Heart Rate Dropping While Exercising

[Imuspe]

I am a 50 y/o female that has been c/o fatigue; been more extreme since recent bout with viral gastroenteritis. I experienced some SOB and significant edema. Seen by a physician who ran some labwork which came back within normal limits, BNP was 253, she did give me lasix for a couple days for which I dropped 14.5 pounds in 2 days. She also ordered a cardiac echo and stress test for me.  Echo showed some regurgitation in the mitral and tricuspid valve but nothing to warrant further treatment and left atrium dilation, and I believe left ventricular end diastolic pressure elevation...again, told nothing to be concerned with.  I've had episodes in the past where my heart rate has dropped down to the upper 30's and then would come back up to 50-60 range.  I would say my normal resting HR has always been around 80.  So, since they labwork was good, the cardiac tests were fine, my PMD said my fatigue has to be my depression.  I personally don't think so but hey, I'll go with it for now.  I'm faithfully going to the gym and working out for 1-2 hours 4 days (or more) a week.  I work hard while I am there, riding bike for an hour, getting my HR from 130-150+.  During that hour though I will see my HR drop down to 60's and then down to the 40's.  It will stay there for maybe 3-5 minutes and slowly climb to 70 and then wham, I'm back up to the 130's again.  To me this does not seem normal.   I'm thinking this may be the reason for my fatigue with the HR fluctuating as it does and not my depression. They have resorted to giving me ritalin to take daily now just so I can function; I hate taking it but if I don't, I certainly wouldn't get anything done.    Am I off in thinking that 45 minutes into biking hard and my HR is running in the 40's?  I know nothing showed up in the 10 minutes of walking on the treadmill but I can't believe that captured the entire situation.  I am on no medications to cause lowering of the heart rate.  I do take lisinopril for my blood pressure but no beta blockers or others that would contribute to this.  I would be interested in hearing your thoughts on this.  Would you think a holter monitor be an appropriate thing?  If so, how do you get your PMD to do this when they are set on it being depression because nothing shows up in the labwork & the cardiac tests?   I do have hypothyroidism and idiopathic intracranial hypertension, type II diabetes (last A1c 5.9).

[Imuspe]

Thanks!  I am just not connecting with this physician.  She's nice enough individual but don't believe we're getting to the 'root of the problem' here.  I'm not real familiar with BNP and I know it's not extremely elevated as you mention with your daughters going upwards into the 8,000 but yet it is nearly 2-1/2 times what the average/normal reading should be in someone without any cardiac history.  Still thinking I would like to have a holter for a week so they can see what is happening while I'm exercising rather than base it on a 10 min. tops stress test that was done.  OK . . to find a new doc now.  All my good docs have left.

[Wisconsin2007]

I'd listen to grendslori on the BNP issue.  Unless the units being reported are different (picograms/ml), I think her advice is on.

I wouldn't take the heart rates seen on the exercise machines as anything but very rough estimates.  You need a better device to confirm (or as you said, manual verification).  But I think the advice you've received so far is probably your best bet.

[grendslori]

If you have been told that BNP has to be in the 1000s to be in heart failure, that's a NEW ONE TO ME! Every hospital, or should i say, every University hospital mewdical center, I know has a normal range of 0-100. They say the proof is in the pudding. No one loses 14+ pounds with depression issues after being given Lasix! I stand by what i say, Get a new doctor, before this one allows you to develop more heart failure issues! My own daughter was admitted for a BNP in the 800's range. Not once, twice! Over the next few days, her rates started going upwards close to 8000. But they admitted her while in the 800 range.

[Imuspe]

Heart Rate being measured while using the measurement tools on the equipment; those "grab bars" and confirmed with taking carotid pulse.

Told BNP not a concern unless in the 1,000's or higher for heart failure.  Tried to find out what else could possibly cause this mild elevation but have not found anything that would.

I've had a significant health history for neurological problems (VP/VA shunts) for the intracranial hypertension over the past 3 years and so maybe this has something to do with it; I don't know.  I'm not in full agreement that depression is the key here either.  Just needed to hear some feedback from others too.  Thanks.

[grendslori]

You need to see a new doctor!! A BNP is in the normal range between 0-100. Higher than that, you are in heart failure. Your doctor must have known that because she put you on Lasix to get rid of the body fluid that you had becuse your heart wasn't getting rid of the fluid. Your heart rates are all over the place! See a GOOD cardiologist who is going to take you seriously and not blame everything on depression.

[Wisconsin2007]

How is your heart rate being measured when you are on the exercise equipment?