Low Pulse Rate / BP

[Old Smokey]

Do I have a problem?

I am 61 years old, about 5 KG (11 Lb) overweight, smoke far too much, and eat all of the "bad" cr@p because it tastes good. I don't drink, and walk about 20 Km per day, up to 40 Km in London. I usually don't exceed 20 Km in the deep Moscow winters.

My boringly typical and consistant resting BP is 115/78 with Pulse Rate 60. I take no medication.

With my 61st birthday and mandatory Stress ECG coming up, I expected a problem on the tread-mill because of a fairly badly strained ankle about 3 weeks earlier. I requested a normal medical with ECG, and a deferment of the Stress ECG for 1 week to allow for my ankle to recover - NO DEAL!:ugh:

Recalling other earlier experiences, I drank 6 cups of coffee and smoked half a packet of fags prior to the "fun run". I was TRYING to raise my Pulse / BP.

Resting BP and pulse were as expected, LOW - Hell and Damnation!:uhoh:

After 30 minutes, at an ever increasing tread-mill speed, I enquired how were my parameters. My ankle was really starting to hurt.

"BP is 120/85 and Pulse is 139"

"What is the Target?, asked I, the victim of latter day torture.

"When your Pulse Rate is 180 we'll take the ECG and BP readings" answered Irma Griese reborn.

The torture machine was now at maximum speed. I thought of my ex-wife, arguing with my present wife, making love with my mistress, and concentrated fully on the pain in my foot. Maybe a bit of psychological stimulation would do it.:ok:

At 45 minutes I asked "How's Progress?"

"BP is still 120/85 but your Pulse Rate has dropped to 136", replied Irma.

I put it to Irma that as I was obviously not out of breath as we were having a normal conversation, my Pulse and BP refused to rise any further, I hadn't raised a drop of sweat, and my ankle was now in EXTREME pain, could we terminate the test without compromising the test result? We were at the 50 minute mark. A quick phone call to the Cardiologist (aka Josef Mengele), resulted in termination of the test.

Now, whilst I have written this post in a conversational tone, all of it is true.

My sincere question to those medically qualified respondants is "Do I have a problem? Maybe Hypotension?" It DOES concern me, as I am at the stage in life where pre-emptive measures in approaching geriatric management make a lot of sense.

FYI, Torture in Singapore (caning) is legal (ask Amnesty International).

Regards,

Old Smokey

[David Horn]

If you're 61, pushing for a heart rate of 180 is ludicrous in the first place IMHO. While there's quite some variance (+/- 20bpm IIRC) for predicting a safe maximum heart rate, a reasonable formula is 206.9 - (0.67 * age).

In your case this gives a maximum of 166. I'm not a doctor but my understanding is that there's not really such a thing as hypotension in someone who's healthy, provided you're not passing out every time you stand up. I'm 24 and it takes me a significant effort to reach 180 on a treadmill (the sort of I'd-better-stop-before-I-throw-up kind of effort).

Low blood pressure is probably accounted for by the vast amount of walking you do.


Source: Maximum Heart Rate (http://www.brianmac.co.uk/maxhr.htm)

[Old Smokey]

Thank you for the fast and informative reply David, and thank you for the link.

My "regular" AME in Singapore also disagrees with the 180 target, considering them ludicrous and dangerous.

No, I don't feel any light headedness or vertigo when suddenly standing, even though the lowest ever recorded BP for me was 102/68.

It must be remembered that in Singapore in the 90's, the Civil Aviation Medical Board mandated angiograms (which carry a mortality risk) for perfectly healthy pilots, it was all part of a survey you see ...........

Further comment welcome.

Regards,

Old Smokey

[clunckdriver]

Smokey, I am 71, still flying and dont smoke {never have} I also was a fair distance runner as a kid, I too have a very slow pulse and low BP, the difference being in Canada our flight surgeons seem to like this! Also I come from a gene pool who normally make it beyond 90 without too much sweat, I wonder sometimes if the medics really know what good or bad in our make up. {If I now drop dead on my snowshoes my wife will post and let you know!}

[Thames virtual]

No you don't have hypotension. At the age of 55 I've had a bp around 110/70 for years, and that's while living a pretty sedentary lifestyle. If your ECG is normal, then your lowish heart rate is the result of being fit.

and I agree a target of 180 is both ludicrous and dangerous.

