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high heart rate

 
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Anonymous
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PostPosted: Tue Mar 29, 2005 11:27 am GMT +0000    Post subject: high heart rate Reply with quote

i've been cycling for over 2 years and i recently got a hr monitor. I have noticed that i have an extremely high hr compared to everyone around me. Before the ride i have seen my hr at 184. It's insane. I've done a little research and i know that some factors play a role in one's hr. I was nervous (it happens before a race or an intimidating ride). I also have EIA (exercise induced asthma) so i know that the inhaler (albuterol) plays a factor in that as well.

I haven't figured out my average hr or my resting hr.. but i'm sure it's prolly high. When i'm breathing fine and feeling good on the bike.. i'm usually at 150-160.

My questions are- Is this dangerous? Do i have a heart the size of a mouse? Very Happy I'm not overweight and im 30 yrs old.. but do i need to worry bout a heart attack from this?

Last weekend i climbed a steep hill for me and i looked at my hr and it was the highest i've ever seen it (200). I did that climb again bout an hour later and i guess my inhaler ran out cuz i had an asthma attack at the top of the hill.

My other question is.. if my heart rate is at 200 and i'm having an asthma attack..it's prolly smart not to inhale my albuterol, right? Should i just wait for my breathing to get normal on its own and not risk raising my hr to 210?

Thanks for any help and any recommendations!
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PostPosted: Tue Mar 29, 2005 1:33 pm GMT +0000    Post subject: Reply with quote

Don't ever compare your bodys workings to others. Climbing at 200bpm is normal for some. I climb lower and know people that climb lower than me. Look at Big Mig. I wouldn't consider it dangerous though. I don't know nothing on asthma. -wink
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Anonymous
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PostPosted: Tue Mar 29, 2005 2:17 pm GMT +0000    Post subject: Reply with quote

I also seem to have a higher heart rate than most. In races I have hit 212 a few times. I can ride comfortable for over an hour at 175. I don't really start feally it and breathing hard until the 190's.
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Nathan Winkelmann
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Joined: 01 May 2003
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PostPosted: Wed Mar 30, 2005 10:53 am GMT +0000    Post subject: Reply with quote

WOW! If I ever see 190, I'm like about to DIE. Lance hits 190ish too, but his is slow at rest and can beat like an african drummer in a drought thats over a year.
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The Bike Doc
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Joined: 08 May 2003
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PostPosted: Mon Apr 04, 2005 1:53 pm GMT +0000    Post subject: Reply with quote

BBrider:

I am back on line after a 10 day (much needed) vacation. Now in regards to your heart rate and asthma you have several questions and issues that you have raised.

First of all, what is normal for you, as has been addressed, may not be normal for someone else. Your max heart rate may be significantly higher or lower than someone else your age and size.

Yes, albuterol can raise your heart rate; however, DO NOT hold off taking your albuterol if you need it for an asthma attack. Your heart rate will be driven higher by an uncontrolled asthma attack more than by the effect of the albuterol used to bring in you asthma attack under control. If you are not getting relief from your albuterol inhaler, THIS IS A LIFE THREATENING EMERGENCY, GET IMMEDIATE MEDICAL ATTENTION!

DO see a doctor who is well versed in managing asthma, ideally a Pulmonologist (Lung Specialist). Excercise induced asthma should not limit your physical activity. Many a great professional athlete has asthma and they perform at world class levels. There are excellent medications that are available for you. Often patients with exercise induced asthma can benefit from daily preventative medication of inhaled anti-inflamatory medications, specifically inhaled corticosteroids. The inhaled corticosteroids available in the US are all WADA (World Anti-Doping Association) and USOC (United States Olympic Commitee) approved. There is a form available from the USOC web site that has to be filled out by your physician to use the approved drug. (BTW albuterol is also an approved drug but must be indicated on the appropriate form signed by your physician and there must be a diagnosis of asthma or exercise induced bronchospasms.) Inhaled corticosteroids are the only class of asthma medications that have been show to reduce the frequency and severity of life threatening asthma attacks in the long term. Individuals with even mild asthma have an equal probablity of having a fatal or near fatal asthma attack as those who have severe asthma. Inhaled corticosteroid at the doses commonly used do not have systemic side effects. So get to a Pulmonary doctor who will help you take control of your asthma and not have asthma control you. I tell you this not only as a doctor but as a patient who has asthma.

