Dear Sports Doc,
I am 57 years old and I was a runner from 11 years old to my mid-forties. When I was in my prime in high school and college my heart rate averaged 48 – 50 bpm. I was a decent runner and participated in college cross-country. I had to stop running because I started suffering from osteoarthritis of the hip, which needed to be replaced. About a year ago, I went to my local VA clinic to have an EKG to get cleared for my hip operation. According to the EKG my heart rate was in the low 30s, which was not normal for me. They rushed me to the local hospital and installed a pacemaker in my chest.
This was very difficult for me to absorb; I thought I was invincible and would live forever. Approximately six months after the pacemaker was installed, I had my hip replaced. I have been riding a bike to try and get myself into some kind of shape, but I have problems climbing stairs or bending over. It doesn’t happen all the time, but I have heavy breathing episodes. The tech’s from Boston Scientific state that I have Atrial Fibrillation (A Fib). I take 100 mg metoprolol tartrate twice a day along with one full aspirin in the morning; I also take a 40 mg tab of simvastatin before going to bed. When I went to the VA clinic that day for the EKG I was not symptomatic, I had no problems breathing until I had the pacemaker installed. Today I forgot to take my medicine in the morning and I felt much stronger on my bike than I have on previous rides. Do you think the beta blocker I am taking could be causing my breathing problems and if so, what would be an alternative solution? Any advice you can provide would be appreciative.
Thanks,
Donald
Dear Donald,
THERE ARE SEVERAL points to discuss regarding your story and thank you for sharing. It is difficult to have a change in life circumstances and you have been hit hard with a pacemaker and a total hip replacement. Aging can be brutal and it certainly takes away that feeling of invincibility.
First, if you are short of breath with activities, you must see your physician soon. I cannot give you any meaningful advice, but may be able to help with some explanations.
As you noted, long time endurance athletes have low resting heart rates. When I am at peak training for in-line skate marathons or doing a lot of Nordic skiing, my morning heart rate is in the low 40s, with my regular fitness activities it is just below 50, and when I was out of action recovering from my total hip and total knee surgeries my heart rate drifted up toward 60. Somewhere below 40 and for sure at 30 beats per minute, the natural pacer has gone on strike and the cardiac output is too low for safety. A pacemaker is the usual intervention. Thankfully we live in an era with good pacemakers and long-life batteries.
Beta-blockers are another story. They slow your heart, cause fatigue (especially with exercise), and are often used to control atrial fibrillation. Beta blockers are also used for congestive heart failure, high blood pressure, and after heart attacks. You may be able to use a lower dose of the metoprolol or there may be alternate medications that your physician can discuss with you. Be sure to tell him or her about your symptoms.
It would be best to get your breathing problem evaluated so you can get back to your fitness plan. I do not recommend running on a new hip at age 57, although many people do. Personally, I have moved to biking and other low impact activities. I think about keeping my new hardware as close to intact as possible to avoid getting another replacement in 20-30 years.
I hope this helps.
Cheers,
Bill
***
