Cardio Visit, new questions . . .

[epstns]

Well, I saw my cardio Thursday for the 3-month visit. As I expected, it was just an office consult and exam. He says the valve sounds "fine" - in other words, just like last time. No new problems. He said we're doing fine with the work-outs and the intensity level is fine. He did ask me not to enter even a 5K run, as he felt it would be too tempting to get competitive and over-run my max heart rate. As much as it hurt to say so, I agreed and will abide by his instructions. He's been right so far, and I trust his judgement. (He is often an attending doc at local events.)

He did, however, note that my BP is on the high side (averages about 140/90) and prescribed a "mild" diuretic to bring it down. He indicated that it would be 5 to 7 days before I even see a change. The diuretic is dyazide, a potassium-sparing combo drug. I have been taking it for 5 days now and so far, no change in BP at all. I have noted, however, that my heart rate is up a little bit in the AM (was 48, now 53), more during the day (now in the 80's or so, was 60's I think) and it has become impossible to keep my heart within the max rate after the mid-point of my run. In other words, my once well controlled heart rate seems to run way up with just the exertion that used to be easy. It is now much more effort to run and I have cut the distance short to avoid over-running my rate. If my BP was down, I might see a connection, but with no change in BP, what would do this to me? Any ideas?

 

[Nancy]

Hi Steve-

Bring the increased heart rate to the attention of your doctor. It could be related to the diuretic and it might not. It might also be related to the blood pressure. But at any rate, it is a change in your body dynamics and these things always mean something, not necessarily terrible things, maybe just adjustment stuff.

Just call the doctor and mentioned that you have noticed this and it is interfering with your ability to exercise the way you want, and ask for suggestions.

That way you get the worry off your back, and onto the back of the one who can do something about it.

Good luck.

 

[Creed3]

Steve,
Hi! I can't really add anything to what Nancy said. What she said is right. I would definately talk to your doc to let him know of any changes. It's probably nothing and you most likely have to have something tweeked a bit, but it is better to get it off your mind.

Take Care!
Gail

 

[ALCapshaw2]

Hello Steve,

I also noticed that my HR would run up with little extra exertion following surgery. This lasted for several months. Just keep an eye on the HR and don't overdo it. It WILL get better in time.

Do you wear a Heart Rate Monitor when exercising? They have become quite inexpensive now ($35-$50 in the sporting good section of Walmart).

'AL' (10 months post op)

 

[Rich]

Steve,
It sounds like a little change in rate there but not real bad.
And your BP seems fine.
It used to be 100+ your age but I guess if someone was one hundred years old that wouldn't be too good.
I'll bet Nancy is right about the drug possibly causing this, did you read up on the possible side effects?
All these great drugs sure help keep us around but some of the side effects sometimes seem worse than the problem theyr'e treating.

 

[epstns]

Hi everyone,

Well, I called my cardio, and I think I may have ticked him off. He wasn't very concerned about the HR increase with exercise, and said that it should take 5 to 7 days for the medication to have an effect. He would not hazard a guess why the rate suddenly became so sensitive, saying that he "does not treat over the phone." He indicated that if I have a serious problem to make an appointment and come in to the office. He suggested that if this med doesn't work well for me, that I should make an appointment with my internist and have her manage my BP (I guess that's beneath his professional dignity, or it is not serious enough). He also said I could try cutting the dose in half for a while to see if that changes anything, but as there has been no change yet in BP, I'm not sure that will accomplish anything.

After this, my wife is convinced he sees me as a cry-baby and one who denies the severity of his condition. I simply see it as if I am newly imprisoned and am testing the limits of my captivity until I know the rules.

I do wear a heart rate monitor while exercising, as that's how I realized that this change occurred.

So at this point, I am going to stay with the medication and watch its impact on me. I am almost due for my annual physical, so if the BP won't behave with this, I will make it a topic of discussion with my internist at that time.

So frustrating. . . probably because it is SO serious to me, but of minimal concern (technically) to the cardio. Now I'm not so sure I have the right guy. . .

 

[ALCapshaw2]

I understand where you are coming from Steve.