Here's the UK CAA guidelines for exercise ECGs: http://www.caa.co.uk/docs/49/20030312BruceProtocol.pdf The Bruce protocol is explained in the British Medical Journal at ABC of clinical electrocardiography: Exercise tolerance testing (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123032/)

You'll see in the BMJ article that the target heart rate is described as
Maximum predicted heart rate

* By convention, the maximum predicted heart rate is calculated as 220 (210 for women) minus the patient's age
* A satisfactory heart rate response is achieved on reaching 85% of the maximum predicted heart rate
* Attainment of maximum heart rate is a good prognostic sign

so you need to achieve (220 - 61) * 0.85, which I reckon is 135 bpm

TV
(a paediatrician, but I do know a bit about the other end of the scale)

[gingernut]

You pilot chaps are hooked up on the figures aren't you?

Old Smokey, my best advice to you, if you want to live longer and better:

a) Choose better parents.
b) give up the fags.

Good health :-)

[Bob the Doc]

Wouldn't worry about that BP. The Bruce protocol is a stress ECG which is limited by changes in BP, HR and chest pain as well as ECG changes. Getting to a decent level is relatively reliable for excluding serious coronary insufficiency. The HR limit is a maximum that you should be allowed to attain, not a target. The test should be stopped if you exceed the maximum HR but you should not be beasted until you get to that target. Stopping a test due to ankle pain is a shame but if you have got far enough on the protocol before you have to stop then that should be fine.

Hypotension can be a problem for some people if they feel faint when they stand up or have a low G-tolerance for example but the blood pressure you describe is not desperately low and having a lowish BP and HR are usually good for you rather than harmful.

I would be reassured that the test was normal and try not to worry about it. Most athletes have low BP and HR. Miguel Indurain (Spanish Tour de France rider) had a resting HR of 28! No-one told him he needed to do something to bring it up. I bet he would have difficulty making his maximum HR on a treadmill (although he would be there and sustain it for 20km riding up the Mont Ventoux!)

Take care (and try and stop the fags!)

Bob

[Old Smokey]

Thank you all....

I'm about to head off on a 6 day pattern, and it would be remiss of me to fail to acknowledge and thank the positive respondants thus far. A sincere thank you to you all (maybe now that I'm not worried, my BP may drop a few points:}).

Ginge, thanks for your good advice. A bit late to choose parents, but Mum and Dad are 85 and 90 respectively, working, and in good health. Grandfather died at 102 after a hard days work, he smoked 60 a day.

I THOROUGHLY agree with you and others about giving up the fags, a 43 year habit is hard to break, but........ my AME (with tongue in cheek) says that giving up may lower my BP even further, to the point where my heart stops altogether. My advice to young people is QUIT! you don't want to end up like me.:ok:

Best Regards,

Old Smokey

[Pugilistic Animus]

I just called the Smoker's quit line; it's so HARD:{,..I'm trying,..actually quite althletic parameters; it seems :)

please do try OS,..I have the lozenges:bored:; my quit date is feb 4:eek:

[zlin77]

Just did a stress E.C.G. in Australia last week, The Cardiologist who is also the A.M.E. said that the target pulse is 90% of your max ( 220 minus age x .9), the protocol is normally an 11 minute routine at a fast walking pace with increasing gradient throughout, this is normally enough to bring your pulse up to the required rate, low resting pulse rates only become an issue below 50b.p.m......

[Old Smokey]

Thank you .........

A sincere thank you to all of the respondants who have put my mind (and my heart) at rest. I was not at all concerned at all by any feelings of "ill health" within myself, in fact I feel that I'm fitter than others of my age. My concern was that I had failed, and continue to fail, to reach the nominally required Pulse Rate and BP even under stress, and by a large margin, even under prolonged stress.

The centre where I did my stress ECG mostly handles Air Force pilots in their twenties, the 180 bpm 'target' does seem to fit the various formulae offered by posters within this thread, and perhaps they have a fixation on this figure.

Younger PPRuNers, do heed Gingernut's advice about smoking. I fully endorse his remarks, it's only luck and good fortune in the genetic lottery that has enabled me to enter advancing age with minimal side effects!

Regards,

Old Smokey

[Loose rivets]

Pushing a 61 year old to attain a 180 is sheer madness. If it had been in the UK I would have urged that some action be taken.

180, is what I recall astronauts reaching - while they're strapped to the biggest rocket in the world.

