Clinical Significance Of Arrhythmias
Arrhythmias following cardiothoracic surgery are thought to result from direct mechanical irritation of the pericardium or myocardium. Obviously, such a mechanism cannot account for the observed incidence in major non-cardiothoracic surgery. Surgery and anaesthesia produce a stress response characterised by increased sympathetic and hormonal activity16,17 which may predispose the patient to arrhythmias. However, activation of inflammatory pathways may account for some of the arrhythmias. Recent data suggest that atrial fibrillation may be triggered and maintained by an inflammatory mechanism.18 The use of cardiopulmonary bypass is associated with a systemic inflammatory response and activation of the complement cascade that may result in arrhythmias.19 Similar inflammatory responses are observed after major non-cardiothoracic surgery.20,21 Arrhythmias occur most often in the first 4 days after surgery5,8, co-inciding with the period of maximal inflammatory response.19
ARRHYTHMIAS AND SEPSIS
ARRHYTHMIAS AND OTHER CARDIAC COMPLICATIONS
ARRHYTHMIAS AND BIOCHEMICAL DISTURBANCES
OTHER COMPLICATIONS
Other complications reported to co-exist in arrhythmia patients include peritonitis,7,12 anaemia,7 cardiac tamponade,7 hypoxia,7 wound infection,8 urinary tract infection,8 cerebrovascular accident,8 pulmonary emboli,6,8,13 and gastrointestinal bleeding.8
EFFECT ON OUTCOME
CLINICAL COURSE OF ARRHYTHMIAS
PRE-OPERATIVE RISK FACTORS
Postoperative Arrhythmias After Cardiac Surgery: Incidence Risk Factors And Therapeutic Management
Giovanni Peretto
Abstract
Arrhythmias are a known complication after cardiac surgery and represent a major cause of morbidity, increased length of hospital stay, and economic costs. However, little is known about incidence, risk factors, and treatment of early postoperative arrhythmias. Both tachyarrhythmias and bradyarrhythmias can present in the postoperative period. In this setting, atrial fibrillation is the most common heart rhythm disorder. Postoperative atrial fibrillation is often self-limiting, but it may require anticoagulation therapy and either a rate or rhythm control strategy. However, ventricular arrhythmias and conduction disturbances can also occur. Sustained ventricular arrhythmias in the recovery period after cardiac surgery may warrant acute treatment and long-term preventive strategy in the absence of reversible causes. Transient bradyarrhythmias may be managed with temporary pacing wires placed at surgery, but significant and persistent atrioventricular block or sinus node dysfunction can occur with the need for permanent pacing. We provide a complete and updated review about mechanisms, risk factors, and treatment strategies for the main postoperative arrhythmias.
1. Introduction
Arrhythmias are very common complications after cardiac surgery and represent a major source of morbidity and mortality. Atrial tachyarrhythmia are the most common postoperative heart rhythm disorder. Ventricular arrhythmias and bradyarrhythmias are less frequent .
Surgery For Atrial Fibrillation: Types Risks And More
What is atrial fibrillation?
Atrial fibrillation is a condition that involves an abnormal heartbeat, or arrhythmia. In normal sinus rhythm, the upper and lower chambers of your heart beat synchronously to pump blood. In A-fib, the electrical signals that coordinate the two chambers of your heart dont work together as they should. This causes your heart to contract erratically. As a result, your heart beats too fast, two slow, or irregularly.
A-fib can happen on a single occasion. In this case, you probably wont need treatment. But if you develop chronic A-fib, you will need treatment. If left untreated, it can lead to dangerous problems. According to the Cleveland Clinic, it can increase your risk of stroke by five to seven times. When youre experiencing A-fib, blood can pool in your atria rather than pump out regularly. This can cause blood clots to form, which can lead to stroke. Your heart tissue may also become damaged, which can eventually lead to heart failure.
Symptoms of A-fib include:
- shortness of breath
In some cases, it doesnt produce any noticeable symptoms.
If you develop chronic A-fib, there are many ways you can treat it, starting with lifestyle changes. Your doctor will likely advise you to quit smoking and follow a heart-healthy diet. They may also prescribe medications to help your heart function more efficiently. In more severe cases, they may recommend surgery.
Learn about the different types of surgery used to treat A-fib.
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What Do Heart Palpitations Feel Like
Heart palpitations can feel like your heart is racing, pounding or even missing a beat. You can have this feeling in your chest, but also in your neck or throat.
