Question for the over 75s.

[Rusty Nails]

I am having a bit of a debate with the cardiology dept at our hospital (I have had a pacemaker for two years). I want my max rate limit set to above its current level (140) as I have had some problems on steep hills ever since the pacemaker was fitted.

I am trying to get them to increase it to something in excess of 160, which is a level I often used to do before the pacemaker, and which I would probably only do for short periods in any ride on the very steep bits.

They are concerned because of my age (76), even though the surgeon who fitted the pacemaker said my heart looked strong and healthy.

I have always kept myself quite healthy and fit but know I am by no means exceptionally so, so my question is how many other 75+ riders on here monitor their heart rate (confession, I don't except when I occasionally go to the gym) and do they exceed and/or match these numbers. I would like to use this info to back my case for increasing the upper limit on the pacemaker.

 

[Sharky]

I'm not quite 76 yet and I don't have a pacemaker fitted. But as I will be 75 next month, I am curious to know, what happens when the heart rate goes above the 140 upper limit.

 

[JtB]

@Rusty Nails I’m 63 and my pacemaker clinic tell me that I regularly have long periods where my heart rate is above 160 bpm while exercising. Note: this is my own heart’s natural pacemaker (the sinus node) and not my implanted pacemaker that’s pacing my heart.

@Sharky An implanted pacemaker just fills in the missing heart beats when the heart’s natural pacemaker is pacing at less than whatever the implanted pacemaker is set to pace at. Rusty obviously has rate response set in his implanted pacemaker which is monitoring his activity levels and increasing his heart rate accordingly up to a maximum of 140 bpm. It sounds like this is not enough and Rusty is getting starved of oxygen on the hills.

Luckily for me my body’s natural pacemaker is still (for the time being) able to respond to increases is activity and so it does not rely on the implanted pacemaker’s rate response function. This means that while I’m exercising my implanted pacemaker is idle. Note: My problem is keeping the heart going while I’m relaxing/sleeping and not while I’m active.

[Edit] @Rusty Nails I forgot to mention that there are some very knowledgeable people on the Pacemaker Club forum.

 

[Rusty Nails]

I'm not quite 76 yet and I don't have a pacemaker fitted. But as I will be 75 next month, I am curious to know, what happens when the heart rate goes above the 140 upper limit.

In my case the body tries pushing blood to the parts that need it when climbing steep hills i.e. the legs, and, because of the limit, doesn't push the blood/oxygen to the head. Extreme light-headedness and dizziness results.

Before the pacemaker this was never an issue, the heart just coped by beating faster.

 

[JtB]

In my case the body tries pushing blood to the parts that need it when climbing steep hills i.e. the legs, and, because of the limit, doesn't push the blood/oxygen to the head. Extreme light-headedness and dizziness results.

Before the pacemaker this was never an issue, the heart just coped by beating faster.

The pacemaker can only fill in the missing gaps, it can NOT make the heart beat slower. Either the event which occurred which led to you requiring a pacemaker means your body is no longer able to speed up your heart to push the blood when climbing or you are now taking medication (beta blockers) which is slowing down your heart, but either way it has nothing to do with the pacemaker.

[Edit] PS. The pacemaker limit is an upper limit on the rate at which it paces the heart when it detects that you are exercising. It in no way limits the rate at which your own body paces the heart.

 

[JtB]

You need to consider also that cycling presents some pretty complicated technical challenges for a pacemaker. For a runner, the pacemaker can more easily detect how much someone is exerting them-self from the movements / vibrations sensed via an onboard accelerometer, the rate-response feature can then increase the heart-rate accordingly to match the level of exertion. But that's not so easy for a cyclist cycling along a smooth road, and how can the pacemaker tell the difference between cycling along a flat and cycling up a hill? I agree that 140 bpm will not be sufficient when cycling up a steep hill, but similarly I wouldn't want my heart racing at 160 bpm while travelling in a car because the pacemaker mistook the bumpy road for physical exertion. I believe there are some pacemakers which are more optimised than others for cyclists and that's a conversation I'm going to have with my cardiologist later this year when my current pacemaker needs replacing.

 

[Rusty Nails]

The pacemaker can only fill in the missing gaps, it can NOT make the heart beat slower. Either the event which occurred which led to you requiring a pacemaker means your body is no longer able to speed up your heart to push the blood when climbing or you are now taking medication (beta blockers) which is slowing down your heart, but either way it has nothing to do with the pacemaker.

[Edit] PS. The pacemaker limit is an upper limit on the rate at which it paces the heart when it detects that you are exercising. It in no way limits the rate at which your own body paces the heart.

Thanks for the explanation.

I was given the pacemaker because of passing out one day which the cardio people said was probably due to a problem they found where the electrical signal stimulating the heart to beat occasionally missed. They were unable to prove this was the cause of me passing out but felt that the pacemaker was a good extra safety measure to kick in if the heart rate dropped too low. The consultant said I would not notice anything different as a result of having it fitted.

The cardio technician I spoke to said that the upper limit was to stop my heart going over a certain rate, and that this could be causing my symptoms when climbing.

I now have an appointment with them on Wednesday afternoon when they will look at the settings to see if anything can be done to resolve the problem. I will try to make sure I fully understand how this pacemaker works on the heart as I admit my health is something I have been a bit blasé about until now.

 

[FishFright]

In my case the body tries pushing blood to the parts that need it when climbing steep hills i.e. the legs, and, because of the limit, doesn't push the blood/oxygen to the head. Extreme light-headedness and dizziness results.

Before the pacemaker this was never an issue, the heart just coped by beating faster.

I got similar symptoms before I was put on Fostair etc . My heart passed the tests but this is when my COPD was diagnosed.

 

[Rusty Nails]

I got similar symptoms before I was put on Fostair etc . My heart passed the tests but this is when my COPD was diagnosed.

