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.

In reply to @dixiegirl "Thank ypu all" + (show)
@dixiegirl

Thank ypu all

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Did you get any help with the questions you had? Your esophagus is very close to your heart. I've read of a man with an arrhythmia that was solved by slightly relocating his esophagus.

Another thing, has anyone considered the possibility of a Hiatial Hernia, where part of the stomach protrudes up through the opening in the diaphragm. This can be constant or sliding (comes and goes).

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@hopeful33250

Hello @mayo33 and welcome to Mayo Connect~

I am so pleased to see all of the healthy lifestyle changes you have made in the recent past. You must be very pleased with your progress. How are you feeling now?

If you care to share more, how is your Sinus Node Dysfunction being treated? Are there specific meds that are helpful to you?

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I've had chest discomfort even though the cardiologist there's nothing wrong with my heart

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@mayo33

Hi @soliloquized

I started going down the same way you are thinking last night. My highest heart rate on the stress echo was around 100 - then they pulled me off the machine to ultrasound and all the techs freaked out like I was going to have an MCI right there. One cardiologist was convinced it was a block, until they did the angiogram and found no blockage.
Last night I found a condition called Roemheld Syndrome. This is pretty obscure, but my history is very consistent with the symptoms and consistent to what you describe above. About 2 months before I got tinnitus, I had a wheezing productive cough (I still have it). My pcp regards it as GERD acting up, but I’ve been on Prilosec for 20 years and never had it this bad. It is Like there is more pressure on my stomach. My wife was also in a bad accident causing 8-10 weeks of extreme stress for me around the same time also gained about ten pounds and stomach/chest felt tight/bloated. Then the tinnitus then the vertigo attack then the heart arythmia issues and bradycardia. The description of Roemheld Syndrome is stomach or GI pressure on the vagus nerve that then causes GERD, tinnitus, vertigo, bradycardia or tachycardia and other symptoms. Could be caused also by hiatal hernia.
I found this because I noticed a pattern in my heart rate yesterday where I get bad bradycardia after a meal, especially when wearing a tight belt or tight clothes. Today I had very small meals and I didn’t get the drop I got yesterday afterwards. I’m not sure if this is just my blood going to my gut after a meal (Postprandial Hyperemia) or something more like Roemheld. ??
I’m scheduled for a heart rate monitor next week, for two weeks. I should be able to test this hypothesis easy enough with different size meals and different/tighter clothes and see how it correlates on the monitor vs on my watch.

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I'm grateful reading this topic that provides another lead in my attempt to make sense of my own long-standing tinnitus, recently emerged gastritis/heartburn and erratic blood pressure . My general health profile is good, but I've always been prone to stress/anxiety and it seems to have finally found a physical outlet. The common element is, apparently, the vagus nerve. My working hypothesis starts with the mild ear infection that apparently set off my tinnitus a year ago and possibly resulted in a minor physical change that sensitised it to activity in the vagus nerve, which among other things has (so I understand) a controlling influence on the production of acid in the stomach. The ear-vagus connection is recently established clinical science. In reflux, stomach acid can travel up to the ear and induce tinnitus, especially when a person sleeps, but my tinnitus declines to near silence after lying down for a while and increases in volume on waking and around mealtimes (in a Pavlovian way, it starts before I've taken a first bite). As for hypertension, there is research evidence that GERD can lead to it. When I described my sudden gastritis and severe reflux to my doctor, he referred me for a gastroscopy then took my blood pressure, upon which he nearly had kittens and on the spot prescribed a calcium channel blocker. He dismissed my suggestion that the hypertention was atypical and possibly connected to the gastritis (which was stressing me into the bargain), and is evidentally innocent of the fact (as I was at the time) that CCB's make reflux worse. I took one tablet and had a disturbing reaction, was advised by an emergency doctor to take no more, then learned this fact for myself. Meanwhile, pending my gastroscopy, I am self-treating the gastritis by following the standard GERD diet and behavior recommendations, dosing with temporary-relief antacids as needed, gastric-acid-neutralising lemon juice before meals, herbal teas or ginger with honey and aloe vera juice to dampen down inflammation and encourage healing of my hurting esophagus. After a lot of reading, I've put on order probiotics, kyolic and cannabidiol (for multiple reasons) and plan to avoid prescribed medicines unless h.pylori is found, in which case I anticipate my self-dosing to assist coping with the antibiotics.

