Fast Heartbeat Post MV Repair

[Shanon__0__0]

Posted by Shannon on August 03, 1999 at 11:22:29
Hi -- I'm trying to understand why, at 12 weeks post op from MV and PFO repair, my heart rate went from a normal speed of about 75 to a constant rate of about 110.  Also started having short tachycardias lasting 2 minutes at 180-200 BPM (which I hadn't had since last January, 2 months pre op).  There is some question as to whether the hardware (Duran ring and patch on PFO) could have shifted in some way, and I'm scheduled for a TEE to check this on Thursday.
My doc is trying me on medications to lower the rate, but my blood pressure started out low, and now is the 90/55 range much of the time from either calcium channel or beta blockers (we're trying different regiments of medication). So of course I'm dizzy a lot of the time.  If I understand it correctly, my cardiologist thinks that medications may keep the rate more normal and effectively "reset" my heart rate so that I can come off medications in a few months.
I just don't understand what could cause my HR to jump up to over 100 at 12 weeks post op, when I was pretty much healed and on my way back to real life.  It's really quite upsetting and no one seems to be able to give me any reasons why it has happened.  Can you help me with this?
Thanks very much --
Shannon

Posted by CCF CARDIO MD - CRC on August 03, 1999 at 13:44:10
I kind of doubt it is from the surgery. There are many causes of tachycardia  (fast heart beat) and they can be divided roughly into sinus (originating from the sinus node or heart’s natural pacemaker) and non-sinus tachycardias.  Nonsinus tachycardias are either  supraventricular (coming from the upper chambers of the heart) or ventricular (coming from the lower chambers of the heart).  Supraventricular tachycardias include:  paroxysmal supraventricular tachycardia, atrial flutter, atrial fibrillation and AV nodal tachycardia. Ventricular tachycardias are more serious in nature and are due to a rapid depolarization of  the ventricles.  
Sinus tachycardia is defined as a heart rate of greater than 100 beats per minute originating from the sinus node.  Sinus tachycardia is classified as either appropriate or inappropriate.  There are many causes of appropriate sinus tachycardia such as exercise, anxiety, panic attacks, dehydration, deconditioning, volume loss due to bleeding or other loss of body fluids, hyperthyroidism, electrolyte abnormalities and many other conditions.
Inappropriate sinus tachycardia can only be diagnosed when all causes of appropriate sinus tachycardia have been ruled out.  It is not clear what causes inappropriate sinus tachycardia but possible etiologies are an increase in the rate at which the sinus node depolarizes and an increased sensitivity to adrenaline.  
Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
Posted by shannon on August 03, 1999 at 14:15:26
Okay, I understand your comments.  Having done a great deal of research and having some medical background, I can recite chapter and verse on various rhythm disturbances, etiology/causes, treatments etc.  It's just that my history doesn't fit any of the descriptions.
My heart rate problem has been ruled IST.  All other possible causes ruled out & EP study done.  
What I don't understand still is what would cause a change in the rate at 12 weeks post op.  I never had heart rate problems until just before I had surgery.  I'm 45 years old, athletic (I skate 10 to 15 hours per week), and it seems a little farfetched to call this problem "underlying" to the valve problem.  
There seems to be some logical "cause and effect," e.g., I had open heart surgery to repair a faulty valve and a PFO, and came out of  it with a speedy heart rate.  How can these events not be connected?  Also, if it's adrenaline related, is there a way to reduce or regulate adrenaline to reduce the heart rate and avoid being on long term medications?
I'm sorry if I'm being dense here.  It just makes no logical or intuitive sense at all.
Shannon

Posted by CCF CARDIO MD - CRC on August 04, 1999 at 09:19:15
I don't think you're being dense, it's just that I can't think of any way that the surgery could cause IST.  I think there is a good possibility this will resolve on its own.  I'm not sure there are ways to reduce adreneline but exercise in general should be good for this problem.  Medications are another option if this fails to resolve on its own.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.