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Dr. Andrew Rynne

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What causes heart rate monitor to reflect a reading of 130bpm while running?

Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 5760 Questions

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Posted on Thu, 26 Apr 2018 in Hypertension and Heart Disease
Question: Early in August 2017, I had a pacemaker implanted at the University of Ottawa Heart Institute because I had some blockage of the electrical signal and, therefore, I had episodes of very slow heart rates. The report on my first evaluation of the pacemaker showed that my lower heart rate was set at 60bpm. The upper rate was set at 130bpm. It is the latter that I do not understand. When I run with a heat rate monitor, 80% of my run is in the upper 130bpm and 140bpm ranges. If my upper limit has been set at 130bpm how to you reconcile the readings that I am getting while running.

On another note, I have loss close to 8lbs since I had the pacemaker implanted. Just coincidence?

doctor
Answered by Dr. Ilir Sharka 21 minutes later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your concern and would like to explain that as your pacemaker has a range of heart rate with minimal and maximal limits, it means that it is a rate-adaptive pacemaker.

So, according to your body requirement (whether resting, cycling, running, sleeping, etc.), your pacemaker may fire electrical impulses at different rates per minute.

As a rule, according to your daily activity needs, your pacemaker is set to generate impulses up to 130 bpm, but from the other side, your pacemaker does not impede your natural heart activity, if it generates impulses above 130. In such case, the pacemaker sensor system keeps monitoring the situation and set the pacemaker in resting condition.

Another explanation of the discrepancy between your monitor reading and pacemaker settings may be that the monitor used may show erroneously higher heart rates than it is in realty.

In such case you just have to check the heart rate manually with your arterial pulse.

Hope to have been helpful to you!

In case of any further questions, feel free to ask me again.

Kind regards,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 18 hours later
Does that mean that the pacemaker is on all the time up to the 130bpm?
doctor
Answered by Dr. Ilir Sharka 4 hours later
Brief Answer:
Opinion as follows:

Detailed Answer:
Hello again!

As your pacemaker is rate-adaptive, it does not fire electrical impulses at a fix rate per minute.

It changes according to your body requirements, and this is properly accomplished by the pacemaker sensor, leading the pacemaker rate to be flexible between the set ranges (60 – 130 bpm).

When you perform any physical activity, your heart work will increase by speeding up your heart rate. If the heart fails to increase the heart rate as needed, the pacemaker will do that, but the resulting pacemaker rate will not increase above 130 beats/minute.

So, if your heart rate is correctly registered and results above the maximal pacemaker predefined limit, then it means that these higher frequencies are generated by the specialized heart system and not the pacemaker.

In conclusion, your rate adaptive pacemaker is set to closely monitor your heart activity.

If the heart manages to maintain a heart rate above 60 bpm and the rate is increased even more according to the body activity level, the pacemaker will just sense the situation and will not interfere by delivering any stimulating electrical impulse to the cardiac muscle.

Only if the intrinsic heart rate fails to couple with the increasing physical activity, the pacemaker will take the command and deliver electrical impulses.

This is the explanation.

Hope to have clarified your uncertainties!

Please. Let me know if you have any further questions.

Regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 1 hour later
Thank you for the clarification. Too bad you can not be my cardiologist.

Sincerely,

xxxx xxxxxxxxx
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
You are welcome!

Detailed Answer:
I am glad to have been helpful to you!

I remain at your disposal for any further discussions about health issues in the future!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 15 days later
A pacemaker was implanted on the basis of an abnormally slow heartbeat. The lower rate of the pacemaker was set at 60bpm. Why have an upper limit (currently set at 130bpm)? My problem was not a fast heart rate.

Why is it so hard for me to run since the implantation of the pacemaker? Used to cruise in the 125 to 130bpm range. After several hours following a hard run in the upper 130bpm to 140bpm, I now get long episodes of non-dangerous extra beats/palpitations. I have had this condition for many years but it has been under control with medication (Metoprolol). My GP amended my meds, i.e. increased the Metoprolol from 25 mgs daily to 50 mgs daily. It helped a bit. I ran yesterday a 4 miler and it took me 46 minutes; a distance that prior to the implantation of the pacemaker would take me 36 to 40 minutes. My surgeon told me that I would be able to return to my normal exercise regime but it
does not appear so.

I have discussed this situation with the Pacemaker Clinic staff during my recent appointment, however, they were not impressed. Advised that I should follow up with my GP with regards to heart function tests, which I already had prior to the pacemaker implantation. They did change my ADL rate from 75 to 105bpm. What does this mean? I did ask them to increase my upper limit from 130 to 160bpm but was turn down. They told me that it could cause damage to my heart. I am so confused.

xxxx

PS: My GP is setting up an appointment with the surgeon.


Modes and rates
Mode DDD
Lower Rate: 60bpm
Upper Rate: 130bpm
Upper Sensor:130bpm
ADL Rate: 105bpm
Hysteresis DISAB
Sleep Rate Blank bpm

Automatic Mode Switch
Detection: 171bpm
doctor
Answered by Dr. Ilir Sharka 5 hours later
Brief Answer:
I would explain:

Detailed Answer:
Dear xxxx!

I know that it may be concerning when the daily physical performance should be at the upper levels.

But you should know that besides an appropriate cardiac output a satisfactory physical endurance is first a matter of body muscle conditioning and metabolism.

Your heart rate is not pacemaker dependent during physical exertion as concluded by the medical report and this is a good news.

So your increased heart rate (above 130 bpm) area result of your heart activity and not the pacemaker. This means that your heart doesn't need a pacemaker support all the time (especially during physical activity).

May be, only an intermittent slow heart rate (due to excessive bradycardia or heart block) has led to the decision of permanent pacemaker implantation.

It is because you are a tough runner that your doctor has switched to a higher level of ADL (Activities of Daily Living) rate, which is the average target rate the patient achieves for moderate activities.

I believe that the real cause why your actual physical capacity may not result in the usual levels could be explained also by the actual cardiopulmonary performance.

In this regard it is necessary to review your cardiac ultrasound data (investigate for possible structural cardiac damages like myocardial, valves, etc. disorders) and also to perform a cardiopulmonary stress test (for exploring the interplay between your heart and lungs).

This could give a more rational conclusion.

In conclusion, I would like to explain you that the less your heart is pacemaker dependent, the better is.

Hoping you are having a pleasant weekend!

Best regards,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 17 hours later
Last question:

I had an iatrogenic left-sided pneumothorax associated the insertion of the pacemaker for which conservative therapy was pursued with subsequent resolution. My last chest x-ray was negative. However, could this be the underlining issue?

Thank you.

doctor
Answered by Dr. Ilir Sharka 4 hours later
Brief Answer:
Opinion as follows:

Detailed Answer:
Hello!

I don't believe that such a trivial pneumothorax could produce adverse effects on your physical capacity, because it is not possible that such a few amount of air entering the pleura space could affect the respiratory function.

Furthermore, it has nothing to do with your predefined pacemaker settings.

So, my answer is definitely No! This could not be the underlying issue.

Hope to have clarified your uncertainties!

I remain at your disposal for any further discussions in the future.

Best regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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