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@cai

I'm grateful reading this topic that provides another lead in my attempt to make sense of my own long-standing tinnitus, recently emerged gastritis/heartburn and erratic blood pressure . My general health profile is good, but I've always been prone to stress/anxiety and it seems to have finally found a physical outlet. The common element is, apparently, the vagus nerve. My working hypothesis starts with the mild ear infection that apparently set off my tinnitus a year ago and possibly resulted in a minor physical change that sensitised it to activity in the vagus nerve, which among other things has (so I understand) a controlling influence on the production of acid in the stomach. The ear-vagus connection is recently established clinical science. In reflux, stomach acid can travel up to the ear and induce tinnitus, especially when a person sleeps, but my tinnitus declines to near silence after lying down for a while and increases in volume on waking and around mealtimes (in a Pavlovian way, it starts before I've taken a first bite). As for hypertension, there is research evidence that GERD can lead to it. When I described my sudden gastritis and severe reflux to my doctor, he referred me for a gastroscopy then took my blood pressure, upon which he nearly had kittens and on the spot prescribed a calcium channel blocker. He dismissed my suggestion that the hypertention was atypical and possibly connected to the gastritis (which was stressing me into the bargain), and is evidentally innocent of the fact (as I was at the time) that CCB's make reflux worse. I took one tablet and had a disturbing reaction, was advised by an emergency doctor to take no more, then learned this fact for myself. Meanwhile, pending my gastroscopy, I am self-treating the gastritis by following the standard GERD diet and behavior recommendations, dosing with temporary-relief antacids as needed, gastric-acid-neutralising lemon juice before meals, herbal teas or ginger with honey and aloe vera juice to dampen down inflammation and encourage healing of my hurting esophagus. After a lot of reading, I've put on order probiotics, kyolic and cannabidiol (for multiple reasons) and plan to avoid prescribed medicines unless h.pylori is found, in which case I anticipate my self-dosing to assist coping with the antibiotics.

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PS. I'm much indebted to Mayo for advice on the GERD diet and much besides. It is my first port of call for medical facts, even as I cast my eye into less well-mapped seas.

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I’ve had long covid for three years the small fiber neuropathy with dysautonomia variety. I diagnosed my own chronotropic incometence . The cardiologists were clueless because there is nothing wrong with my heart, its the autonomic nervous system which can’t tellmy heart to beat faster with exercise. It actually goes up to about 110, then drops to 75 and stays there until I pass out or stop. Its also called cardiac deceleration. It is easily picked up on a regular stress test, but they don’t normally monitor with a tracing the parameters that help to describe it. Just have blinders on looking for ischemia which does not exist. I don’t have bradycardia, just not enough increase as the muscles draw more oxygen out of the blood, it doesnt either get to the brain or the signal doesnt get from the brain to the heart and lungs. I also dont increase my breathing naturally, so get extremely short of breath and the pulse ox goes from 98 to 90%.
A separate short circuit is the circulation to the legs. Instead of the vessels to the leg muscles dilating, mine seem to constrict as my legs suddenly ‘ turn to jelly ‘ at a certain point in exercise.
As time goes on some of the nerves have seemed to heal and work almost normally. But I still reach a limit with the heart rate.

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Wondering if anyone has been diagnosed with this?
If so, how are you exercising and what type of diet restrictions?

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@ffud

Wondering if anyone has been diagnosed with this?
If so, how are you exercising and what type of diet restrictions?

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Hi @ffud, welcome. Good question about managing chronotropic incompetence with diet and exercise.

I moved your question to this existing discussion of the same name here:
- Chronotropic Incompetence: how are you managing it? https://connect.mayoclinic.org/discussion/chronotropic-incompetence/

I did this so you can read through previous helpful posts and easily connect with members like @mleitnaker @soliloquized @mayo33 @exboater @cai and more.

@ffud, how long have you been dealing with chronotropic incompetence? What helps?

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@johnwburns

Thanks for asking. It hasn't been 100% root caused yet. That will take a hotter and another stress test. Outside chance that its ischemic which would be easier to remedy. Per the cardiologist it can only be ameliorated via a pacemaker. The usual things can help slow deterioration, like weight loss and exercise. I am struggling with the notion of a pacemaker, more than I did with cancer, probably because the symptoms I have are sudden onset and have a clear impact, plain old worn out. Pacemaker implantation is routine these days but if there are complications, like infection, they need to go in. Like everything else at this stage, its a hangman's choice.

Here is a prognosis breakdown:

http://emedicine.medscape.com/article/158064-overview#a6

The thing that I was trying to bring out by posting this topic is that the onset of symptoms can be sudden and easily mistaken for other issues. Apparently the node wears but functions until it reaches a tipping point. The process is driven by the natural pacemaker tissue becoming fibrotic.

I went for the checkup expecting bad news about my aortic stenosis or aneurysm. Both are fine but my left ventricular diastolic function is significantly compromised, Mayo grade 2/4, and then there's this sick sinus deal. Goes to show, you won't hear the one that get's you. :). I had 2 echocardiograms in Portland at a major clinic and both missed the left ventricular issues. Mayo caught it. Why? Probably better equipment and a better doctor reading the results. Regional clinics? No thanks.

Jim

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What was your ejection fraction? My husband just restarted seeing a new cardiologist as his was killed in a car wreck last year 😳, very sad. But his heart rate was 50 and this had never been an issue either. He did have atrial fib but has come off the meds and hasn’t had any since - I think it was postoperative afib. Anyway, the chronotropic incompetence was mentioned. He will be having a stress test, etc next week. His ekg was also abnormal. I’m just looking up everything right now ahead of time lol.

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