Post Op Exercise Stress Test: Good and Bad

[johnp]

The big day finally arrived, my first exercise stress test following MV repair surgery on Dec 27. This test was actually my 3rd workout post op. I did some stairs about 2 weeks ago, and ran/walked 3 miles last Staurday.

So they hooked me up to a thousand wires and got the treadmill rolling. It was quite some time before I got even the least bit tired, at least 4 or more levels, as my heart rate finally approached 120. But I felt fine and had no problem keeping a conversation with the attending Dr and Nurses. We went for quite a bit more, not sure how many levels but it became difficult to walk that fast. I wanted to run, but they said not to run because it disturbes the EKG. I finally called it quits around 160 beats per minute, but joked that I could do another level or two if there was money riding on it.

Now the bad news. I had quite a number of PVCs and couplets as my heart rate went through the 110-120 range. My heart got quite regular again above 130 to 160 bpm. But during recovery I had 2 or 3 instances of 3 PVCs in a row, after the exercise part of test was stopped. Thats a bad thing, especially with my history of dangerous VT that I had pre-op (thought to be caused by worsening MVP)

The Dr said I was one of the fittest people she had seen on that treadmill - and unheard of for someone less than 2 months post mitral valve surgery to be able to go that far. But I do wonder if the PVCs might prevent my Electrophysiologist from blessing my taking part in any strenuous exercise, ever.

I am going through a few scenarios in my head, wonderig if I can realistically give up exercise for good, if it comes to that. I won't talk to my doctor until next week, but I know he is going to have reservations.

 

[Bean Counter]

There is another member (nate c) that had some problems with PVCs when he started to get back into running. I believe that they put him on Beta Blockers for a short time, but he is good now. Hopefully he will chime in.

 

[JeffM]

It may be a temporary thing. It hasn't been long since your surgery. The heart remodels for at least a year following surgery. I'm curious to hear what your doc says about the PVCs. No VT during the test though?

 

[johnp]

3 PVCs in a row is technically considered non sustained VT. I had 2 or 3 runs of 3 in a row after my stress test. Sounds arbitrary, but this is how the classification is made. This becomes an indicator for potential serious VT problems.

I think there is compelling evidence that my MVP created a situation for dangerous VT/VF in the first place.

But what is not clear at all is what happens during remodeling.

 

[tobagotwo]

Your heart can remodel for as much as a year, although as well-exercised a heart as yours may take considerably less time. During that time, your left ventricle shrinks and your heart's shape changes. The timing of your electrical pulses will change as the mass of heart muscle tissue changes, and parts of the impulse may now be travelling over scar tissue, which may take some time to sort out. In short, your rhythm has a lot of reasons to be off right now. Your blood pressure may vary widely during this time as well. Most of these effects are temporary, often quite short-lived in nature.

But your heart rhythm system will work to balance itself again as it goes along.

There is also a tendency for the heart to go into a good rhythm when stimulated externally by a regular physical rhythm, such as walking, running, or jogging. Even some music can have a similar effect.

If you have a concerning arrhytmia that shows up, you may need to modify the level of your exercise for a while (eight weeks isn't very long after surgery: the heart's physical wound is healed, but that's only part of what happens during its recovery). No point in tempting fate to get a month ahead in your exercise. But you should be able to do longer, but more moderate exercising, with your doctor's blessing in the meantime. Totally pointless to try to make judgements about your future capabilities at this early juncture.

It may be necessary for you to monitor your arrhythmia, but generally, watching your heart too closely after OHS will make you crazy. It does a lot of things you'd rather not know about before it's completely back in business with you and running smoothly again. I had couplets, triplets, I had (and still sometimes have) long pauses, AFib, and PACs/PVCs. I actually found the pauses kind of humorous, in a keep-it-to-myself kind of way.

Your post-op chickens aren't ready to hatch, so please don't count them yet. You have a ways to go yet, and I imagine much better news to hear later in your recovery.

Best wishes,

 

[camgough]

I am about 8 months post op and since my valve-sparing aortic root replacemt surgery I have had a couple bouts of high heart rate. I went to the Emerg and they caught it on the ECG and said it was SVT. Generally not dangerous, but annoying. I did a Holter Test last week and am waiting for the results. The ER doc thought it could be from scar tissue creating extra electrical paths in the heart. I also have a pacemaker, and am not sure what influence this might have. You seem do be doing well so far, keep it up AND be patient! I overdid it early on and am finding that slower is better for recovery.

 

[ALCapshaw2]

Arrhythmias are Very Common following OHS and may come and go for several months.

It is not uncommon for your Heart Rate to be stable during exercise but to go into an arrhythmia as you 'cool down'.

If you don't have a stethoscope, I highly encourage you get one (an inexpensive model is 'good enough' to listen to your heartbeat).

'AL Capshaw'

 

[johnp]

ok, just got the green light to do some cardic rehab, despite the stress test. They want me to do a few sessions on my current meds, and then increase the beta blocker to see how this impacts the PVCs and my stamina. More to come...

 

[Mentu]

John, one of the positive aspects of Cardiac Rehab is that you end up, typically, with 12 weeks of monitored exercise. That's a lot more data than one test on one afternoon is ever likely to provide. As you have mentioned, the weeks of rehab are a good time to try altering medication since you will be able to see the effects as the days pass. And, John, like the other's have said, your heart is going to be changing throughout these next months. Almost certainly, what you see today will not be what you see as your heart continues to adjust to its new situation. After all, it has been awhile since it had a good valve. Let us know how things are going, John.

Larry

 

[spartangator]

All the best in rehab. Keep your head up. The above comments are right: things are going to change over the next few months so one test doesn't necessarily indicate the future.

