implanted with defibrillator

[billreillyjr]

i'm an experienced long distance hiker.i was recently diagnosed with hypertrophic(obstructive)cardiomypathy(homc)and implanted with an implantable cardioverter defibrillator(icd).does anyone have experience with this condition/implant and hiking?--thanks--uncle walt

[HiKen2011]

Not me but what does your doc say, I'm curious about this as a friend of mine may have something similar implanted soon.

[billreillyjr]

she says i can hike as long as i go slow,as a 60 yr old keep pulse below112, stay hydrated,get a phone.

[Wise Old Owl]

Hypertrophic cardiomyopathy is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is hypertrophied (thickened) without any obvious cause.It is perhaps most well known as a leading cause of sudden cardiac death in young athletes. The occurrence of hypertrophic cardiomyopathy is a significant cause of sudden unexpected cardiac death in any age group and as a cause of disabling cardiac symptoms. Younger people are likely to have a more severe form of hypertrophic cardiomyopathy

HCM is frequently asymptomatic until sudden cardiac death, and for this reason some suggest routinely screening certain populations for this disease.^[8]
A cardiomyopathy is a primary disease that affects the muscle of the heart. With hypertrophic cardiomyopathy (HCM), the sarcomeres (contractile elements) in the heart replicate causing heart muscle cells to increase in size, which results in the thickening of the heart muscle. In addition, the normal alignment of muscle cells is disrupted, a phenomenon known as myocardial disarray. HCM also causes disruptions of the electrical functions of the heart. HCM is most commonly due to a mutation in one of 9 sarcomeric genes that results in a mutated protein in the sarcomere, the primary component of the myocyte (the muscle cell of the heart).

In those patients deemed to be at high risk, the benefits and infrequent complications of implantable cardioverter defibrillator (ICD) therapy are discussed; devices have been implanted in as many as 15% of patients at HCM centers. The ICD is the most effective and reliable treatment option available, harboring the potential for absolute protection and altering the natural history of this disease in some patients


I do not have any experience with this... looks like you are supposed to take it easy. Shortness of breath is your first clue, followed with uncomfortable awareness of the heart beat (palpitations), lightheadedness, fatigue, fainting (called syncope)...

I am surprised your cardiologist did not discuss / or you did not ask prior to the implantation. - If you just had the operation I would suggest small parks near hospitals for a while.

[billreillyjr]

i did discuss w/ the cardiolist--i asked if anyone here had experience.

[Wise Old Owl]

well - I could not tell from the first post.... so how long has it been from the operation?

[billreillyjr]

6 days.....

[Wise Old Owl]

ohh now I understand...

[brian039]

I worked in cardiac rehabilitation for 6 years. I had a little experience working with patients with Cardiomyopathy but they also had this condition in conjunction with a massive heart attack where they had lost a lot of heart muscle. In those cases it was debilitating to them, they could do very little exercise without feeling extremely short of breath. It sounds like in your case that you still have your heart muscle intact. I would strongly recommend (if you have health insurance that will pay for it) to enroll in cardiac rehabilitation if you qualify. You'll be in monitored exercise sessions 3 times per week for 12 weeks. The main risk with this condition is a fatal heart arryhthmia, but since you have an ICD, that should detect it and automatically give you the electric shock you need.

Ask your cardiologist if your diagnosis would qualify you for cardiac rehabilitation, it's been a while since I've worked in that field so I'm out of the loop on what insurances cover it for what diagnoses. Otherwise, make sure your doctor knows what you mean by hiking, she may assume you're talking about a walk in the park without a backpack. I'd assume that different people handle the condition better or worse, as is the case with all heart-related conditions.

[Junk]

I have hypertrophic obstructive cardiomypathy, I am 38 and was diagnosed with it at age 18. It was treated with medication and limited physical activity ( which I pushed the limits of ) until 2 years ago. Then, with increased symptoms, that were no longer being taken care of with medication, I decided with a lot of input from several cardiologists to have septal myectomy surgery. The recovery was pretty hard, but since then I have felt great, and can do a lot more physical activity. Including hiking harder trails than I used to, with little to no symptoms.

