Heart rate after surgery

How to Keep Your Heart Healthy After Surgery

If you’re about to have surgery, anxiety could momentarily give you butterflies and make you feel as though your heart is racing. But the actual surgery can leave some people with a rapid pulse and heart fluttering, known as post-operative atrial fibrillation, or afib.

Most of the time, atrial fibrillation after surgery lasts just a short time — hours to days, says Shephal Doshi, MD, director of cardiac electrophysiology at Providence Saint John’s Health Center and a cardiac electrophysiologist at the Pacific Heart Institute in Santa Monica, California. But once you experience atrial fibrillation, you’re at an increased risk for having it again. It’s more likely to become a chronic condition within five years of your first episode, Dr. Doshi says.

Surgery can trigger this condition because of the stress it places on the body. “Any kind of stress to your system can cause atrial fibrillation,” says Smit Vasaiwala, MD, assistant professor of cardiology at Loyola University Medical Center’s Stritch School of Medicine in Maywood, and an electrophysiologist at the Center for Heart and Vascular Medicine at Loyola Gottlieb Memorial Hospital in Melrose Park, both in Illinois.

“Some types of surgery, notably heart surgeries, are more likely to cause afib than others, especially open heart surgery,” Dr. Vasaiwala says.

Atrial fibrillation occurs in from 5 to 40 percent of people who undergo coronary artery bypass graft surgery, according to a study published in 2012 in the Avicenna Journal of Medicine. Another study of 229 people who had coronary artery bypass surgery found that nearly 25 percent experienced an episode of atrial fibrillation afterward. Those findings were published in September 2014 in the journal Heart, Lung and Vessels.

Afib is common after heart valve replacement surgery, too. It occurred in more than 40 percent of participants who had aortic valve replacement surgery, according to a study published in April 2014 in the Journal of the American College of Cardiology.

Advanced age is another risk factor for atrial fibrillation. About 25 percent of people over age 85 who have abdominal surgery experience afib, according to a study published in January 2015 in the World Journal of Surgery. Having chronic obstructive pulmonary disease (COPD) and being obese also increase the risk for post-op afib, Vasaiwala says.

How to Reduce Your Risk for Atrial Fibrillation After Surgery

Because overall heart health plays a role in developing atrial fibrillation after surgery, Doshi wants his patients to be as healthy as possible before surgery. “A significant amount of atrial fibrillation treatment is prevention,” he says. “We may be able to adjust their medications and get them in the best shape prior to surgery.”

Work with your doctor to plan a healthier diet and improve your physical conditioning with exercise, the American Academy of Orthopaedic Surgeons suggests.

Here’s what else you can do to reduce your risk for atrial fibrillation:

  • Ask your doctor about post-op pain relief. Research suggests that pain may trigger a response that contributes to post-op irregular heartbeats, according to a study published in 2011 in the journal ISRN Cardiology.
  • Ask your doctor about your pre-op blood test results. The same study found that anemia (an iron deficiency), an electrolyte imbalance, and elevated blood sugar levels could be risk factors for post-op atrial fibrillation.

RELATED: A Surgeon Gets Back Into Rhythm After Her Atrial Fibrillation

Taking Care of Atrial Fibrillation After Surgery

While in recovery following heart or other surgery, you’re likely to be on a heart monitor so that the nursing staff can check you for atrial fibrillation by looking for a heart rate that’s over 160 beats per minute (normal is 60 to 100 beats per minute, according to the American Heart Association). Most people can feel if their heart flutters and their pulse races. But some, exhausted from surgery, may not, Doshi says. That’s why patients are closely monitored.

Most of the time, post-operative afib goes away by itself. If not, you may need to take medication to control both heart rate and heart rhythm.

Your doctor also may give you a blood thinner to prevent a stroke, which is the biggest concern with afib. Blood thinners prevent clots that can form and break off, causing a stroke. But depending on the type of surgery you had, your doctor may need to wait — for your safety — before prescribing a blood thinner. The wait can vary from a day to a week or so, Doshi says.

Depending on the extent of the afib, your heart might need to be shocked back into normal rhythm with a procedure known as cardioversion, notes the Heart and Vascular Institute at Johns Hopkins Medicine in Baltimore.

