Any heart experts here?

[cujet]

I am 38, and in poor health due to a virus (mono) 4 years ago. I sustained heart muscle damage to my right ventricle (sp?) durnig the hospital stay for mono. I can no longer even run 200 feet without getting severly out of breath. I also have no thyroid due to same. I did not have a heart attack, and therefore I am not on heart medication.

I used to be a semi competitive bicyclist and could hold my own physically. When I try to ride bicycles I now have to contend with a rising heart rate that, over time (20 miles) increases, even with decreasing effort. By the end of a bike ride even a walking pace brings heart rate into the 160 range.

I have given up on excersize as no matter how hard I work out or bicycle I do not gain muscle or stamina. This is partially due to thyroid failure, partially due to heart as my limit is so low.

Does anyone have any good suggestion to get improved heart performace? How about muscle gain? I need to do somthing.

Chris

 

[Rumpelstiltskin]

Both your thyroid and cardiac condition need to be addressed by a qualified physician before course of action can be suggested. Most surely you'll need a specific program tailored to you, and one that is supervised. You'll likely be referred to a cardiologist and possibly cardiac rehab. No one here is going to make any program suggestions for you with your condition. See a physician before pushing yourself physically and causing a heart attack or something.

 

[cujet]

Good advice, however I currently see the best cardiologist around and a very good endo for thyroid. I visit the doc every 2 months. I have been told that I am not at risk. however that does nothing to improve my condition. because I was an avid cyclist, my resting heart rate is low, around 45 at night and many heart meds lower it even more often below 40. that is why I have not been successful on meds. The stiff right ventricle muscle is causing my high heart rate during excersize. I need a way to improve my physical shape without over taxing my heart. Any suggestions.

TIA

Chris

 

[Rumpelstiltskin]

If your looking for stamina you'll never achieve it without some sort of aerobic exercise. It doesn't matter what it is. Even if you do not feel any great gains you should do something, anything, because at the least you will slow or prevent any deterioration. With an already compromised cardiovascular system it's even more important. If you don't do something it will definitely deteriorate. Just do anything aerobic that you'll stick with and do it at a pace that doesn't cause you to over exert yourself. Just 20 minutes three times a week should be adequate. For me I prefer the stairclimber. For muscle you have to pick up them weights. That's something that's mainly anaerobic when done at heavier weights and low reps. A few basic mass building exercises are the bench press, squats and clean and jerk. Done with with a weight which you can do 6-8 reps and 3 sets. Resting a few minutes between sets. It doesn't even have to be just these exercises. Heavy leg press, military press etc. Just pick a few that taget your upper and lower body and do them with heavy weight low reps. Make sure eat eat properly (Plenty of protein and maybe increasing your calorie intake). Allow 1-2 days rest before hitting the same muscle group again. Also allow for plenty of sleep because that's when your body repairs itself and builds muscle. It's a slow process so you have to be patient and stick with it. Just make sure get the ok from the doc.

 

[skmcbride]

Chris,
Can you give more info on the nature and extent of the problem with your right ventricle. Did you have endocarditis? How were you treated? Did you have a heart cath. done to evaluate right ventricle function (pressures)? Do you have a problem with fluid retention in your ankles of feet? I can tell you that barring major ventricular dysfunction, you can improve your exercise tolerance (fitness).

The concern with right ventricular problems is that they can, in certain cases,
to carry-over into left heart dysfunction. Basically a plumbing problem where the left heart is working against greater resistance due to poor right heart stroke volumes. Training when the heart is the limiting factor can be done, but usually requires monitoring. Do you have a heart rate monitor?