Touch wood, I have no problems with lungs/breathing and some recent scans show no physical problems.

Growing old always brings something new to worry about.

 

[JtB]

Thanks for the explanation.

I was given the pacemaker because of passing out one day which the cardio people said was probably due to a problem they found where the electrical signal stimulating the heart to beat occasionally missed. They were unable to prove this was the cause of me passing out but felt that the pacemaker was a good extra safety measure to kick in if the heart rate dropped too low. The consultant said I would not notice anything different as a result of having it fitted.

The cardio technician I spoke to said that the upper limit was to stop my heart going over a certain rate, and that this could be causing my symptoms when climbing.

I now have an appointment with them on Wednesday afternoon when they will look at the settings to see if anything can be done to resolve the problem. I will try to make sure I fully understand how this pacemaker works on the heart as I admit my health is something I have been a bit blasé about until now.

It seems rather strange to me that you received a pacemaker on the basis of passing out once without a diagnosis. There could be any number of reasons why you might have passed out which might or might not be helped by a pacemaker implant. I would recommend posting on the Pacemaker Club forum I mentioned previously to get yourself a bit more prepared prior to your consultation on Wednesday. There are a few really well informed members on that forum who will be able to advise you on the sorts of questions to ask during your consultation. Good luck and let us know how it goes.

[Edit] PS. In view of your post-pacemaker implant symptoms (dizziness etc.) when hill climbing, it might be worth requesting a Stress Test which is where they put you on a treadmill and measure how your heart rate, blood pressure and breathing respond to exercise.

 

[Rusty Nails]

It seems rather strange to me that you received a pacemaker on the basis of passing out once without a diagnosis. There could be any number of reasons why you might have passed out which might or might not be helped by a pacemaker implant. I would recommend posting on the Pacemaker Club forum I mentioned previously to get yourself a bit more prepared prior to your consultation on Wednesday. There are a few really well informed members on that forum who will be able to advise you on the sorts of questions to ask during your consultation. Good luck and let us know how it goes.

[Edit] PS. In view of your post-pacemaker implant symptoms (dizziness etc.) when hill climbing, it might be worth requesting a Stress Test which is where they put you on a treadmill and measure how your heart rate, blood pressure and breathing respond to exercise.

The passing out led to a fall where I ended up unconscious and with concussion. I was standing in the kitchen ander under no stress at all when it happened. At the hospital and before that in the house with paramedics, tests showed the issue with the missing signals to stimulate the heart. The consultant said that without another fainting episode taking place while my heart was being monitored there was no way to be 100% certain.

I will take your advice on questioning the cardio staff further and also ask about the possibility of a stress test to get more information.

 

[JtB]

Ah, I miss-read your earlier post, I see now that the hospital did observe pauses in your heart rhythm. One of the questions I’d ask therefore is how long these pauses were and how regular.

I’ve just searched for a particular discussion thread I recall seeing on the Pacemaker Club forum and I don’t know how true it is, but apparently pacemakers are generally considered necessary once you start getting pauses lasting about 5 seconds or longer.

I myself had pauses of over 5 seconds and this abnormal rhythm continued for 40 seconds causing me to pass out. This started happening without warning one day every time I fell asleep. This occurred over a dozen times in a 24 hour period frightening the life out of Mrs JtB. She took me several times to A&E but they couldn’t see any issues and so each time they sent me home again. Eventually Mrs JtB gave the A&E unit a piece of her mind and convinced them (begrudgingly) to admit me to their acute assessment unit. It was close to midnight and as soon as I fell asleep they captured everything on their ECG and I was diagnosed with sick sinus syndrome / bradycardia. I subsequently received a pacemaker the following day but not before I’d passed out a further two times.

 

[JtB]

I now have an appointment with them on Wednesday afternoon when they will look at the settings to see if anything can be done to resolve the problem.

How did today’s appointment go?

 

[presta]

She took me several times to A&E but they couldn’t see any issues and so each time they sent me home again. Eventually Mrs JtB gave the A&E unit a piece of her mind and convinced them (begrudgingly) to admit me to their acute assessment unit. It was close to midnight and as soon as I fell asleep they captured everything on their ECG and I was diagnosed with sick sinus syndrome / bradycardia. I subsequently received a pacemaker the following day but not before I’d passed out a further two times.

Once when I was on the Emergency Assessment Unit they brought a guy in during the night. I forget what his heart rate was, about 30-35 I think, and over the next few hours I sat and watched it go down: 30, 28, 25, 22, 20 , nobody did anything, and it carried on: 18, 15 , 14,13,12...

The last I saw was 11, before it stopped altogether, then there was a flurry of activity. When the curtains opened he was sat there looking a lot more chirpy, with a wire sprouting from his neck to a pacemaker stood on the bedside cabinet.

I spent all morning chatting with him, he'd been a Stirling bomber pilot during the war.

 

[Rusty Nails]

How did today’s appointment go?

I explained my issues and they agreed that my pacemaker upper level was possibly set too low and could be causing those issues when the heart was working harder. They have increased the limit to 150 (I don't think they were comfortable with too much of a jump in one go) on the understanding that it will be reviewed at my annual check-up this summer to see if further adjustment is necessary.

They confirmed your comments about the limitations on measurement of the impact of effort on the heart when cycling compared to running. I suggested a stress test might help but they said that that could be considered around the check-up time.

Overall I am quite pleased that they listened to my concerns and are taking steps to improve the situation.

I went for a two hour ride this morning which included a couple of shortish, moderately steep hills and it is difficult to tell whether I was imagining it but it did seem to be a bit less strain than usual on reaching the top. I will not rush it but gradually increase my strength on climbing to see how it goes as I have avoided steep hills for a long time now.