Afib Awareness Results in Risk Reduction

If you have risk factors for afib — such as high blood pressure, a heart condition, or hyperthyroidism — and are planning any kind of surgery, discuss it with your doctor.

Once home from the hospital, call your doctor right away if you experience atrial fibrillation signs and symptoms. Don’t wait for your follow-up appointment, Vasaiwala stresses.

Know the Symptoms of Atrial Fibrillation

According to the American Heart Association, symptoms may include:

  • Quivering, fluttering, or thumping heartbeat
  • General fatigue or fatigue when exercising
  • Fast, irregular heartbeat
  • Dizziness, faintness, and weakness
  • Shortness of breath, anxiety
  • Sweating
  • Chest pain or pressure in the chest

What should I expect during open heart surgery?

A person undergoing open heart surgery will need to stay in the hospital for 7 – 10 days. This includes at least a day in the intensive care unit immediately after the operation.

Preparing for the surgery

Preparation for open heart surgery starts the night before. A person should eat an evening meal as usual but must not consume any food or drink after midnight.

It is a good idea to wear loose, comfortable clothing to assist with restricted movement following surgery, but wear whatever is comfortable.

Be sure to have all personal medical information on hand. This might include a list of medications, recent illness, and insurance information.

It is normal to feel anxious before an anesthetic, and people should not hesitate to seek reassurance from the healthcare team.

The doctor may request that the person washes their upper body with antibacterial soap. A member of the healthcare team may need to shave the person’s chest area before they can have the anesthetic.

The doctors may also need to run tests before surgery, such as monitoring the heart or taking blood samples. A doctor or nurse might place a line into a vein to enable the delivery of fluids.

After the medical team has completed the preliminary tasks, the anesthesiologist will administer general anesthesia.

During the operation

The length of time it takes to carry out open heart surgery depends on the type of procedure and the needs of the individual. As a guide, the National Heart, Lung, and Blood Institute (NHLBI) state that a coronary artery bypass takes 3 to 6 hours.

To access the heart, the surgeon makes a 6-to-8-inch incision along the middle of the chest. The cut will go through the breastbone.

The medical team might use a heart-lung bypass machine during the surgery. This involves stopping the heart from beating. The bypass machine takes over the heart’s pumping action and removes blood from the heart via tubes. The machine then removes carbon dioxide from the blood, adds oxygen, and returns the blood to the body. This surgery is called “on-pump” surgery.

Sometimes, a surgeon might work “off-pump.” When a bypass machine is not in use, the person’s heart keeps beating. A member of the surgical team uses a device to steady the heart while the surgeon performs the procedure.

There is insufficient evidence to confirm whether on-pump open heart surgery is safer than off-pump surgery. However, according to the National Institute for Health and Clinical Excellence (NICE), survival rates 1 year after either form of open-heart surgery are similar at about 96–97 percent.

Who is in theater for open heart surgery?

A team of doctors and other health professionals work together in the operating theater during open heart surgery.

The team is likely to include:

  • the lead surgeon who will direct others surgeons who will assist during the operation
  • the anesthesiologist, who is in charge of giving and anesthesia and monitoring vital signs
  • the pump team, also known as perfusionists, operate the heart-lung machine and other technical equipment that supports open heart surgery
  • nurses and technicians, who assist the surgical team and prepare the operating theater for surgery

Beta-blockers to prevent death or serious events after surgery not involving the heart

This review assessed evidence from randomized controlled trials (RCTs) on whether beta-blockers reduce deaths or other serious events when given to people undergoing surgery other than heart surgery. The findings for heart surgery are covered in another review.

Background

Surgery increases stress in the body, which responds by releasing the hormones adrenaline and noradrenaline. Stress from surgery can lead to death or other serious events such as heart attacks, stroke, or an irregular heartbeat. For surgery that does not involve the heart, an estimated 8% of people may have injury to their heart around the time of surgery. Beta-blockers are drugs that block the action of adrenaline and noradrenaline on the heart. Beta-blockers can slow down the heart, and reduce blood pressure, and this may reduce the risk of serious events. However, beta-blockers may lead to a very low heart rate or very low blood pressure which could increase the risk of death or a stroke. Prevention of early complications after surgery is important, but using beta-blockers to prevent these complications is controversial.

