Does reaching 130 bpm during exercise increase stroke risk?

Question

Hello doctor,

I am a 76-year-old woman, weighing 121 pounds with a BMI of 20. The results from my annual wellness check-up are as follows:

Coronary calcium scan: LMA 0 HU, LAD 185 HU, LCX 1 HU, RCA 90 HU, Total: 276 HU.
Routine wellness EKG summary: Aortic valve thickened and calcified. Normal mitral valve with mild mitral regurgitation. Mild cuspid regurgitation. Mildly increased PASP. Physiologic pulmonic regurgitation.
Arterial Doppler of legs: Normal flow and pulse.
Medication: Irbesartan 150 mg only.

Without medication, my blood pressure varies between 120/70 mmHg and 155/80 mmHg, making it labile. I take Irbesartan to stabilize it, and with the medication, it is nearly always 120/80 mmHg.

Additional data: I was a smoker for 19 years but quit 24 years ago. Genetic data analysis suggests a high risk for coronary heart disease (CHD).

Exercise: I began exercising two to three times a week about six months ago, engaging in 60 to 100 minutes of aerobic exercise and weight training. On the treadmill, I aim to keep my pulse at 90 percent of my maximum (targeting 130 bpm). However, my heart rate reaches that target within six minutes of walking at 3.73 mph and often goes up to 135 bpm, at which point I slow down to bring it back down. My recovery time to drop 12 bpm is 75 seconds.

Question: Am I at risk of a stroke by pushing myself beyond 130 bpm (90 percent) even if only for a short period? Should I regularly see a cardiologist?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

Firstly, in response to your queries, you should visit a cardiologist regularly and avoid strenuous activities to reduce the risk of acute coronary syndrome. Your echocardiogram shows some abnormalities that are age-related, and there is no evidence of coronary artery disease (CAD). However, your calcium score is elevated, indicating a significant risk of CAD, likely in the early stages, as you do not experience any symptoms during the treadmill test.

Nevertheless, even minor plaques may rupture and lead to acute coronary syndrome (ACS). Therefore, you should avoid strenuous activities and consider taking both antiplatelet medications like Aspirin and statins. Additionally, you should undergo a stress test, such as a stress thallium test, stress echocardiogram, or treadmill test.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

You may discuss with your local cardiologist about the appropriate antiplatelets. Also, until your evaluation is complete, activities lasting more than 30 to 40 minutes continuously or reaching more than 90 percent of your maximum heart rate should be avoided.

I hope this helps you.

Thank you.