[miloandotis]

I agree that cardiac rehab may be the place for you to start to get back to your baseline. A few things to discuss with your cardiologist if you haven't already is what grade hiking you do. (I am assuming you are not doing easy long distance hiking, but moderate and/or strenuous. If you do easy grade, you should be ok-given the max heart rate you were told) Do you know what your heart rate was when hiking? Your heart has to work harder and you may find 112 could be difficult to maintain depending on what type of hiking you want to return to. You can request an exercise stress test so your cardiologist/electrophysicist can set your ICD parameters more specific to you. That will also give you a "controlled" test before hitting the trail again. Also consider your pack...if it was not taken into account when the ICD was placed, strap locations may be a problem. Also, does you cardiologist know how much weight you carry. (If you are a UL, may not be a problem) When you carry a cell phone, keep it away from your ICD-it can interfere. You will have to weigh the risk of hiking where you can not get help to you quickly (or cell phones don't work) if needed and if you were a solo hiker are you willing to have a hike buddy in case you need help and can't call for your self. As long as you don't have comorbidities that put you at greater risk (congestive heart failure, diabetes, seizure disorders, etc) then there is no reason you can't rehab back to you previous baseline.

[kidchill]

Up front, I don't do cardiology, I administer anesthesia, and I'm in no way offering medical advice, but I just wanna throw some info at you, so you can ask your cardiologist better questions and have all of the facts. First, the AICD (automatic internal coronary defibrillator) is nothing more then a device that interprets the electrical activity of the heart and administers an electrical shock for lethal arrhythmias. What is a lethal arrhythmia? Ventricular fibrillation and pulse-less ventricular tachycardia. There's no other reason to shock unless someone is performing a cardioversion (you're AICD will not do this). Instances of sudden cardiac death are primarily associated with lethal arrythmias and without prompt treatment, the patient expires. This is what the AICD protects you from. Now, I don't pretend to understand the exact pathology of this form of cardiomyopathy, but there are some distinct characteristics of cardiomyopathy that you should understand. The heart is an organ that's roughly the size of an adult fist and is primarily composed of cardiac muscle. Now, with most cardiomyopathies there is a change to the muscle of the heart, and there's often times a change to the dimension/volume of the chambers. Why is this important? The pumping ability of the muscle of the heart is dependent upon the supply and demand of oxygen. If you have hypertrophied (larger) muscle, then you need more oxygen at baseline then a person with normal heart muscle. Just because you have an AICD and hypertrophied cardiac muscle doesn't mean you can't do cardio exercise; however, you may be more prone to the formation of lethal arrhythmias (hence the AICD). The real question is, at your physiological state, how much stress can you place on your heart? And, that's where the question arises, how far can you hike? Now, you say that you're an experienced long distance hiker....So, here's some questions...How did you find out that you have this condition? Do you find yourself short of breathe, have chest pain, tend to awake at night frequently to urinate, have swollen ankles, any history of congestive heart failure, how often do you hike and have you had any changes in symptoms lately? If you have a good cardiologist then you should be able to sit down and have a decent discussion with her about your limitations. The heart rate thing makes sense (although I'm not sure how she arbitrarily chose 112bpm) and this is why... In terms of oxygen supply/demand a fast heart rate is a double whammy! First, increasing heart rate increases the demand on the heart for oxygen (this is due to increased work). Second, it decreases the supply of oxygen to the heart. The coronory arteries (the arteries that supply blood/oxygen to the heart) fill during diastole (the resting phase of the cardiac cycle). So, the higher the heart rate, the less time the heart spends in the resting phase, the less blood that's supplied to the muscle. Now, if you truly are an experienced long distance hiker and have good cardiovascular health, then your resting heart rate is probably around 60 and you could most likely hike and maintain a heart rate around 100. So, in short, if you're well hydrated, have a well conditioned heart, proper electrolyte levels (potassium, magnesium, sodium, calcium), and manage your heart rate...you'd probably be fine. If you are determined to continue hiking, it wouldn't hurt to get one of those pulse measuring watches and see what kind of strain you can place on your body and maintain a heart rate less then 112. Without any further information, that's all I can say. Again, I'm not giving medical advice, these are just some thoughts. There's so many variables to be considered, not to mention I have no idea of what your medical and social history entails. I just know from experience that docs don't always explain things the best they can, and I'd rather take the time typing so you're not injured. Also, unless you sustained some sort of injury there's no real reason to have cardiac rehab. Further, the whole stress test thing may not be a bad idea, but it's also probably not necessary (unless you were previously experiencing shortness of breathe/chest pain). When I pre-op my patients I tend to look for the real world stress test. How much activity can you do without having shortness of breath or chest pain? A heart rate monitor during exercise would answer that question and give you a baseline idea of how much you can stress your heart and maintain that target heart rate.