Study characteristics

The evidence is current to 28 June 2019. We included 83 RCTs with 14,967 adults who were undergoing different types of surgery other than heart surgery. Eighteen studies are awaiting classification (because we did not have enough details to assess them), and three studies are ongoing. The types of beta-blockers used in the studies were: propranolol, metoprolol, esmolol, landiolol, nadolol, atenolol, labetalol, oxprenolol, and pindolol. Studies compared these beta-blockers with either a placebo (disguised to look like a beta-blocker but containing no medicine) or with standard care.

Key results

Beta-blockers may make little or no difference to the number of people who die within 30 days of surgery (16 studies, 11,446 participants; low-certainty evidence), have a stroke (6 studies, 9460 participants; low-certainty evidence), or experience ventricular arrhythmias (irregular heartbeat rhythms, starting in the main chambers of the heart, that are potentially life-threatening and may need immediate medical treatment; 5 studies, 476 participants; very low-certainty evidence). We found that beta-blockers may reduce atrial fibrillation (an irregular heartbeat, starting in the atrial chambers of the heart, that increases the risk of stroke if untreated; 9 studies, 9080 participants; low certainty-evidence), and the number of people who have a heart attack (12 studies, 10,520 participants; low-certainty evidence). However, taking beta-blockers may increase the number of people who experience a very low heart rate (49 studies, 12,239 participants; low-certainty evidence), or very low blood pressure (49 studies, 12,304 participants; moderate-certainty evidence), around the time of surgery.

In a few studies, we also found little or no difference in the number of people who died after 30 days, who died because of a heart problem, or had heart failure. We found no evidence of whether beta-blockers alter the length of time in hospital.

No studies assessed whether people who were given beta-blockers had a better quality of life after heart surgery.

Certainty of the evidence

The certainty of the evidence in this review was limited by including some studies that were at high risk of bias, and we noticed that some of our findings were different if we only included placebo-controlled studies or studies that reported how participants were randomized. We also found one large, well-conducted, international study that had different findings to the smaller studies. It showed a reduction in heart attacks and an increase in stroke and all-cause mortality when beta-blockers were used, whilst the other studies did not show a clear effect. We were also less certain of the findings for outcomes with few studies, such as for ventricular arrhythmias.

Conclusion

Although beta-blockers may make little or no difference to the number of people who die within 30 days, have a stroke, or have ventricular arrhythmias, they may reduce atrial fibrillation and heart attacks. Taking beta-blockers may increase the number of people with a very low heart rate or very low blood pressure around the time of surgery. Further evidence from large, placebo-controlled trials is likely to increase the certainty of these findings, and we recommend the assessment of impact on quality of life.

Progress is a huge motivator – and paying attention to your resting heart rate is an excellent way to gauge how your aerobic fitness is improving.

Measure it regularly to see long-term progress and daily fluctuations that can tell you whether you’re fit for training, overtrained or stressed. Read more about how to measure your resting heart rate.

A normal value for an adult is between 60 and 80 beats per minute. If you’re fit, your resting heart rate can be significantly lower than that. To find out what’s your lowest resting heart rate, the best moment to measure it is in the morning after a rest day. After strenuous exercise, your sympathetic nervous system will be active and your resting heart rate higher. There are also several factors that affect your heart rate while exercising.

If you notice changes in your resting heart rate, read through this list and see if there’s something that could explain the said changes.

Age

Resting heart rate usually increases with age. This is mainly due to the decline of physical fitness.

State of training

Your sympathetic nervous system is more active during recovery than when you’re well recovered. Also the hormonal state (adrenaline) and the recovery processes of your body keep your heart rate up for several hours after training.

If your resting heart rate is elevated, your body could be in a state of overtraining due to too much training and too little recovery.

Training background

When you do aerobic training long enough, your heart will become more efficient. The capacity of your left ventricle will increase and your ventricular muscles will become stronger which leads to an increased stroke volume. That is, your heart will pump more blood per beat than before.

When you do aerobic training long enough, your heart will become more efficient.

This increased stroke volume can be observed as a lower resting heart rate as well as a lower training heart rate. Perfectly logical, right? To pump the same amount of blood, your heart needs fewer beats because the volume per beat has increased.

Note that extensive strength training that aims to increase muscle mass elevates the resting heart rate – especially if the aerobic fitness deteriorates simultaneously.