Thanks,
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Anonymous
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PostPosted: Tue Apr 05, 2005 8:58 am GMT +0000    Post subject: Reply with quote

thanks for the replies and advice! I'll be sure to keep my inhaler with me at all times when i ride and take it if i have an attack even when my hr is high.

I believe i have a mild case so this was new to me:

'individuals with even mild asthma have an equal probablity of having a fatal or near fatal asthma attack as those who have severe asthma.'

i also heard this weekend by 2 diff. people that to have a high hr is a good thing as long as u can recover?! go figure.

thanks,

bb
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The Bike Doc
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PostPosted: Tue Apr 05, 2005 11:11 am GMT +0000    Post subject: Reply with quote

BBrider:

I am not surprised this is news to you. The data has been available for years but it is not well known by many primary care physicians, that is why I recommend you get to a pulmonologist.

Here are PubMed summaries of four articles (there are many more), two describing fatal or near fatal asthma attacks occurring even in mild asthma sufferers and the two on the effect of low dose inhaled corticosteroids in preventing fatal or near fatal asthma attacks.

Ann Allergy. 1992 Aug;69(2):111-5.

Fatal and near fatal asthma.

Kunitoh H, Yahikozawa H, Kakuta T, Ono K, Hamabe Y, Kuroki H, Tsutsumi H, Tanaka T, Watanabe K, Awane Y, et al.

Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan.

Despite the recent development of apparently effective asthma drugs, the number of deaths from asthma has not declined. The authors tried to establish an optimal strategy for the prevention of acute asthmatic death by analyzing the circumstances of acute fatal or near-fatal asthma. Data were collected from 51 adult patients admitted to Bokutoh Tertiary Emergency Center due to acute asthma between November 1985 and May 1990 and 38 asthmatic patients admitted to Yokohama City Hospital in 1990. Pre-admission data were obtained through interviews with the patients, their families, or doctors who had seen them. A total of 89 patients were classified into three subgroups: group 1 consisted of
patients dead-on-arrival (DOA); group 2, non-DOA patients with disturbed
consciousness; and group 3, patients with less severe episodes. Little
background information was significantly different among groups, but symptomatic episodes in group 1 patients tended to occur more rapidly. The speed of onset of the episodes was also dependent on the asthma control status. Prehospital care of groups 1 and 2 patients was very poor despite severity of the symptoms. All patients in groups 2 and 3 were successfully treated and discharged, but five of the 26 patients in group 2 died during follow-up periods. Prognosis of patients after discharge appeared to be dependent upon asthma control status before the
acute episodes. It was concluded that acute fatal or near fatal asthma could occur in apparently low-risk patients as well as high-risk ones. It was also suggested that the optimal strategy for preventing asthma deaths might be variable.

PMID: 1510284


Pediatr Pulmonol. 1992 Jun;13(2):95-100.

Pediatric asthma deaths in Victoria: the mild are at risk.

Robertson CF, Rubinfeld AR, Bowes G.

Thoracic Medicine Department, Royal Children's Hospital, Parkville, Victoria, Australia.

Previous reviews of pediatric asthma mortality have mostly been from
hospital-based clinic populations and suggest that only those with severe asthma are most at risk. This report summarizes an investigation, by
interviewer-administered questionnaire, into the circumstances surrounding the death in all patients aged 20 years or less who died from asthma in the State of Victoria over a 3 year period from May 1, 1986. During this period, 51 deaths due to asthma were reported. Thirty-three percent of these were judged to have a history of trivial or mild asthma, and 32% had no previous hospital admission for asthma. However, 36% were judged to have had severe asthma, 43% were taking regular inhaled beclomethasone or sodium cromoglycate, and 10% were taking
regular oral steroids. Twenty-two percent had a previous admission to an ICU. Death occurred outside hospital in 40 (78%) subjects. In the final attack 63% had sudden onset and collapse within minutes, 12% were found dead, and 25% had acute progression of an established attack. The investigators assessed 39% of the deaths to have had potentially preventable elements. The preventable factors included: inadequate assessment or therapy of prior asthma (68%), poor compliance with therapy (53%), and delay in seeking help (47%). The majority of subjects in this survey could not be classified as "high risk." Therefore, clinicians should ensure that all young patients with asthma are aware of optimal maintenance management, can recognize deteriorating asthma, and follow a clear individualized crisis plan.

