Chronotropic Incompetence: how are you managing it?

Posted by JohnWBurns @johnwburns, Aug 17, 2016

Basically a lofty sounding description of one's heart not being able to perform under load anymore for various reasons.

"Chronotropic incompetence (CI), broadly defined as the inability of the heart to increase its rate commensurate with increased activity or demand, is common in patients with cardiovascular disease, produces exercise intolerance which impairs quality-of-life, and is an independent predictor of major adverse cardiovascular events and overall mortality. However, the importance of CI is under-appreciated and CI is often overlooked in clinical practice. This may be due partly due to multiple definitions, the confounding effects of aging, medications, and the need for formal exercise testing for definitive diagnosis. "
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065291/

I am dealing with this and the surprising thing is the relatively abrupt onset, at least in my case, in a matter of weeks at most. Suddenly your heart rate drops into the bradycardia range,

Interested in more discussions like this? Go to the Heart & Blood Health Support Group.

exboater | @exboater | Dec 20, 2018

In reply to @mayo33 "Hello Mayo Connect. First time posting — Thank You for the wonderful forum. I am late..." + (show)

I too have sss. I had a total heart bloc, level three . Drs immediately put in a pacemaker five years ago . also had bradycardia. Pacemaker was set at 60 heart beats for low limped along with this and meds clonidine patch metatopol and some luck this spring after a wellness dr visit I got curious and studied up on my situation. Found out there are triggers that can set afib off. I have changed my lifestyle and diet to avoid these. Last one was alcohol. Now avoid this. Used to have arrhythmia late at night. Since I got hold of my lifestyle and no alcohol I have good Rhythm, with good bp.

jbystry | @jbystry | Dec 26, 2018

In reply to @mayo33 "Oh no. It looks like my post got cut off. I’m a noob. Here is the..." + (show)

@mayo33

Oh no. It looks like my post got cut off. I’m a noob. Here is the full post:

I am late 40’s male moderately overweight and recently diagnosed with Sinus Node Dysfunction (SSS or Chronotropic Incompetence). I had no meaningful medical history until 3 months ago when I started experiencing tinnitus in both ears. Then six weeks ago I had a vertigo attack (3 hours - horrific) and the next day the ENT diagnosed it as Menier’s Disease (some loss of hearing in left ear). After that diagnosis, I put myself on an aggressive program of daily exercise (running 1-3 miles a day) and diet (very low sodium less than 500mg, no extra sugars, no caffeine, alcohol was already out). A few weeks into the program I added supplements Vinpocetine and Gingko Biloba, as well as a multivitamin at the suggestion of support groups.
Then two weeks ago, I went for my normal 3 mile run in the morning, but I couldn’t run. My heart rate couldn’t get above 130 without me feeling faint and my chest/shoulders tightening up. The next day I tried to run again and couldn’t go above 120. Within a four days I couldn’t get my heart rate above 100, so I went to see my doc who sent me to the ER and the Cardiologists. I got a full work-up. Stress test echo, blood work, MRI of head/neck/heart, and then an angiogram. I also had follow-ups with a heart rhythm specialist (cardiac electrophysiology). At this point, their best guess is Sinus Node Dysfunction. I’m scheduled to go on a two week monitor starting next week to get more data.
My Apple Watch has been fantastic at capturing my heart data and now even ECG data over the last six months. It is clear that my resting heart rate dropped 10-15 points when I added Vinpocetine and Gingko, but I have been off of them for 10 days and no rebound. My resting heart rate (calculated on the watch) is around 48-50. My Sinus rhythm looks normal at rest, but once I get my heart to around 85-90bpm it freaks out (my medical term) and the Apple Watch can no longer count beats.
I trust that my cardiologists are on the right path with the monitor as the next step, but I also have a nagging feeling that there is something more system or root cause going on, since I got tinnitus, a vertigo attack, and the sinus dysfunction, all within a few months of each other. The head MRI ruled out something major in the brain. I am also going in for a sleep study to rule out sleep apnea (I do snore a lot). Also getting back to the dentist. Also considering an anti-viral, as that seems to help a lot of people with Tinnitus. My blood work is all clean, although there is some elevation of my ALT liver enzyme. I feel like I am in a race to find or rule out other possible underlying causes that might be correctable before too much damage is done or I concede to a pace maker. Does this group have any other suggestions on other potential causes or paths I should be exploring?