Symptoms of palpitations are more likely to be related to an abnormal heart rhythm if you have:
- Significant risk factors for heart disease.
- An abnormal heart valve.
What Happens With Afib
Your heart pumps blood to your body through contractions in the upper, then lower chambers of the heart. The hearts electrical system controls the speed at which your heart contracts. Most peoples heart rates are between 60 and 100 beats per minute.
But sometimes a series of rapid, chaotic pulses misdirect your hearts rhythm. When this happens, the chambers cant contract effectively and blood isnt squeezed out properly.
Afib can occur sporadically or persistently. If it happens once, its more likely to happen again at a later time.
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Are There Any Side Effects To Anesthesia For Atrial Fibrillation
In general, the risks associated with anesthesia are very low.
On the other hand, because cardiac surgery is very complex, and the patients who come in are not in peak health, there is some risk. Side effects include a few reactions to narcotics such as nausea and vomiting. Combined with surgery, the drugs can also result in shivering and some mental confusion. All these generally clear up for patients very quickly.
What Is Atrial Fibrillation
Atrial fibrillation is a specific type of irregular heartbeat where the upper chambers of the heart beat out of sync with the lower chambers. A patient might notice symptoms such as irregular heartbeat, heart palpitations, shortness of breath, fatigue, and weakness. Some types of arrhythmias are chronic, but post-operative AFib often resolves on its own by the time the chest heals.
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How Are Heart Palpitations Diagnosed
Keep track of your heart palpitations. Note the following:
- When they happen.
You may need to wear a monitor after you go home so your doctor can get more information about your heart and symptoms.
Other tests to check for a heart problem include an electrophysiology study and cardiac catheterization. You may also need to see an electrophysiologist .
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.
Heres 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 electrolyte imbalance, and elevated blood sugar levels could be risk factors for post-op atrial fibrillation.
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How Do I Get Ready For A Maze Procedure
To make sure you are healthy enough for this open-heart surgery, you may need some tests:
- Electrocardiogram, also called an ECG or EKG, to assess the heart rhythm
- Echocardiogram, or echo, to assess heart structure and function
If you are scheduled for a maze procedure, your surgeon will give you specific instructions, including:
- Avoid eating or drinking anything after midnight the day of surgery.
- Stop smoking before the procedure.
- Stop taking certain medications beforehand, particularly blood thinners.
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How Many Years Can A Person Live After Bypass Surgery
In fact, the survival rate for bypass patients who make it through the first month after the operation is close to that of the population in general. But 8-10 years after a heart bypass operation, mortality increases by 60-80 per cent. This is new and important knowledge for the doctors who monitor these patients.
How long can heart palpitations last?
Heart palpitations are common, and they often last for a few seconds. The tips listed above can help to stop palpitations and reduce their occurrence. Speak to a doctor if the sensation lasts for longer than a few seconds. This may indicate an underlying condition that requires treatment.
Does AFIB go away?
Paroxysmal atrial fibrillation is one of the types that starts suddenly and goes away own on its own. However, patients should still be monitored and treated. Usually, atrial fibrillation is permanent, and medicines or other nonsurgical treatments cant restore a completely normal heart rhythm.
Heart Palpitations After Knee Surgery
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What Goes Into Preparing A Patient For The Anesthesiology Portion Of Surgery For Atrial Fibrillation
The most important consideration is the patients overall medical condition and how frail he or she may be. You have to plan an anesthetic that takes into account many factors and plan accordingly to provide very safe management.
If a patients condition is chronic, the patient may have other conditions such as heart failure, difficult breathing and lying flat, kidney dysfunction, and other abnormal findings. Typically, he says, the patient will come through pre-admission testing a few days before surgery.
If a patients condition is acute when he or she needs emergent surgery, then the cardiac anesthesiologist must rely on his expertise and experience in handling very sick patients.
Are Heart Palpitations Normal After Bypass Surgery
The most common type of heart rhythm issue after surgery is atrial fibrillation. Up to 40% of patients who have heart surgery experience post-operative AFib. Inflammation in the chest after surgery is the suspected cause of the arrhythmia, and many times the heartbeat returns to normal as healing occurs.
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Care Of Your Incisions
As you heal, your incision will look better and the soreness will go away. Changes in the weather, too much or too little activity and sleeping in one position too long may cause increased soreness. You may also feel numbness or itching or see redness or swelling, which will also stop with time. To care for your incisions, we suggest:
- Wash gently with mild soap during your daily shower. Dry carefully with a towel. Pat it dry Do not rub the incision.