PMID: 1495863


N Engl J Med. 2000 Aug 3;343(5):332-6.

Low-dose inhaled corticosteroids and the prevention of death from asthma.

Suissa S, Ernst P, Benayoun S, Baltzan M, Cai B.

Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University
Health Centre, Montreal, QC, Canada. samy.suissa@clinepi.mcgill.ca

BACKGROUND: Although inhaled corticosteroids are effective for the treatment of asthma, it is uncertain whether their use can prevent death from asthma.
METHODS: We used the Saskatchewan Health data bases to form a population-based cohort of all subjects from 5 through 44 years of age who were using antiasthma drugs during the period from 1975 through 1991. We followed subjects until the end of 1997, their 55th birthday, death, emigration, or termination of health insurance coverage; whichever came first. We conducted a nested case-control study in which subjects who died of asthma were matched with controls within the cohort according to the length of follow-up at the time of death of the case patient (the index date), the date of study entry, and the severity of asthma. We calculated rate ratios after adjustment for the subject's age and sex; the number of prescriptions of theophylline, nebulized and oral beta-adrenergic agonists, and oral corticosteroids in the year before the index date; the number of canisters of inhaled beta-adrenergic agonists used in the year before the index date; and the number of hospitalizations for asthma in the two years before the index date.
RESULTS: The cohort consisted of 30,569 subjects. Of the 562 deaths, 77 were classified as due to asthma. We matched the 66 subjects who
died of asthma for whom there were complete data with 2681 controls. Fifty-three percent of the case patients and 46 percent of the control patients had used inhaled corticosteroids in the previous year, most commonly low-dose beclomethasone. The mean number of canisters was 1.18 for the patients who died and 1.57 for the controls. On the basis of a continuous dose-response analysis, we calculated that the rate of death from asthma decreased by 21 percent with each additional canister of inhaled corticosteroids used in the previous year (adjusted rate ratio, 0.79; 95 percent confidence interval, 0.65 to 0.97). The rate of death from asthma during the first three months after discontinuation of
inhaled corticosteroids was higher than the rate among patients who continued to use the drugs.
CONCLUSIONS: The regular use of low-dose inhaled corticosteroids is associated with a decreased risk of death from asthma.

PMID: 10922423

JAMA. 1992 Dec 23-30;268(24):3462-4.

Risk of fatal and near-fatal asthma in relation to inhaled corticosteroid use.

Ernst P, Spitzer WO, Suissa S, Cockcroft D, Habbick B, Horwitz RI, Boivin JF, McNutt M, Buist AS.

Department of Epidemiology, Montreal General Hospital, McGill University,
Quebec, Canada.

OBJECTIVE--To examine the relationship between patterns of use of inhaled beclomethasone dipropionate and the risk of fatal and near-fatal asthma.
DESIGN--Nested case-control analysis of a historical cohort; a further analysis.
SETTING--The 12,301 residents of Saskatchewan aged 5 to 54 years who were dispensed 10 or more asthma drugs from 1978 to 1987. PATIENTS--The 129 persons who experienced asthma death (n = 44) and near-death (n = 85) and their 655 controls matched as to age and date of entry into the cohort, with the additional matching criteria of at least one hospitalization for asthma in the prior 2 years, region of residence, and having received social assistance.
MAIN OUTCOME--Life-threatening attacks of asthma defined as death due to asthma or the occurrence of hypercarbia, intubation, and mechanical ventilation during an acute attack of asthma.
RESULTS--After accounting for the risk associated with use of other medications and adjustment for markers of risk of adverse events related to asthma, subjects who had been dispensed, on average, one or more metered-dose inhalers of beclomethasone per month over a 1-year period had a significantly lower risk of fatal and near-fatal asthma (odds ratio, 0.1; 95% confidence interval, 0.02 to 0.6).
CONCLUSION--These data support recent guidelines from several countries that recommend the use of inhaled corticosteroids in moderate and severe asthma.

PMID: 1460737

Thanks,
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