Additional note: today was worse. This afternoon after lunch I was sitting in a long meeting and started to feel unwell/faint. My Apple Watch then alerted me to a low heart rate for ten minutes (41bpm). I got up walked around and go some tea and felt better. Then this evening after dinner I felt the same way. My hr was 42, but I could lay down and I felt better. In he previous weeks I only felt the bradycardia as a result of exercise.

I am not on any meds for the sss. Should I be?

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I also have SSS and did not get on a pacemaker fast enough. I past out driving broke my neck, my ribs my my heel, etc, I now have Brown Sequard sydrome but am lucky with my spine cut in half I am not parylized. I don’t know what your doc’s are waiting for but you need you get on a pacemaker! I recently had to have an Ablation , but that is a whole different story!. Good luck.

mayo33 | @mayo33 | Jan 19, 2019

In reply to @mayo33 "Hello Mayo Connect. First time posting — Thank You for the wonderful forum. I am late..." + (show)

After six weeks of investigation, ZioPatch monitoring, and other tests, I finally got a diagnosis. I have CPVT (Catecholaminergic polymorphic ventricular tachycardia). My cardiac MRI and the angiogram show a very healthy heart, no blockage, and nothing abnormal with the muscle. I have ventricular tachycardia with exercise or extertion and I also have a very low resting heart rate (low 40’s with dips to 30-35 and 5 second pauses at times). CPVT is also indicated by a mutation of the RYR2 gene and I have multiple mutations consistent with CPVT alleles. I am getting ready for an ICD and also meds (beta blockers?), but I have been trying to find more good information on CPVT — very little information seems to exist. Does anyone know who in the country is the best expert on CPVT?

dfelix | @dfelix | Jan 24, 2019

In reply to @exboater "I too have sss. I had a total heart bloc, level three . Drs immediately put..." + (show)

Does anyone get a fib when waking in the morning?

exboater | @exboater | Jan 24, 2019

In reply to @mayo33 "Hello Mayo Connect. First time posting — Thank You for the wonderful forum. I am late..." + (show)

My arrhythmia was from 1:00 am to about 3:00. I started working to see what caused it. Checked out all my meds , not the cause, then worked on lifestyle. Stopped getting over tired finally stopped alcohol complete and last dropped coffee for decaf now don’t have Arrythems at night . Suggest you look at lifestyle

dixiegirl | @dixiegirl | Mar 27, 2019

In reply to @hopeful33250 "Hello @mayo33 and welcome to Mayo Connect~ I am so pleased to see all of the..." + (show)

Hello I WOULD LIKE TO KNOW IF ANYONE CAN GUIDE ME I HAVE CHEST TIGHTNESS...FEELING OG LIQUID AND FOOD GOING THE WRONG SIDE NEAR HEART...I've had this for 2 months now...I have seen a Dr. Blood work chest xray heart monitor everything came out good and normal. Can someone please guide me I still feel tbe same.

Soliloquized | @soliloquized | Mar 29, 2019

In reply to @dixiegirl "Hello I WOULD LIKE TO KNOW IF ANYONE CAN GUIDE ME I HAVE CHEST TIGHTNESS...FEELING OG..." + (show)

You've done the right thing being seen by your doctor and having tests. Don't be afraid to return to him or her if you still have concerns, or get a 2nd Opinion.

I'm not sure what you mean by "Feeling OG liquid and food going the wrong side near heart". Can you talk a little more about this?

AFRobin | @afrobin | Mar 29, 2019

In reply to @mayo33 "Hello Mayo Connect. First time posting — Thank You for the wonderful forum. I am late..." + (show)

Do you maybe have reflux? Take a TUMS, Rolaids or even baking soda in water and if the feeling goes away, you have your answer. I can see why they call reflux 'heartburn' although it has nothing to do with your heart. Your digestive system and your cardiac system are two separate things.

dixiegirl | @dixiegirl | Mar 29, 2019

In reply to @soliloquized "You've done the right thing being seen by your doctor and having tests. Don't be afraid..." + (show)

Sorry delete OG...just liquid 🙂