I too get this 'why are you bothering me about this trivia' type attitude from my Cardiologist (who has REALLY been there for me when I was having more serious problems).

Even following my surgery when HE was supposed to be my followup man, I couldn't help but feel he classified me as an 'overreactor' in spite of 5 trips to the ER in the first 4 weeks, primarily related to breathing and lung problems which turned out to be caused by bruising of my chest wall from my chest tube. After he prescribed an anti-inflamitory to reduce the swelling and interwall motion when breathing, my difficulties subsided substantially. He finally admitted my recovery was "one standard deviation harder than normal" but still only wanted to see me every 6 MONTHS ! I suspect this group is overworked and possibly trying to do too much, being a regional Heart Center covering a 50 mile radius

 

[Nancy]

Hi Steve-

Kinda sounds as if the man blew you off, doesn't it. All I can tell you is that if it bothers you and it is something that interferes with your exercise, then you will have to seek an answer.

I've been going back and forth with Joe's cardio. concerning his heart rate also. But his is in a quite high range. His is at 112 at rest. His Digoxin level is about MAX, so can't increase that. One of the PAs told me that if the kidneys are too dry, then the heart rate can increase to compensate for it. So they reduced his Lasix, but the heart rate stayed the same, and he started putting on water weight. So we are back to the higher level of Lasix, and I'm monitoring his heart rate for several days to see how it reacts. He sees the cardio on the 21st.

Joe's condition is extremely complicated, though, so it wouldn't be apples to apples with yours.

My point is, I guess, that kidneys, hearts and lungs are very much intertwined.

It's hard to find a delicate balance that makes all the guys happy.

 

[Marty]

Ideal heart rate?

Ideal heart rate?

Steve, the heart rate post open heart valve surgery is normally unstable for months after they have been mucking around in your conduction system. I agree with your cardio that you don't have much of a problem. You have a heart monitor and can gear your rehab for the next few months to your heart rate. You look around 50 yrs old so your HRmax is about 170 I would advise 40 minutes running or walking 3 or 4 days a week with your HR at 80% max about 130-140 bpm for 20 of those 40 minutes. I wouldn't push beyond this for a while. Eventually as you condition ,the heart rate will stablize at a lower level and you will be fine.It will probably have a good effect on your blood pressure too. I have a valve buddy who is about 50 and it took him two years but he now runs the Marine Corps marathon annually.

 

[TIM W.]

I don't really have a lot to add, but since my surgery 3.5 weeks ago, my heart rate stays 44 - 48 no matter what I do. Dipped into the 30's a couple times while in the hospital when sleeping. The nurse came in once, had to wake me up, and asked me if I had sleep apnea! I told her no, to let me sleep, and talk to the Dr. about it. He cut my atenolol in half (100mg to 50mg) and since then I stay 44 - 48 all the time. Seems low to me but the Dr. says it's okay so I don't argue. He knows more about it than I do.

 

[Georgia]

Tim - let's add 'em up & split the difference

Tim - let's add 'em up & split the difference

Gosh Tim - since I had surgery nearly 3 months ago, my heart rate won't go under 100. They've quadrupled my Toprol (from 25 mgs to 100) and my blood pressure is now down to 94/70; but heart rate is STILL 105 at rest (taken 3 times per week at cardiac rehab. Cardio is not happy with it.

I was quite happy to read MATXR's regarding heart rates being rather erratic for a while after surgery. I think the next time they want to increase the beta blocker I'll wake up (har) and mention that to them.

Meanwhile, I have a few extra I can lend you to get your rate up!

 

[epstns]

I see I've started something here -- I'm not alone in either the strange heart rate OR the arrogant cardio! Thank God, otherwise I would think I was crazy, too.

Marty - I should clarify my situation. I am still pre-surg, with moderate to severe aortic stenosis. I'm trying to maintain my "normal" lifestyle until it changes for me, or the echo's tell us to go onward.

At the moment I've decided to stay with the original prescription for at least a week or two to see if the med actually affects BP. After 4 days, no dice. Doc said it would take 5 to 7 days to notice an effect, so who knows. . .

