I need aortic valve replacement "within a year'. How do I know/monitor if my running is doing me good not harm?

[DickyValve]

I am a regular runner and I have been told by my consultant to keep as fit as possible for my operation. I monitor my runs with a Garmin. What are the safe limits for my heart rate and what are the signs that I might be doing more harm than good? My resting pulse rate is around 45.

[StevepH2012]

Hi,You don't mention whether you've any other conditions, in particular dilated/aneurysmic aorta. During the wait for my 'Valve plus route' op 'cardio' exercise was good, but high BP to be avoided (sudden exhertion) . Everyone's different, but high heart rate doesn't always = high BP.

If you have any heart muscle damage then high heart rate probably best avoided.

If you have dilated aorta, high BP best avoided.

For me (5'8", 11 stone) high BP >140, high HR >160.

Steve

[DickyValve in reply to StevepH2012]

Hi Steve and many thanks for that, very helpful. I haven't focussed much on the aorta but never heard aneurism mentioned and only the word 'mild' in relation to dilation. My 5k run yesterday produced a peak HR of 170 and an average of 145. I was surprised as the run was slow for me (8minspkm) and felt undemanding. Think I need to try my chest strap HRM to see if the watch is producing anything unusual. My running used to be less anxiety laden, monitoring only for muscle damage - which I've suffered a bit of over the years. Now I know about the op., I worry more!

[StevepH2012 in reply to StevepH2012]

As Cliff_G says, I think 'the numbers' appropriate to each one of us are very different.

My non-medical interpretation goes along these lines.

If you're stressing (about anything) your BP will rise and your heart has to work 'harder' to compensate. Working 'harder' is combination of strength & rate - fit people generally have stronger heart muscle and so lower HR.

If you have a duff valve but a 'fit' heart muscle, the strength of the beats compensates to some degree for the leakiness of the valve without greatly increasing HR. When exercising you can still be relatively asymptomatic, but your HR will be increasing as the efficiency of your valve decreases.

This is how I rationalised feeling that I was asymptomatic - only when my valve stenosis became moderate did I begin to struggle for breath when exercising. My heart muscle was OK, HR going through the roof, but leaky valve meant slower oxygen supply.

(If the weather for you yesterday was anything like here (brass monkey) then I'd expect higher HR anyway). By the sound of it you're way fitter than average OHS patient and my advice would be to carry on running but not hard, listening to your body as Cliff_G says, but do follow all the advice on lowering BP. (warm-up & down becomes more important as you want your blood vessels to gradually expand/contract at beginning & end of exercise- something I hadn't thought of/understood until Cardio Rehab nurse explained to me).

Making sure you have reasonably in shape core is equally important for recovering well after operation as you need to minimise the strain on your sternum when it is healing and being able to get out of chairs/bed without using your arms helps greatly.

but - everyone's different, listen to your body, do your research and talk to your cardio team (which I know may be tricky at present - I had a post op echocardiogram at beginning of January, but the cardio is on Covid ward duty and so will "get around to sending the notes through we she can". Luckily I feel fine!)

All the best

[DickyValve in reply to StevepH2012]

Great advice Steve and thanks again. Liked the simple but so important thing about core and leg strength for post-op - wouldn't have thought too much about that. Ran yesterday and used my chest HRM - much more what I would have expected and very reassuring. Avg 109, max 135. Glad you are feeling good and best wishes.

[Cliff_G]

I'd agree with Steve's response.

Excessive BP and heart rate are both detrimental (why does your valve need replacing?)

Your heart rate is low, is that due to beta blockers or naturally (fitness)? I'm not quite that low but I have always struggled to get much over 120 when exercising hard. I would say as a pre-op regime and without knowing your details, probably 100-110 max. Note that one doesn't need demanding exercise to stay fit enough for an op, more the regularity and length, with HR up somewhat.

Ditto with BP you'd want your resting BP at 120/80 if you can. That's based on aneurysmal risk, but a high BP will also make aortic regurgitation worse. Difficult to check BP when exercising (unless treadmill) but I'd be concerned above 150/100 straight off the end of a run, and I'd want it to be dropping under 140/90 quite quickly. With only gentle exercise enough to open up the curculation, I'd be looking for nearly a resting BP, during.

With all of this, I am not medically qualified, but am used to what I was like before an aortic dissection (incl. valve replacement) and now afterwards. Before, my resting BP was creeping above 140/90 then 150/100 and no doubt contributed to my dissection, my resting HR was 60 bpm. The guidelines are pretty quiet on recommendations, save one which says keep it below 130/80.

Signs that you're doing too much? Probably shortness of breath and any reduction in your normal exercise capacity. The usual listen-to-your-body.

It's very true that fitness helps before an op. I probably would not have survived my emergency without. Yours is planned, so not the same, but fitness is good. Best wishes to you

[DickyValve in reply to Cliff_G]

Hi Cliff, thank you too, very much.I have a bicuspid valve which I knew about in 2012 and which I hoped would hold out if I kept fit and ate healthily - head in the sand?! - but now the time is coming for intervention.

No, not on beta-blockers but I have been prescribed Losartan recently to keep BP down.

My consultant has encouraged me strongly to keep up my exercise regime with the only caution being to monitor for chest pain, shortness of breath and light-headedness. None of these to report yet.

If I followed your advice about HR, I doubt that I would be doing much more than taking a brisk walk. Not saying you are wrong and maybe that's what it boils, to but I am SO reluctant to give up my running which has been important to me for some time but especially during this Covid crisis. However, if I had to I would - certainly don't want to collapse while out running and have to be scraped up off the path by some poor overworked paramedic.

Listen to the body or be guided by the metrics? Maybe some of both eh?

[Cliff_G in reply to DickyValve]

Hi. Yes, I think so, bit of both.

Everyone us different on heart rate. I've never got near the standard HR calcs, my vagal drive is too high. Maybe use something like goodcalculators.com/heart-r... and back off a bit from what it recommends?

Bicuspid valve is known to affect the aorta above it, so I would definitely keep your BP well under control.

[DickyValve in reply to Cliff_G]

Thanks again Cliff. And for the link. Amazing how many different ways there are to calculate max HR, also quite a range of answers. Welcome advice.