying weaning off a drug by small amounts to find the right dosage. I sort of remember the word from chemistry class in high school. It also has a medical use. My doctors use it, so I've picked it up.

[CyclingRunner]

I'm 48, been on Metopronel before exercise for 14 months or so as higher HR put me into AF. So different from your circumstances but I have been very interested in how BB have affected my cycling, so hope this helps. Started with 1/2 tab, now down to 1/4 tab and drops about 10-15 bpm off my HR. However it's quite uncomfortable to push it - my brain tells me to push harder, but heart doesn't want to so feel lactate in legs around 130 which I used to get at 150. Can't do turns at the front anymore when cycling in a pace line and have dropped probably around 15% or so of VO2. Dropped on Strava from top 20% to around halfway down the leaderboard. The BB definitely has the effect on me you described.

I found that after a period of time I improved my ability to function at a lower HR, so there's obviously some adaption to cope. Just did a ride called Three Peaks Challenge on the weekend which was 235k and 4000+m elevation - avg HR around 118 for 10.5 hours riding and took 1/4 tab every 4 hours. No AF. But then a month or go I sprinted up a 300m long hill at full gas to 165 and spent 36 hours in AF!

So my 10c worth is that I've been able to adapt so it's tolerable, but performance dropped. Having said that my cardio has now referred me to EP to review an ablation, as my threshold for pushing into AF is dropping and I'm told there's a better chance of success when younger.

[Alphakiwi in reply to CyclingRunner]

Ooh dont want to be a party pooper but with my hindsite hat on i would be modifying my sport a tad in the interests of longevity. Believe me its not good at my end the journey. Got a mate thst took took pain killing tabs during duathlons .Hes scored a few goldsbut only because there wasnt any competition to speak of! So what theres no pot of gold up that mountain is there ? I say after 50 keep cycling for fun fitness and companionship but wow avoid the extended periods of highs. I know a little guy in the UK i met down here in NZ who is so fit at 81 you wouldnt believe . He has biked everywhere on an old gravel bike and seen the world just riding probably at Z2 all the time,bike all loaded up. Now he does shorter road trops maoinly over there but goes in the odd age group duathlon marathons and tris o and yes park runs and cleans up. Good on you though for your determination. 48 is young so got lots of time left in the tank if you look after it. Not good if you feeling the lactate effect at 130. I dont have that problem because i get into short breath first becauuse im in aflutter most of the time. Avoid this situation like the plague. Very interesting comments from you about taking heart meds before excersise !! All the best from me in NZ

[Alphakiwi]

Here I go again. Itsjust on 6.30 am here in nz and ive been semi awake semi sleeping since 1.30 am l am feeling oh so tired in left side the rat is back thats what i call this stinkin thing called broadly arrythmia. Yesrerday i had such a marvelous day . I really thought u had it cracked. Been going to our multisports club gym, excerdising now for half hour on the excercycle having built up to this over a period of approx 4 wks.The Rat is back is a term i coined in my search for a description a few years back to describe to gp how it felt to have this thing that has the power to wake me to shake me to make me o so stuffed and not have any answer for it. I live healthily so i consider . I have always loved excersising and found during my life that athletics and cying were my go to activity especially the cycling for the fantastic companionship it provides but here i am at at now quarter to seven all alone with the rat in my chest . Its dark outside, its dark inside and i have found a new description of how i feel. Its like ive got parkinsons on steroids in my chest. I havent got parkinsons but some friends of mine have and i know they wont mind me taking a tiny piece of what they must be going through. Im not a wimp but i will have to stagger on. Im actually starting to feel a lot eadier after getting this off my chest and i took 40mg of verapamil an hour ago which mygp gave me a few months ago for just such occasions. Its just breaking day now so im considering getting up. Ill have a hot shower. This is going to be a fantastic day.

Thank you tall of you who have taken the time send me all those messages of concern and knowledge, even from the northern hemisphere. You are wonderfull. Colin in Kerikeri , Bay of islands New Zealand