The 2 major ways your heart compensates with exercise is via stroke volume and rate. Obviously your right ventricle falls short on the volume end and then, accordingly, your heart rate goes up disproportional, to move the less oxygenated blood to your lungs. Not knowing the particulars, I will not speculate on your heart's ability to adapt, but I can tell you it is a muscle and does respond to training. The key, however, will likely be found in your skeletal muscles ability to train and become more efficient at extracting oxygen from your blood at any given volume...make sense? This is easily done and at intensities that will not over tax your heart. Increased mitochondria, collateral circulation, and enzymatic adaptations. to name a few, will all occur at relatively low intensities. The more muscles involved in the activity the less "back pressure" on the heart. Muscles that are working need more blood and blood vessels going to them will dilate to bring it, thus lower resistance. What does this mean? Swimming, elliptical training, cross country skiing (or machine equivalent) will probably be the best way for you to train. Anything using both arms and legs. If you like to bike try an Airdyne stationary bike that uses arms and legs.

All this should be cleared by cardio doc. An exercise test would not be a bad idea to determine your target heart rates for working out. You need to find the zone where you will train but not overly tax your heart and maintain an intensity to reap the benefits of skeletal muscle adaptation. Got to get back to work.

Good Luck, Keith.

 

[cujet]

Thanks for the detailed reply Keith. I do not know if I have endocarditis, I have no idea what that is. I do know that standard ultrasound and stress echo ultrasound were done to provide the diagnosis. I did not have a cath.

I do not have any swelling of ankles or feet,,,yet. My doctor keeps checking, I think he is expecting problems. I am quite active, with dirt biking and some cycling in addition to heavy outdoor labor.

Swimming is not an option, as I can get horribly out of breath. I tried to snorkel and ended up sucking in water while totally out of breath. Good thing I could stand up in this area.


Your mention of Rt side problems leading to Lh side problems seems interesting. As, on certain days, my heart rate is lower and I go cycling. I start out at 15MPH with a HR of 135. After 10 miles my heart rate is 140 @ 15MPH. After 13 miles, heart rate increases to 160 with speed decreasing to 5 to 10MPH.


I like your theory on working more muscles at the same time. It makes sense and I will try it.

Thanks

Chris

 

[skmcbride]

Your mention of Rt side problems leading to Lh side problems seems interesting. As, on certain days, my heart rate is lower and I go cycling. I start out at 15MPH with a HR of 135. After 10 miles my heart rate is 140 @ 15MPH. After 13 miles, heart rate increases to 160 with speed decreasing to 5 to 10MPH.

Chris,
I believe this phenomena you are describing is normal given your current circumstances. It is reflective of a decrease in your overall fitness and cardiac output. You can not compare to what you used to do since your circumstances have changed. A rising heart rate at a steady intensity is quite common when the intensity is too high. I run what are called fatigue test on a regular basis at the University where people are placed on a treadmill at 70% of their VO2 max until they fatigue. On average, this takes 15-25 minutes. Unfortunately you may need to lower the bar so to speak to prevent early onset of fatigue. Your inability to recover likely is related to inability to clear CO2 build up from the right heart dysfunction. Training intensities as low as 40%-50% max HR can induce a training effect. Your low resting rate is likely attributed to good left ventricular stroke volume and the right sided weakness does not get "exposed" until O2 demand goes up, resulting in the "spike" HR.

This is where a HR monitor will help, sounds like you might have one. Find the intensity that you can maintain for 45-60 mins and work from there. If you are starting at a steady rate of 135-140bpm for 10 miles, you better be pretty fit! That's about 70%max give or take your formula of choice. I see this a lot in athletes trying to pick-up where they left off after an injury or remembering how easy a certain work out used to be.

You need to wipe the slate clean and start from scratch. Remind yourself of the limitations that you face and realize that even at slower pace you are "training" under your current condition. Pushing it to old standards will fail and could lead to further limitation. I don't want to sound preachy, but cut yourself some slack. Start slowly, frequent physician follow-ups, and gradually you should see improvement. You might want to train indoors first on equipment that you can control/modify the intensity. Cycling outdoors creates problems with intensity maintenance, as one hill could push you into O2 dept and lead to fatigue. Let your HR monitor dictate the intensity on any given day.

