I don't know whether anyone can help with this or offer some insight... I've been a keen runner for about 12 years and consider myself to be reasonably fit, though overweight. 3 years ago at the age of 42, I had a minor NSTEMI heart attack - the angiogram showed a partial blockage of just one artery so it was treated medically with no stents. I've not had any angina or problems since then.
When I was discharged I was given the same advise as is given everyone I suspect, with or without stents, which is to keep effort levels of exercise to a level where you could hold a conversation. With the beta blockers, this usually correlated to a heart rate of about 130bpm for me. As time has gone on though, given that I've not had problems, I started to push myself again with the running and a good effort run (once a week, often a parkrun) took my heart rate to about 145 bpm. Recently though, my watch has started telling me that my pulse is not dipping below 150 during an decent run and can go up to 180. My resting heart rate seems unchanged. Given that my heart attack was relatively minor, do you think I should be worried about this? Will it increase my risk of further problems? I don't have much confidence that my regular GP will know the answers, so they will just give the standard advice again I'm sure. Any thoughts?
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DaleyT
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I was reading an interesting article on exercise levels for people with CHD. The article quoted Dr Jonathan Whiteson who is a Medical Director in a Cardiac Rehab Centre in the States. The recommendation is to establish max heart rate and to train at 70 - 80% of the max heart rate. I calculate in (using the formula in the article) your heart rate when training should be 142 max. I have found it difficult to get Consultants and GP's to give advice on a max heart rate. You could try contacting a Physio at your local Rehab team. If you want to read the article Google 'bad heart? Time to hit the gym' and it should show in your search. Apologies for not being able to copy a Link. Is your higher rate on exercise, compared with the past, due to running harder? If so you could maybe slow the pace for stages of your run. Of course these heart rates are a guide but useful.
I had a cardiac arrest on 7 June 2015 and had a stent implanted. For the first year afterwards my cardiologist suggested that I not allow my heart rate while exercising to rise above 90 BPM. After a year, and while still on beta blockers, he told me that there was no longer any advisable maximum heart rate, the exception being one that would kill or maim anyone! 😂
So far I have had my heart rate up to 145 BPM comfortably in the gym and I’m gradually increasing it. My recovery time is improving too.
I don’t use a watch or monitor because the gym equipment I use has heart rate monitors built into it and they are calibrated regularly. Technogym equipment is amazing. (I should say that I have no connection with the company, any of its distributors and this is not an advertisement.)
I don’t think I’ve contributed much to your post, but I thought I’d share my story in the hope that it may help in some small way.
Hi Daley , like you, I am a regular runner. I was a bit too ambitious after my quad bypass two years ago in my goals however. My operation was the end of April and I had a half marathon booked for the October. Fortunately I saw sense and settled on a 10k to celebrate the first year anniversary then did the half the following October. The point of my waffling is this, I used to be fiercely competitive but now I have relaxed enough just to enjoy running. My rehab team told not to get hung up on HR but rather listen to my body. I do keep an eye on my Garmin HR monitor but only to confirm that I might be pushing too hard. If I'm running a long hill and it feels tough I will check the HR. Sometimes it will be sub 150 but if it's in the 160s I will walk now.
We have been given a second chance, I figured it isn't worth doing anything silly.
Your estimated max heart rate is 220 minus your age. So for you that is 175 bpm. About 80-90% of your max would typically be regarded as your high intensity level (so that would be roughly 140-155). These numbers are for fit people without beta-blockers - the advice is to take 20-30 off that number if you take a betablocker. So you are now down at 110-135 sort of level. As with most of these things, these numbers are all estimates and are OK as guides.
The best advice I ever got was to listen to your body - it'll tell you if you are overdoing it. I'm a good few years older than you and I set my own exercise max at 130bpm - it works for me as I'm looking to keep a good level of general fitness (which I sort of manage to do). I think you should not be hitting 180bpm with anything like regularity - it really should be exceptional as that is high by any measure - otherwise, I think you are probably top end of where you should be so just about OK, but if it were me, I'd be looking to back off a bit.
I think you should speak to your specialist. I have A Stenosis which was mild/moderate for about 6 years with the advice that exercise could be unrestricted. 2 1/2 yrs ago I took part in a gym challenge that meant I was doing about 1000 cals a day for 10 days. This was stupid and I had an episode of AF and hospitalised for one night. Everything went back to 'normal' although my stats pushed my A stenosis up to moderate/severe. I asked my GP about exercise now that I was taking a low dose of beta blockers, he said keep it below 100 bpm (having in mind my dose beat blocker would reduce my heart rate by 15-20 bpm); his advice was very good I can still work out well in the gym 3-4 days a week, never feel out of breath or tired. Strangely enough my AS this year- after 2 previous measurements of moderate to severe now is shown as being firmly in the moderate band- anyone else had things apparently improve like this?
In short I would be most careful as the bpm you are checking could be 20 beats less than your un-medicated heart would be registering- so do not push it, why would you want to?
Referring to Nathan's point your absolute max bpm should be about 120- check it out, all the best.
Some extremally good advice/points here from running community so let me add my two pence worth.
I totally agree that MHR is just a number and it should be taken just as guideline, not absolute. The most important part is to listen to your body, I could not emphasise that enough.
Unlike Phil-52, I was not sensible enough, had stenting done last year, May 2017 and completed Tokyo marathon this year, Feb 2018. I was all booked a year earlier to ran Tokyo, naturally before the unexpected arrived, please don’t take this as recommendations.
I had a few conversations with the cardio team around the MHR, they agreed that 220-age is not entirely applicable to everyone, especially to us runners. I was privileged to deliver a speech, organised by my local hospital, to a bunch of ‘wanna be’ sports cardiologist. I had a valuable discussion with the experts and during the discussions I made my point that in order to establish individual’s MHR, they must perform some sort of stress test using the appropriate equipment when establishing MHR, unlike 220-age, they agreed.
Coming back to OP’s point, like you I also hit 180MHR during one of my stress test, that was pre-BBs era though, now I am on BBs the ticker has slow down a little.
I came to this conclusion that there is no right or wrong answer, the best option is to listen to the experts/their guidelines and make a judgement call aka listen to our body. There are so many variations, our age, our background, our diet, our exercise regime, our meds, list goes on so how could we all be prescribed same exercise parameters?
I would be keen to read Dr Jonathan Whiteson, thanks Nathan for sharing that.
BTW I have documented my journey in detail here, please see the link below if you want to know more.
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