Dr Fett..HR and exercise????

[amyls]

Dr Fett,
I'm on 25 mg of Coreg BID and 10mg of enalapril BID, I asked my new cardio and we forgot to talk about it before I left. My EF is 45% what is a good HR on the coreg?? I have AVN of the hip, so it limits some of the exercise I can do, but the glider doesn't hurt it much. What is a good HR to help in losing weight?
amy

[JAMESFETT]

From this net I have come to realize that SusanD is an excellent source of info for questions just such as yours in regard to exercise and conditioning. The heart rate target goal varies so much from individual to individual on beta blockers. I hope that SusanD picks up on this thread, and good for you in your exercise/conditioning goals--it is good to also discuss this with your cardiologist.

JD

[amyls]

Thank you!
I totally agree, and we did discuss it, we just didn't get to it! :) HAHA It was only my 2nd meeting with him and he did the intake on me asked me everything about my histroy and he had all the papers from all my other Docs, so it was nice... last time(6 months ago) was when my resting HR was 117 and my EKG had something funny on it. Needless to say, he was more concerned about that! Since changing from the Toprol XL to the coreg my HR is almost normal except for some fast runs in the evening. So it is much better!

I will ask Susan...Thank you Dr Fett!
amy

[SusanD]

Are you asking for what might be a good target heart rate for exercise or a good heart rate in general ?

[amyls]

for exercise....:)

[SusanD]

Well, the *gold standard* for determining an ideal target heart rate would be using a maximal treadmill test. If you take a test like that on the same drugs that you take every day, then you can determine quite an accurate and achievable target heart rate.

Most people don't have that to go buy so we usually teach people to stay within 20-25 beats of their resting pulse AND to use the Rating of Perceived Exertion chart. You should stay in the 12-15 range. Do a google search and type in RPE or "Rating of Perceived Exertion." Lots of research has been done on the RPE scale and they have found that your level of perceived exertion correlates quite nicely with target heart rate.

Did that help any ?

[JAMESFETT]

Seems to me that's an excellent bit of advice. Above all, I encourage recovering PPCM patients exercise and activity within a limit of comfort, avoiding sustained heart rates in excess of 100 to 120. There is some evidence in animal studies that excess activity in the first few weeks after onset of heart failure and dilated cardiomyopathy there may actually be harmful effects to the heart. A walking regimen is often a good start.

JD

[JAMESFETT]

P.S. I am always amazed what Haitian PPCM mothers endure once they are discharged from hospital following diagnosis, carrying heavy burdens on their back or heads while tromping over steep hills, a part of their daily life in the pursuit of food and water for their families.

JD

[amyls]

Me too, Dr Fett...although I was in complete denial for the first 2 yrs...My husband wouldn't let me do anything except carry my son...he still doesn't let me shovel!
I keep praying for them. We have a sister church in Haiti and I keep reminding the people who go over to help the children with clothes and supplies. They also help build houses and give them mattresses and such, but I want them to know that the new mothers who have this need help too, unfortunately they only want to help the kids...not that thats bad, I just wish I could convince them to have a whole seperate part to help the woman..all in good time...I will keep trying...

amy

[JAMESFETT]

Good for you! Keep it up. In Haiti, every 300 to 400 pregnancies, a mother develops PPCM, that's about 10 times the frequency in the USA. Although I am no longer in Haiti, through the PPCM Project with the Hôpital Albert Schweitzer in the Artibonite Valley, we have "adopted" every PPCM mother and pay for her medications and medical visits. Because they are not only ill but also desperately poor, this is the difference between life and death. There are about 150 surviving PPCM mothers in this 500 square mile district with 300,000 people.

JD

[amyls]

I will, perhaps you can refresh my memory of how much it costs for the meds to help keep them healthy. I can go to my priest and propose it to him. Our church goes over there in OCT and spring. It's amazing how little they all have and yet how gracious they are.

Or send me more ifo to my e-mail..then I can talk with my priest about it and be totally educated and updated on it.
Thanks!
amy

[JAMESFETT]

In the system at Hôpital Albert Schweitzer, Deschapelles, Haiti, the Artibonite Valley, the cost per month for treatment of a PPCM mother (diuretic, ACE-I, and B-B) is approximately $25. This is the best coordinated treatment program of PPCM in Haiti. Unfortunately, many areas do not have this available and all over Haiti peasant women with PPCM do not receive adequate treatment.

JD

[Deb]

Dr. Fett,
Sorry to change the subject about Haiti, it really is very important...but, you raised a topic on the HR that I wanted to clear up.

You mentioned that HRs shouldn't remain in the 100 - 120 range, as that can further damage your heart. How much dmge can it cause and over what period of time? I am 99% certain I'm shifting my care over to Dr. Baughman next week, due to the lack of concern my current doctor seems to show regarding my care. My resting HR tends to hang out around 100 and immediately goes up to 120, and one time to 160 when I was moving laundry from the washer to the dryer. It definitely tires me out.

Further damage to my heart over the course of the past 51/2 months since diagnosis has been a great concern to me....

[JAMESFETT]

What I tried to emphasize is that early in the treatment of PPCM, during the first 2 months or so, I would not encourage exercise that sent the heart rate over 120 per minute. Your high rate even at this time would not be the same situation, and there is no possibility of determining "damage" to heart by sustained higher rates--only to work to see what may need to be done to help arrive at a slower resting pulse and determine best type of conditioning program. Best wishes,

JD