The one comforting thing so far is that today I felt much more like my normal self. I think I may have been fighting some low-grade virus or other bug, becuase my daughter has been complaining of similar stuff (headache, flushed, feels like low fever, tired, etc.) for the last day or so -- so that may be it.

Today I hit the gym for a "light" work-out. I ran a reduced distance at a slower pace and all went very well. My heart rate again was within acceptable limits. If I still feel this well tomorrow I may pick it up a little more. I also think I may have been a bit dehydrated, so I've been drinking a lot more water the last couple of days. Cardio gave no instructions on behavior changes (water, foods, etc.) or on possible side effects, so I'm running blind here.

Anyhow, at least things are back to no worse than before, and I don't have to confront the beast until Mid-July echo. Keeping all my fingers and toes crossed.

 

[Marty]

Sorry,Steve!

Sorry,Steve!

Sorry, Steve......I thought you were post op. Pre op with moderate to severe aortic stenosis, I would take it easy. Once you get fixed up you can deal with cardiac rehab.

 

[epstns]

Marty, I hear your caution, but I HAVE backed off quite a bit!

I used to run 3 or 4 miles at 7:30/mile, 7 days a week. I have cut down to the same 3 or 4 miles at 9:00 to 9:30/mile, and only 5 days a week. My cardiologist is OK with the exercise and my target max heart rate of around 150. We're just trying to get BP down a bit. So far I've been taking the diuretic for almost a week and no change. Anybody know if these things usually have a delayed reaction?

 

[mamsram]

Steve

This may not help, but I have a recent history of blood pressure problems.

On the day of my physical, when my Dr. heard my murmer and sent me on numerous follow-ups, I had readings of 160/80 range.
sensing it may be white-coat anxiety, he had me drop in just for quick checks about 8 times, then he prescribed 25 mg. of toprol.
This med dropped my pulse rate from mid 60's to low 50's. My readings were now swinging anywhere from 120's to 150's. (bottom # always seems to be under 90 ). he then added that inexpensive drug recently hailed as good for blood pressure and cheap.---- 25mg. of hydrochlorothiazide.

I couldnt get over the change in readings. (I bought a home b.p. unit) After rising, b.p. is around 110/60 and thru the day is around 120's AND my pulse rate picked up so that it is back into the mid 60 range. ( of course this is resting pulse)

This new med has put me at a point I consider perfect.

Thats my history Oh yeah, I have severe aortic stenosis no symptoms and no other health problems.

I just feel like THE SWORD OF DEMOLICLESE is hanging over my head. I'm sure thats not the correct spelling

 

[Nancy]

Hi Steve-

Along with your diuretic, maybe try to lower your sodium intake to allow the diuretic to work better.

I was on Diazide quite a while ago, for about 20 years for blood pressure. The diuretic effect should kick in fast. But it may take a little while to eliminate enough fluid from your system to show up in the BP. It is a mild diuretic. With something like Lasix, the effect would probably be more immediate.

 

[epstns]

Ram and Nancy - I think you're both on target. Ram, the dyazide I'm taking is a combination of triamterene and hydrochlorothiazide -- probably similar to your prescription. Doc said it was a mild diuretic and that it wouldn't show any BP effect for 5 to 7 days. Nancy is probably right on that part -- I just found an article on the web that indicates that the full BP effect may not be felt for several weeks!

So, I guess my current plan stays in place -- I will stay on the stuff for a couple or three weeks and watch the impact on BP. If good, no issue. If no help, I can make an appointment with my internist and refer the BP management to her.

Ram - wish I had your BP stats. Mine has always been in the range of 13X/8X, but recently has risen to the low 140's over 90-something. We're trying to get the diastolic (lower number) down into the 80's. Cardio doesn't want to go too far, as he says that would increase the risk of dizziness or syncope due to the valve.

If it all fits together, I'll be fine for a while yet -- I hope.

 

[Nancy]

Just hang loose, Steve. It'll all work itself out. You are not too far out of line, just enough to be annoying, but it doesn't sound like enough to be dangerous.

Everything is so slow for a triple type A guy, right? I'm married to one. Absolutely no patience, wants everything done yesterday. If he has anyone quote on a job, he always asks if they can start tomorrow. LOL