Heart Rates: Why are they important to know?

 There are many things that can affect the heart rate and are important to consider if you are a heart patient. Heart rate vary as the body’s need to absorb oxygen and excrete carbon dioxide changes, such as during, exercise or physical activity, sleep or illness. The normal human heart rate is between 60-80 beats per minute at rest.

 

Slow Heart rates

Exercise implications of a low heart rate can indicate a problem when the heart rate does not increase sufficiently with exertion, creating increased fatigue, shortness of breath, exercise intolerance, or EKG changes.  It is important  for heart patients to observe how the heart rate responds to exercise. Does it increase and by how much? 

Medications known as beta blockers frequently lower resting heart rates to upper 40-60 range. That isn’t always considered a problem. If there are no symptoms of compromise such as shortness of breath, chest discomfort, fainting, overwhelming fatigue or cognitive changes and the treatment is tolerated, there is not usually concern. When the rates start to get into the low 40’s there is  more concern. When you sleep the heart rate usually drops another 10 beats per minute, and heart rates in the 30’s are not able to adequately get enough circulating oxygen in the bloodstream to nourish the organs. You might not notice it thus might be found in sleep studies, or if on remote monitoring with holter monitor studies.

If you are on beta blockers the the heart rates are quiet a bit lower than traditional heart rate posters. Many people  on beta blockers have a very blunted heart rate response to activity. On beta blockers your heart rate ranges are usually set 10-20 points lower than the traditional age predicted heart rate ranges or are often prescribed at 50 -70% of age predicted values (see chart below). This doesn’t mean you don’t get the benefits from exercise. The benefits are not directly linked to the heart rates. Exercise conditions the muscles to be efficient at utilizing the oxygenated blood and  thus takes demand off the heart to work harder to provide the blood flow to the working muscle. So the heart doesn’t have to pump as fast.  Think of the muscles as a secondary pump that extracts the oxygen and pushes the blood back to the lungs for re oxygenation.

Commonly prescribed Beta Blockers are usedd to treat the following conditions

  • HTN  is Hyperension
  • Angina =Chest Discomfort
  • Arrhy=arrhythmia or irregular heart rhythm
  • MI = Myocardial Infarction meaning heart attack
  • CHF = Congestive Heart Failure – Shortness of breath and fluid retention in abdomen, legs, weakness of the heart, low ejection fraction

  • Acebutolol -Sectral
  • Atenolol – Tenormin
  • Betaxolol – Kerlone
  • Bisoprolol – Zebeta, also sold as Ziac
  • Carteolol -Cartrol
  • Carvedilol -Coreg
  • Labetalol – Normodyne, also sold as Trandate
  • Metoprolol – Lopressor, also sold as Toprol
  • Nadolol – Corgard
  • Penbutolol – Levatol
  • Propranolol – Inderal, Inderal LA
  • Timolol – Blocadren

This is a question for you and your healthcare professional. What should my target heart rate range be at given my being on beta blockers? It is up to you to determine how you will measure and track your rates. Here are some methods and tools to monitor. 

 The Beltless Heart Rate Monitor

 

To monitor the heart rate you should  measure the rate for 60 second to determine the rate. It is also useful to note if it is regular. Fitness plays a role here. The more fit you are the lower the resting heart rate. If the heart is efficient and the muscle are strong there is less demand for the heart to go faster to meet the supply and demand of the muscles. Most symptoms of this are shortness of breath, fatigue, exercise intolerance. Then exercise is progressed more on tolerance than by the goal of getting the heart rate elevated to a higher percentage but a rate between 50 and 85% of age predicted target heart rate range.

Exercise  elevates the heart rate. How high is too high?

Most frequently the Karvonen target heart rate is method to determine the age adjusted threshold which is 220  – minus age = Maximal Heart Rate range at which one should not try to achieve when exercising a heart that has had  cardiovascular health issues. A percentage between these ranges is often prescribed by your healthcare practitioner. It is a range!!!! Not an I have to hit the top of this to benefit my heart range. The goal is to be somewhere in that range, we all have good days and bad especially when struggling with heart issues.