- If you have small pieces of white tape over your incision, you must remove them after you have been home for seven days. If the strips come off on their own, you may leave them off.
- If your incisions are puffy, have areas of redness, are oozing, or begin to open slightly, call your surgeon.
- Women should wear a bra. A good support bra will reduce the tension placed on the incision. If the bra bothers you, you may put a small piece of gauze under the bra for added comfort.
- For discomfort or soreness, you may use a heating pad. Apply it four or five times per day on the low setting for about 20 minutes each time. If needed, take pain medication prescribed by your doctor.
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 . 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.
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What Can Be Done To Prevent It
As you prepare to have heart surgery, you may be looking for ways to reduce the chances of complications. Managing your overall risk factors for AFib is the best way to reduce your risk for post-operative atrial fibrillation as well. Although some risk factors are impossible to eliminate, keeping your body as healthy as possible before surgery will reduce the likelihood of post-operative AFib and other complications from surgery.
- Manage your chronic conditions. Thyroid problems, anemia, diabetes, and high blood pressure are among the risk factors for AFib. If you have any of these or other chronic conditions, treating them prior to surgery may reduce your risk for complications. This includes taking any prescribed medications and following your doctors advice on managing these conditions.
- Eat healthy foods and exercise. The healthier you are going into surgery, the healthier you are coming out of surgery. Eat a heart healthy diet and make exercise part of your daily routine. Aim for 30 minutes a day of moderate exercise at least five days a week.
- Limit stress. Stress can be a trigger for atrial fibrillation, and we know that having surgery can be a stressful event. Managing stress includes physical stress on your body as well as mental or emotional stress in your life. After surgery, managing your pain reduces stress on your body, and having the right support systems in place can help manage mental and emotional stress.
How Are Palpitations Treated
The best type of treatment for you depends on what causes your palpitations. You may not need any treatment. If the palpitations are related to certain foods, you should avoid those triggers. If you have heart disease or an abnormal heart rhythm, you may need medication, a procedure, surgery or a device to correct the problem. Its important to keep all follow-up appointments with your provider.
If your palpitations get worse or suddenly happen more often, call your healthcare provider.
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What Happens After Maze Surgery
After surgical ablation, you will be moved to a recovery room, where you will wake up from the anesthesia. You will be a little sore, but you shouldnt feel severe pain.
You may have a tube in your throat to help you breathe. You also might have a tube in your chest to drain extra fluids. The tubes are usually removed within two days after surgery.
Your health care team will:
- Monitor your heart rate and other vital signs through machines at your bedside
- Teach you breathing exercises to help remove fluids that can collect in the lungs during surgery
- Give you only liquids to drink at first, then slowly add food you can eat
- Encourage you to sit in a chair and walk with help during the first day or two
- Monitor your pain and give you medications and strategies to manage it
- Remove the tubes as you recover
Most people stay in the hospital for a few days after a maze procedure. Someone should drive you home.
After you leave the hospital:
- Avoid lifting anything heavy for several weeks.
- Follow all recovery instructions, including regarding medications, exercise, diet, wound care and driving.
- Have someone help at home.
- See the surgeon in seven to 10 days for a follow-up appointment and for removal of stitches or staples.
- You will slowly recover your strength over several weeks.
When Should I Worry About Heart Palpitations
Heart palpitations are usually not dangerous. They may be a sign of a more serious health problem if you also:
- Feel dizzy, confused or lightheaded.
- Have chest pain or pressure.
- Have trouble breathing.
- Pass out when you have palpitations.
- Pain, pressure or tightness in your chest, neck, jaw, arm or upper back.
- Shortness of breath.
- Symptoms that are new or get worse.
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Does Your Heart Rate Increase When Healing From Surgery
After surgery, your heart rate may increase. The condition is called postoperative tachycardia, in which heart rates are higher than 100 beats per minute.
According to the American Heart Association, a normal resting heart rate for adults ranges between 60-100 beats per minute, although it varies from person to person and is affected by certain factors such as
- Age: Children have a higher resting heart rate than adults.
- Exercise: Temporary increases in heart rate may occur during physical activity.
- Emotions: Extreme emotions, stress, and anxiety can affect heart rate for a short period of time .
- Weather: Heart rate may be slightly elevated in higher temperatures and humidity levels.
- Weight:Obese people tend to have a higher heart rate.
- Medications: Beta-blockers tend to slow down heart rate, whereas thyroid medications can increase the heart rate.
- Substance use: Tea, coffee, and tobacco can increase heart rate.