I keep babbling, but your condition could potentially qualify you for cardiac rehabilitation. A phase II or III program would be the best, they are often incorporated into big "wellness centers." You can get exercise or stress test and be trained with monitoring for approximately 12 weeks. They are designed for post heart attack and by-pass surgery, but any limiting heart disease could warrant consideration. Of course, you will also learn how to train on your own at the appropriate levels and could leave sooner then that if you felt comfortable. Don't tell them I said that! ;) It often involves a copay on your insurance and you will need a referral from your cardiologist.

Good Luck, Keith

 

[cujet]

Wow! Thanks keith. I was in good shape before the virus, so my legs were very strong. I tried to maintain a certain level of fitness. I started out very slow, with my HR around 120 or less. I kept loosing physical ability though. It seemed that no matter what I did I lost ground.

Some days I had a HR over 100 right away, at a walking pace. Those days I would not even try to ride.


I guess what you call fatigue is not what I would consider fatigue. I am not even tired! On my bike, I rarely push myself to the point of being out of breath. I think heart fatigue is somthing I need to learn about.

As I ride with a HRM and in Florida where it is flat, intensity is easy to control.

What about weight lifting?

Thanks again!

Chris

 

[skmcbride]

Chris,
Once again it is difficult and I am hesitant to give anything but general advice without knowing the particulars. Knowing your current heart function and thyroid status in more detail will influence your training. What is the status of your thyroid function? Do you take hormones? Secretions from the thyroid (high or low) can effect heart function in both the short and long term. Endocrine function is not my strong suit.

Generally speaking: I will assume you had a viral thyroid infection that has now resolved and function is normal. Given this, your heart function will be of greatest concern with weight lifting. Heavy weight lifting put a great deal of stress on the heart. Bench pressing, for instance, involves marked increased in intra thoracic pressure, blood pressure and "pressure loads" the heart. This type of loading should be avoided with ventricular dysfunction. I would not, however, rule weight training out as a whole. The same idea as the aerobic training will hold true. Compound movements involving multiple muscle groups with low weight high rep should work well. Proper breathing is important. Bulking up would do your heart a disservice as you want to develop as much aerobic capacity into muscle as you can. You can still get stronger. Remember that there is a stronger strength component to endurance training than endurance component to strength training. Hope that makes sense. In essense, low weight and higher rep can still yeild strength and power benefits whereas, high weight and low rep will do little in the way of endurance and can actually reduce muscle resistance to fatigue.

Sounds like you need to get some firm answers from your doc. If you don't ask, they usually don't tell. Does he know of your desire to improve your fitness? He should be the one prescribing appropriate restrictions and limitations as far as exercise goes. If you can get a baseline heart function test under load beit invasive or not, you can be sure that the type of exercise you are doing, with subsequent testing, is not determental to your heart condition. Don't get me wrong, I love to give advice and my opinions, but I certainly don't know you like your doc. The fact that you own a street legal '94 Husky 360 tells me you're a rare bird :) . You must get some strange looks at the stop light on that:eek: ! BTW, does the clutch drag on your Husky, my friend had a 360 that used to give him fits.

Good Luck, keep us posted, Keith

 

[cujet]

Very good info,,, again! I will aviod lifting weights as a method of fitness. I actually had intended to start lifting. Sure I would like to be Mr muscle, however, I am more than strong enough. It is the endurance that I lack.

I do take thyroid replacement hormones, (armour) and work with my endo to maintain proper levels.

The viral infection I had was a form of Epstien-Barr (mono). It put me in the hospital with very serious problems, (the heart thing almost killed me). Including total thyroid failure, spleen, liver and kidney problems. The virus also affected my heart muscle and leg muscles. The remaining problems are thyroid failure and heart Rt ventricle stiffness.

I have discussed this in detail many times with my doc. It seems that I will have to accept a decreasing physical endurance over time. I am learning that my training is now not for improvement but for less loss of ability over time.


Yeah, if you think the looks I get while on my Husky at the stoplight might be funny, You should see the bike riding down I95! Billowing clouds of blue smoke swirling behind:) I use a 24 to 1 mix!

As for the dragging clutch, I solved that problem by using a lever assy with greater cable pull. I also adjusted the clutch internally so the internal cam operates at it's prime position.