[miloandotis]

First, the AICD (automatic internal coronary defibrillator)
Also, unless you sustained some sort of injury there's no real reason to have cardiac rehab.
Further, the whole stress test thing may not be a bad idea, but it's also probably not necessary during exercise would answer that question and give you a baseline idea of how much you can stress your heart and maintain that target heart rate.

Just so you know where my thoughts/suggestions are coming from, I'm a cardiopulmonary nurse. And it's probably good to add the disclaimer I was not offering medical advise, but thoughts to discuss with your physician. And I'm not trying to get into a knowledge pissing contest, but you are incorrect on a major point and that is the function of the ICD.

So that mumbo jumbo being said, An ICD is an implantable cardioverter defibrillator. The C is for cardioverter. If a patient has an ICD and the device senses a ventricular rate (ventricular tachycardia) that exceeds the programmed threshold (which probably has something to do with the selected rate of 112), the device may fire antitachycardia pacing or defibrillation. An ICD can pace, cardiovert and defibrilate. It is not only for V fib and Pulseless VT.

I agree with the cardiac rehab because this person is probably not the average person you see on your table. And the stress test would help with the programming of the ICD, again because he's not the average person but has more specific needs and goals that need to be taken into account.

[kidchill]

I stand corrected. Yes, the C is cardioverter NOT coronary...not sure why I said that. In terms of cardioversion, the way I understand the impulse generation is based on 2 different episodes. Antitachycardia (controlling excessively high heart rates) and I guess they call it cardioversion (although I don't think of it that way). The anti-tach programming is really just overdrive pacing (we used to do this all the time in CCU with external devices through a cordis). The "cardioversion" as they call it is still kinda defibrillation to me. They just depolarize a small area of the ventricles in hopes of breaking the rhythm. It is a smaller shock then a defib, but I'm not sure of the synchronization properties. My problem with a HR of 112 is the question of whether it's an s.tach or a v.tach. Two completely different rhythms and treatments. I would like to think this guy could maintain an s.tach rhythm of a little greater then 112. A v.tach rhythm is different due to the 30% loss of CO without atrial kick. It's not that hard to get a sympathetic response and quickly jack a heart rate to 120 in a matter of seconds. Whether or not the device interprets the difference between the two, I don't know, that's not what I do. You probably know more about those properties then I do. Honestly, if I see an AICD on a patient I de-activate it and roll them back to the OR. The last thing I need is to be treating an R on T torsades from the friggin bovie. At this point I'm actually kinda curious as to how she got that number (I'll have to read up on the AHA guidelines). Either way I still don't see a need for rehab unless there was an insult/injury, but, as I stated before I have no idea of this guys health history or how they found it in the first place. I would imagine they'd have to get an echo, and if so, why'd they do it in the first place? A stress test is only going to help programming if he's symptomatic; unless they're also using visual EF% at rest and during stress as an end point. If you have any quick info about the synch properties of the cardioversion for v.tach vs overdriving for s.tach I'm more then interested...but I'm starting to feel like we hijacked this guys thread ;(

[GregoryK]

The 112 heart rate limit is what would scare me. it reads. I would get a heart rate watch or band and monitor your heart rate. Go for a walk and see what it reads. Then go for a hike on some hilly terrain and monitor it. Did you doctor or insurance company provide you a heart monitor? They might cover the costs.

[miloandotis]

but I'm starting to feel like we hijacked this guys thread ;(

Agreed. lol....hazard of the professions, i guess. :-)

[kidchill]

I feel bad about the thread hijack, so here's some quick info for you:
http://circ.ahajournals.org/content/.../e783.full.pdf That's the AHA guidelines for HCM...Read page e813-e815...It speaks directly to exercise tolerance in patients with HCM (table 4 specifically lists "hiking"). Also, in the limited reading I did, it seems as though your limitation lies more with the physiological consequences of the cardiomyopathy then the AICD itself.

http://www.medscape.com/viewarticle/522418_3 This is a medscape article (so I can't tell you if it's peer reviewed or not) that contains some primary research of activity level and patient's living with HCM. Apparently quite a few people continue to exercise liberally with this form of cardiomyopathy.

[Mr. Bumpy]

A few years back I had a cycling buddy who was very fit for a 50 year old. His heart stopped for no real reason and he dropped dead for a few minutes and he ended up with an implanted defibrillator. He was able to get his defibrillator rate set much higher--probably in excess of 170 bpm or so. He's never had it go off, but no one really likes being behind him if he is sprinting. Point is, the zapping threshold can be adjusted considerably, but I suppose the underlying condition matters most.