I think we all have to be a bit careful about some of the people we trust. I've been shocked at some of the 'treatment' that I and some of my family and friends have received in the name of medicine.

Having said this, I also have reason to be very grateful for British medicine. It's just the few that seem to let a mass of good professionals down.

I went to an Essex hospital to see a specialist about carpal tunnel syndrome, and he wired me to an antiquated machine, then proceeded to jolt my arm with ever increasing pulses of D.C. It didn't just bloody hurt...it :mad:ing hurt. He watched me for some time - seemed like an hour - then just made the comment that people like me, that worked with electrical stuff, were always more worried about 'getting a belt'. [Sic]

I have long thought that since I was displaying classic symptoms, the tests were quite without merit. Even had they had any validity in the first place. My (professor) son sort of concurred, though as usual he didn't say much - despite being an expert on picking up voltages from the skin. But what he did say substantiated my thoughts.

The bloke was either an idiot with a pre-war toy that he was proud of, or a sadist. Most horrible thought of all was that he will one day publish on pain thresholds, having used unwitting people like me. Preposterous? Doing it in the first place was preposterous.

On a lighter note, I gathered a crowd at Praed St when it was the Aviation medical centre. I nearly blew the needle off the table of the old cast-iron puffer machine, and they egged me on to try - time and time again - to see if I could do it. To give the machine its due, it was almost exactly the same every time. It was for their amusement/curiosity, but at least it was fun.

Another gaggle of medics surrounded my bed after eye surgery. They'd never seen an 80 over 40. Got a new machine and tried again. Then a barometric one. They told me not to even try to walk to the loo, but I assured them that I could have run home, if me eye hadn't been likely to fall out. I don't think I've ever had a medical without some comment about low BP and Pulse rate. I'd never considered
it being a problem.

Going to Spain gave me a source of Cuban cigars. I cared more about them than food. It was one hell of a job to give up, but it had to be done.

The statistics are there, and from 50 years on, I'm seeing more and more life-loving people being taken out by smoking. Worst still, those that don't die and lead a nightmare life of emphysema, nebulizers and Oxygen. It wrecked 30 + years of my mother's life, hanging on to furniture just to cross the room...etc., etc. She died at 93, of unrelated problems.

Just to guild the lilly, I wrote this - nearer to the time of my mother's demise. I'd just been talking to a surgeon in Colchester. He told of people that had lost a limb due to smoking, and had a wire thing made to hold their cigarette with the stump. Yes, there's a certain rage, but it's against the tabbaco processors, not the victims. One of my kids had been trying to give up for most of his life. He took $1,000 to his pal a while back. He'd lost the bet...again.

Hanging onto the furniture to help you get across the room. Looking at peoples winces as your lungs crackle so much that it makes them feel sick. Knowing that they really don't want you sitting at the meal table with them...but what can they do?

Seeing you families faces as they carry in the 02 bottles...for the third time that week. Then there's the Ventolin. Just see how you feel when your nebulizer busts, looking at all those vials lined up and no way to get the stuff into your lungs.

Wave your family goodby as they go on holiday...you won't be able to miss the other in-law that is included....the one with the SCUBA gear in his car. Fcuk him you'll say.

Years and years of wasted life, why won't the damn thing take you so that you can have some peace? It will, sometime soon after you notice lung tissue issuing out as you cough. Soon you will be drowning despite being in normal air.<<<

[manuel ortiz]

Hello Old Smokey,

Had an electro cardiogram yesterday, my pulse rate was 42.
Used to be as low as 38 when waking up a few years back.
Age 57

Dr was happy with all.

My father will be 100 next year and he also has a low pulse.

Cheers for the low HB´s!!

Manuel

[tommoutrie]

mines sky high

wanna team up and take the average?

[Pugilistic Animus]

'Cuz Real Pro's stay cool:cool:

:}:}:ok:

[Brit312]

A few years ago I did my stress ECG and was not too worried about it [ well perhaps a bit] . Anyway the machne starts up and every 3 minutes the speed increase and the inclination increased. Now I had be told by a friend that usually at about 12 minutes they stopped it,but in my case they just carried on ever faster and steeper. I queried this ,but like many of you I was told that I had not reached the required heart beats and " do Not run" and "do not hold onto the rails"

Well after 15 minutes I felt I could not move my little legs any quicker without running and I eventually fell off the back of the machine, much to the nurse's concern not in case I had hurt myself, but because I had still not reached the required heart beats.