 

[nate_c]

There is another member (nate c) that had some problems with PVCs when he started to get back into running. I believe that they put him on Beta Blockers for a short time, but he is good now. Hopefully he will chime in.

Just noticed the post. I did have PVCs, couplets, triplets, etc., following surgery for several weeks. They came on suddenly a few weeks post op, along with a couple episodes of afib. Seemed to happen every night for a couple hours, like clockwork... My heart rate would go all funny... Sometimes more PVCs than regular beats. Very annoying and sort of disturbing. Like you, I also got them whenever my HR elevated. For me, 140 - 150+ seemed to be the trouble zone. I was on beta blockers for a while but not sure it did any good. The good news for me was that they just stopped, very suddenly, one day. I'm now running pretty much every day, putting in about 50 a week, and no rhythm trouble at all. Hopefully it's just a temporary thing for you too. Good luck!

(By the way, one of the explanations i got for rhythm trouble post-op was that scar tissue formation and nerve damage can cause "short circuits" in the normal electrical impulses going to the heart. It takes a while (weeks) for the nerves to start to regrow and reroute, and then things get back to normal. Seems at least plausible in my case.)

 

[johnp]

Update- Things are moving along nicely, but the recovery is a slow process.

Its been said that re-starting exercise after valve surgery is like going back to your first run. I would agree, but in my case, it might even be more challenging.

On a good day, I can now run almost 5 miles without stopping. But my pace is no better than 10 or 11 minute miles. Its not really bothersome, I have the rest of my life to improve, but its almost comical.

Last Saturday a woman passed me pushing one of those Baby Strollers for runners. What the? I remember having both kids in the double and being able to do 8-10 miles and never slower than a 9:15 minute mile. But this past Saturday my Garmin was telling me I was doing a 10:30 to an 11 minute mile.

This is a whole new experience running through a surgery recovery!

 

[epstns]

Well, all of you are giving me some hope, too - no matter how convoluted the path to recovery becomes. I'm just two weeks post op, so no exercixe yet, but I do have ll of the rhythm issues mentioned before, along with a shiny new pacemaker. I went from 7:30 miles a few years ago to 10 and eventually 15 minute miles as my valve got worse. Now to hear that even with the rhythm issues there is a path back to some level of exercise and ability just makes my day! At my age (63), I won't worry about attaining elite capabilities, but I do look forward to getting back out there and just enjoying my new heart.

 

[tprice54]

We came up with the phase POPR for post op personal record, because we really should not be comparing times pre op to post op, because we tend to forget how bad it was right before surgery, but we can remember our 7:30 miles from years ago!

 

[johnp]

We came up with the phase POPR for post op personal record, because we really should not be comparing times pre op to post op, because we tend to forget how bad it was right before surgery, but we can remember our 7:30 miles from years ago!

We should not, but we do!

I often wonder how much of the new-found slowness is physical versus how much is in my head. Like a few days ago, I was running along for about a mile, and then I said to myself "you've been running for almost a mile are you tired yet?" Then I started to feel tired and slowed down. And these days if I do feel tired, I am quite ok to stop for a few seconds. The end game is the same, I get my workout and feel better the rest of the day.

 

[johnp]

An update here...

I am now able to run 5+ miles no prob, though my pace is slow. My pace and distances seem very similar to the Nate posts. I have a very nice Garmin 310XT something or other. But I try not to get too hung up on the stats.

I do my cardiac rehab. They really push me. They put me on the machines and crank up the levels.

PVCs now way down from my stress test days, but I have some on and off days. Trends of PVCs is clearly down.

Was thinking of signing up for a half marathon or a triathlon, but doubt I will. No rush. Just enjoying the runs, and I'll walk a little if I feel, if nobody's watching

 

[Bill B]

Update- Things are moving along nicely, but the recovery is a slow process.

Its been said that re-starting exercise after valve surgery is like going back to your first run. I would agree, but in my case, it might even be more challenging.

On a good day, I can now run almost 5 miles without stopping. But my pace is no better than 10 or 11 minute miles. Its not really bothersome, I have the rest of my life to improve, but its almost comical.

Last Saturday a woman passed me pushing one of those Baby Strollers for runners. What the? I remember having both kids in the double and being able to do 8-10 miles and never slower than a 9:15 minute mile. But this past Saturday my Garmin was telling me I was doing a 10:30 to an 11 minute mile.

This is a whole new experience running through a surgery recovery!

I used to be a VERY fast long-distance runner. BUT after I got home from my valve surgery I couldn't jog 10 feet. I improved rapidly but I started from a rather debilitated state. I actually didn't expect that. I figured once the terrible outflow restriction was removed, I would be good as new if not better, but that was not the case. My ejection fraction was LOWER, not higher. The operation beat the crap out of me even though it went very well and I felt good. I just had no exercise capacity. I could walk briskly for miles, but put any load on and I was dead. Although progress was rapid in rehab I still have long way to go. It's hard work. My heart is still feeling the effects of the stenosis and perhaps the operation. I still have mitral regurg, poor diastolic relaxation and high blood pressure. I'm hoping the remodeling is not done even though it's been almost 1.5 years.

 

[johnp]

So I ran my longest distance yet on Saturday. 6 miles. I will admit, it was a bit of a challenge.
Then Saturday night, over a few beers, my buddy talked me into doing a 5k the next morning. The wives agreed to walk it.
I turned in a blazingly fast time of 33 minutes. lol I walked a couple of times. This was the first time I ever walked in a race, ever.
The last time I ran this race I did it in under 25 minutes. And that was a few weeks after cardiac arrest and an ICD shock. I had a few scary short runs of vtach during that race. I could have gone much faster.
But 33 minutes and no heart issues (max HR 138) is a better place, no doubt about it.

 

[tprice54]

JOhn, your recovery sounds so much like mine! Just keep at it, keep a good attitude about the running...