Temperature

As the temperature rises, so does the need to cool the body down.

In higher temperatures, blood flow is directed closer to the surface of the skin so that blood can be cooled down. Your heart beats faster to accelerate your blood circulation and so regulate your body temperature.

Conversely, when you’re in a cooler environment, the blood circulation in peripheral parts of the body decreases. Your heart has less work to do and your resting heart rate will decrease.

Dehydration

When you’re dehydrated, the amount of plasma in the blood decreases. Because there’s less blood in your body, your heart has to pump faster than normally to maintain an adequate body temperature and to provide enough oxygen and nutrients to muscles in peripheral parts of the body.

This is why your resting heart rate tends to go up when you’re dehydrated.

Stress

Mental or physical stress increases the activity of the autonomic nervous system.

When under stress, the central nervous system orders the heart, as well as your brain and large muscles, to prepare for a fight-or-flight situation. This leads to an increase in your resting heart rate.

State of mind

Different emotions affect the autonomic nervous systems through hormonal activity.

When you’re very calm, the activity of the autonomic nervous system lowers your heart rate. When you’re very excited, your heart rate goes up.

So by controlling your emotions you can also control your resting heart rate indirectly.

Genetics

Your genome is one of the most important factors affecting the resting heart rate. The effect of genes on the resting heart rate can be seen as a difference of more than 20 beats per minute in two persons of the same age and level of fitness.

But my mom/brother/friend/neighbor…

You shouldn’t compare your resting heart rate with someone else’s. You’re unique and beautiful and that’s how it should be. While your neighbor’s resting heart rate might be lower than yours, it might be for a dozen different reasons.

Instead of comparing yourself to others, you’re better off monitoring how your resting heart rate is changing over time. When your resting heart rate decreases as a result of training, it’s a sign that your aerobic fitness has improved.

Take that, neighbor.

If you liked this post, don’t forget to share so that others can find it, too.

Share: Twitter Facebook Pinterest LinkedIn WhatsApp

Or give it a thumbs up!
I like this article You liked this article Thanks!

Please note that the information provided in the Polar Blog articles cannot replace individual advice from health professionals. Please consult your physician before starting a new fitness program.

Tachycardia refers to a heart rate that’s too fast. How that’s defined may depend on your age and physical condition.

Generally speaking, for adults, a heart rate of more than 100 beats per minute (BPM) is considered too fast.

View an animation of tachycardia.

Types of tachycardias

Atrial or Supraventricular Tachycardia (SVT)

Atrial or supraventricular tachycardia (SVT) is a fast heart rate that starts in the upper chambers of the heart. Some forms of this particular tachycardia are paroxysmal atrial tachycardia (PAT) or paroxysmal supraventricular tachycardia (PSVT).

With atrial or supraventricular tachycardia, electrical signals in the heart’s upper chambers fire abnormally. This interferes with electrical impulses coming from the sinoatrial (SA) node, the heart’s natural pacemaker.

The disruption results in a faster than normal heart rate. This rapid heartbeat keeps the heart’s chambers from filling completely between contractions, which compromises blood flow to the rest of the body.

A profile for atrial or SVT

In general, those most likely to have atrial or supraventricular tachycardia are:

  • Children (SVT is the most common type of arrhythmia in kids)
  • Women, to a greater degree than men
  • Anxious young people
  • People who are physically fatigued
  • People who drink large amounts of coffee (or caffeinated substances)
  • People who drink alcohol heavily
  • People who smoke heavily

Atrial or SVT is less commonly associated with heart attack or serious mitral valve disease.

Symptoms and complications

Some people with atrial or supraventricular tachycardia may have no discernible symptoms. Others may experience:

  • Fainting (syncope)
  • Lightheadedness or dizziness
  • Rapid heartbeat or palpitations
  • Fluttering in the chest
  • Bounding pulse
  • Chest pressure, tightness or pain (angina)
  • Shortness of breath
  • Fatigue

In extreme cases, those suffering with atrial or SVT may also experience:

  • Unconsciousness
  • Cardiac arrest

Treatment for Atrial or SVT

If you have atrial or SVT, it’s possible that you won’t need treatment.