If you are in the low end of the range that is just as good as the upper end when it comes to exercise, and there are times when the upper range is too high and it is better to be in the lower range. Again there is an art versus  science of target heart rate ranges the best advise is  be active at a level for which you are  free of symptoms, yet the effort feels fairly light to somewhat hard and does not feel physically hard to perform for several minutes.

Some heart patients  may find a fast resting heart rate if medications are off, or if complications are developing such as the heart rhythm abnormalities or changes.  If the rate is faster than normal and in the recommended exercise levels when resting do not exercise instead contact your healthcare provider ASAP. 

Wall motion, blood pressure, heart rhythm, exercise intolerance, pacemaker or ICD programming must be discussed to really understand the extent of your target heart rates for exercise. Because of such complexity, initially starting to increase activity on a regular basis that elevates the heart rates some and remaining free of symptoms, being able to talk while exercising is an important assessment tool of how well one is tolerating exercise. Make sure to include this discussion at your cardiology or primary care appointment. Discuss safe heart rate ranges for activity, and how your medications and heart condition will influence it. What are your medical concerns?  Heart patients are not instructed to exercise at age predicted maximum heart rate ranges.

Below  is a standard chart your healthcare staff  uses to prescribes a ranges for safe activity. For heart patients there may be ranges where there are ischemic changes meaning there is a change in the EKG noted while in  Cardiac Rehabilitation or with stress testing. Theoretically one could monitor their own  for issues through use of the new Ipod apps for heart rhythm monitoring, or small handheld electronic devices like those shown above. Most exercise is initially prescribed light following a heart issue and gradually increased to meet daily living needs including work, physical, and activity/exercise needs.

Age

Maximum HR

50 percent

75 percent

85 percent

20

200

100

150

170

25

195

98

146

166

30

190

95

142

161

35

185

93

138

157

40

180

90

135

153

45

175

88

131

149

50

170

85

127

144

55

165

83

123

140

60

160

80

120

136

65

155

78

116

132

70

150

75

113

127

75

145

72

108

123

80

140

70

104

119

85

135

68

101

115

If you have cardiovascular issues such as  angina, poor heart wall motion due to the injury to the heart  from a heart attack or cardiomopathy, inadequate blood pressure responses, EKG electrical changes, then the target heart rate ranges are established by your physician to a safe level. This target heart rate range is your individual level based on your medications, your heart issues, and your fitness goals.

Most rehabilitation of the heart is done in lighter zones initially, then progresses gradually too higher heart rates to meet daily living needs including work, physical, and activity/exercise needs. Many are able to do high levels of physical exertion when trained including returning to jogging, cross country skiing, or strenuous job requirements. Rehabilitation programs are beginning to work select patients to higher target heart rate ranges with interval training. Sometimes the art of exercise prescription outweighs the science of it when balancing a complex medical history of cardiovascular disease.

 

 

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Vitamin K and Coumadin

A common concern many heart patients first share is their diet concern following a cardiac event. Blood thinners are very commonly prescribed for heart conditions such as atrial fibrillation, or post valve replacements. Many are told to be careful about leafy green vegetables. What the heck does be careful mean? Many take it to mean they can’t eat green vegetables, but then question how they are to eat a healthy diet. This is a very common misconception. It is important to get vitamin K in the diet, and the goal if taking coumadin/warfarin is to get the approximate same intake each day. This is very difficult to do, thus INR levels are fluctuate greatly and this creates health issues if not closely monitored. Most doctors aim to keep INR around 2.5-3.5.

Vitamin K can help prevent Cardio Vascular Disease. Good sources from cabbage, cauliflower, spinach, and other green leafy veg.

http://www.cc.nih.gov/ccc/patient_education/drug_nutrient/coumadin1.pdf

Important Drug and Food Information

From the National Institutes of Health Clinical Center
Drug-Nutrient Interaction Task Force

Important information to know when you are taking: Warfarin (Coumadin) and Vitamin K

The food you eat can affect how your medicine works. It is important to learn about
possible drug-nutrient interactions for any medicines you take.

Why was warfarin (Coumadin) prescribed for you?
Warfarin (Coumadin) is a medicine prescribed for people at increased risk of forming
blood clots. Sometimes medical conditions can make blood clot too easily and quickly.
This could cause serious health problems because clots can block the flow of blood to
the heart or brain. Warfarin (Coumadin) can prevent harmful blood clots from forming.

How does warfarin work?
Blood clots are formed through a series of chemical reactions in your body. Vitamin K is
essential for those reactions. Warfarin (Coumadin) works by decreasing the activity of
vitamin K; lengthening the time it takes for a clot to form.
International Normalized Ratio (INR) and Prothrombin Time (PT) are laboratory test
values obtained from measurements of the time it takes blood to clot. Individuals at
risk for developing blood clots take warfarin (Coumadin) to lengthen the usual time it
takes for a clot to form, resulting in a prolonged INR/PT. Doctors usually measure the
INR/PT every month in patients taking warfarin (Coumadin) to make sure it stays in the
desired range.

What can help keep INR/PT in the desired range?
To help warfarin (Coumadin) work effectively, it is important to keep your vitamin K
intake as consistent as possible. Sudden increases in vitamin K intake may decrease
the effect of warfarin (Coumadin). On the other hand, greatly lowering your vitamin K
intake could increase the effect of warfarin (Coumadin).
To keep INR/PT stable and within the recommended range, it is important to:
• Take your medicine exactly as your doctor directed.
• Have your INR/PT checked regularly.
• Keep your vitamin K intake consistent from day to day.

How do I keep my vitamin K intake consistent?
Keep your intake of foods rich in vitamin K about the same each day. For
example, you may plan to eat only ½ cup of these foods per day. If you like
these foods and eat them often, you can eat more, but be consistent. 

  • Eat no more than 1 serving of food that contains 200%-600% DV of vitamin K
  • Eat no more than 3 servings of foods that contain 60-200% DV of vitamin K
  • Eliminate alcohol if you can, or limit yourself to no more than 3 drinks a day
  • Take no more than 800IU of vitamin E supplements
  • Avoid cranberries and cranberry juice as they can raise INR and risk of bleeding
  • Limit or avoid grapefruit and grapefruit juice
  • Work with your doctor when taking CoQ10 as it can hamper the effectiveness of Warfarin
  • Many natural supplements affect PT/INR levels, so it is best to avoid them unless your doctor advises otherwise. The following supplements definitely affect PT/INR levels: arnica, bilberry, butchers broom, cat’s claw, dong quai, feverfew, forskolin, garlic, ginger, gingko, horse chestnut, insositol hexaphosphate, licorice, melilot(sweet clover), pau d’arco, red clover, St. John’s wort, sweet woodruff, turmeric, willow bark, and wheat grass.
  • To find foods low in vitamin K, see the article on low vitamin K foods, check the nutrition facts for a particular food, or use the nutrient ranking tool to find low vitamin K foods in a particular food group.

Source: http://ods.od.nih.gov/pubs/factsheets/coumadin1.pdf

What are my chances of getting Heart Disease?

What Are My Chances of Getting Heart Disease Infographic

The Multiplier Effect

  • 1 risk factor doubles your risk
  • 2 risk factors quadruple your risk
  • 3 or more risk factors can increase your risk more than tenfold
By doing just 4 things – eating right, being physically active, not smoking, and keeping a healthy weight – you can lower your risk of heart disease by as much as 82 percent

Making a difference

Today I gave a talk to the Senior Center on Women and Heart Disease. I arrived a little early to get set up, review my material, put out my handouts. The crowd slowly filtered in. I recognized several faces of patients I had worked with in Cardiac Rehabilitation over the years. I strolled over to a couple and said hello, took a few minutes to chat on their health since I last saw them.

As I began to do my lecture, I quickly realized I would need to adapt my materials to the audience. These were very elderly folks. Talking about lifestyle and prevention of heart disease wasn’t going to be the same watch your dietary fats, stop smoking, moderate exercise talk I have frequently given. This talk needed to be more specific to the elderly. OK I decided I would focus on causes of heart problems,  blood pressure, sodium, signs and symptoms, emergency action.

Surveying the crowd, I could see severe Osteo and Rheumatoid Arthritis, in a few in the crowd. I spoke to the non traditional causes of heart disease, including Rheumatoid and Lupus. I discussed the importance of keeping moving, engaging the muscles to help the heart. This hit home to many. How to stay active in an aged body with worn out joints. Sit and be fit, using your body as a gym, hidden forms of exercise, stairs instead of elevator, walk a little further from parking space, walk around grocery store before shopping.

Then I started discussing other causes of heart problems with the elderly including anemia. There was one lady in the crowd who I knew I worked with in the past but didn’t get a chance to say hello to before the talk. When I started in on  anemia and how it contributes to heart problems she quickly began nodding her head, tapping her friend on the hand, and whispering. After the talk she told me how I saved her life. She had been coming to cardiac rehabilitation but wasn’t progressing, was fatigued and didn’t want to exercise. On the day she was referring to she came in visibly short of breath, pale and not feeling. A quick review of her vital signs showed her breathing rate was elevated, her blood pressure a bit low, lung sounds were normal, EKG was normal. I wouldn’t let her leave and go home, nope something wasn’t right. I called the doctor who felt she was just old and not progressing. I wasn’t satisfied with that response, so contacted her primary care provider and told him I must follow my gut. I had worked with many and could tell the difference between someone who just didn’t want to work at getting better versus having a true problem, and I knew in my gut something was wrong. I pleaded to at least get her in to his office that day for a blood work up. Low and behold she had a GI bleed going on  and her blood counts were bottoming out. Her hemoglobin was 4. We traditionally intervene with blood transfusions when it falls to seven. It was a miracle this lady was able to walk in the door and complain that she didn’t feel up to exercising. She hugged me over and over today, thanking me for saving her.

Advocating for the patient, following my gut, preventing further health issues from escalating. This is what the Cardiac Rehabilitation staff does daily. The rewards of providing patient care are not necessarily immediate gratification, but sometimes many years later, coming back to you when least expected. Today was one of those days, and I left that talk feeling satisfied in so many ways, not only was it a great lecture and discussion with lots of engagement from the group, but extra special due to the hugs of a woman who’s life I had made a difference in. 

Happy Cardiac Rehabilitation Week Everyone!

Cardiac Rehabilitation Week Continue…Patient Gratitude

Cardiac Rehabilitation Week  Feb 10-16

Reflections from a heart patient  “My ReBirthday”

Today is my eighth rebirthday. Something that most people who have suffered heart failure never get to experience. Eight years ago I was dying, a little bit more every day and my family could only sit and watch. Then late one afternoon I went into surgery and they implanted my pacemaker/defibrillator. I slept most of that evening and night and when I woke up the next morning, I felt alive. I walked the halls, I took a shower and went home. I didn’t have to hold the railing to get up the steps, I wasn’t gasping for breath. I hurt like hell from the surgery and the implant in my chest felt like it weighed 15 pounds, but it was like a great weight had been lifted from my shoulders. It had…the weight of death.

In that eight wonderful years I was given, I have watched my son marry the love of his life; I have gotten to know my husband in ways you only can know someone after 33 years. I learned to sort the really important things in life from the shit and to throw away that shit. I learned that time is precious and oh so fleeting. I learned that there may not be a tomorrow, but there is always today and today is all that matters.

In these eight years, I have found friends and made them family. I have experienced and given love like I never knew I could. I began walking the path of the Buddha and discovered peace and serenity to the point where death no longer frightens me, it’s just another adventure.
Sometime this yea,r I will be getting my implant replaced with a new one (I tend to wear out batteries faster than most…go figure). It’s a good thing because I have great plans. I have gardens to plant, places to go and things to do. I just got my blue belt in Kung Fu and black is only a half a battery away. I plan on being here for those two years too! I will never give up on life and even though I don’t fear it, death will have to hunt me down.

Thank you to all the people who made this new life possible, Not just the doctors and nurses that made me bionic, they only gave me life, but the people who have made it worth living. To my family, to my friends, to the people who have touched me and didn’t even realize it, THANK YOU. I love you and am so very grateful that I got this time to love you.