But if the episodes are prolonged, or recur often, your doctor may recommend treatment, including:

  • Carotid sinus massage: A healthcare professional can apply gentle pressure on the neck, where the carotid artery splits into two branches.
  • Pressing gently on the eyeballs with eyes closed. Caution: This procedure should be supervised carefully by a healthcare physician.
  • Valsalva maneuver: This consists of holding your nostrils closed while blowing air through your nose.
  • Using the dive reflex: The dive reflex is the body’s response to sudden immersion in water, especially cold water.
  • Sedation
  • Cutting down on coffee or caffeinated substances
  • Cutting down on alcohol
  • Quitting tobacco use
  • Getting more rest

In patients with Wolfe-Parkinson-White Syndrome, medications or ablation may be needed to control paroxysmal supraventricular tachycardia (PSVT).

Sinus Tachycardia

Sinus tachycardia is a normal increase in the heart rate. In this condition, the heart’s natural pacemaker, the sinoatrial (SA) node, sends out electrical signals faster than usual.

The heart rate is faster than normal, but the heart beats properly.

Causes of sinus tachycardia

A rapid heartbeat may be your body’s response to common conditions such as:

  • Anxiety
  • Fright
  • Severe emotional distress
  • Strenuous exercise
  • Fever
  • Some medicinal and street drugs

Other, less common causes may include:

  • Anemia
  • Increased thyroid activity
  • Heart muscle damage from heart attack or heart failure
  • Severe bleeding

Approach to treatment

Your doctor should consider and treat the cause of your sinus tachycardia, rather than just treating the condition. Simply slowing the heart rate could cause more harm if your rapid heartbeat is a symptom of a more serious or long-term problem.

Ventricular Tachycardia

Ventricular tachycardia is a fast heart rate that starts in the heart’s lower chambers (ventricles). This type of arrhythmia may be either well-tolerated or life-threatening, requiring immediate diagnosis and treatment.

The seriousness depends largely on whether other cardiac dysfunction is present and on the degree of the ventricular tachycardia.

Explaining the problem

In cases of ventricular tachycardia, electrical signals in the heart’s lower chambers fire abnormally. This interferes with electrical impulses coming from the sinoatrial (SA) node, the heart’s natural pacemaker.

The disruption results in a faster than normal heart rate. This rapid heartbeat keeps the heart’s chambers from filling completely between contractions, which compromises blood flow to the rest of the body.

Causes of ventricular tachycardia

Ventricular tachycardia is most often associated with disorders that interfere with the heart’s electrical conduction system. These disorders can include:

  • Lack of coronary artery blood flow, depriving oxygen to heart tissue
  • Cardiomyopathy distorting the heart’s structure
  • Medication side effects
  • Illicit drugs such as cocaine
  • Sarcoidosis (an inflammatory disease affecting skin or body tissues)

Range of symptoms

Symptoms for ventricular tachycardia vary. Common symptoms include:

  • Dizziness
  • Palpitations
  • Shortness of breath
  • Nausea
  • Lightheadedness
  • Falling unconscious
  • Cardiac arrest, in extreme cases

Treatment options

The cause of your ventricular tachycardia will inform your treatment options. Possible approaches include:

  • Medication
  • Radiofrequency ablation
  • Surgery
  • Immediate electrical defibrillation, in extreme cases

Understanding Changes in Resting Heart Rate

Robert J. Myerburg, MD, is a professor at the University of Miami Miller School of Medicine who for 31 years served as chief of the school’s division of cardiology. “We have known for a long time that a higher heart rate is associated with increased risk for heart disease,” he says.

The people in the new study were healthy, he points out. The new study findings may not apply to people with heart disease.

Don’t panic about these findings, says Kousik Krishnan, MD. He is director of the Arrhythmia Device Clinic at Rush University Medical Center in Chicago. “People who have a heart rate that goes up over time may have some other underlying condition,” he says. “If you have a resting heart rate that is over 100, ask your doctor to do a physical exam to see if something else is going on.”

Suzanne Steinbaum, DO, says the study provides empowering information. She is a preventive cardiologist at Lenox Hill Hospital in New York City. “Resting heart rate gives us an indication about our heart health,” she says. “The best way to keep your resting heart rate down is aerobic exercise.”

This means that if your resting heart rate is edging up, your activity level has probably taken a dive. “You are still in control,” she says. “Start exercising more and see a doctor to make sure something else isn’t going on.”

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *