Post-Surgical Sinus Tachycardia

Hi all,

I am now day 5 post-

“1. Minimally invasive mechanical composite root replacement via modified bentall conduit (On-X valve 27/29 mm / 26 mm Gelweave Valsalva graft)

2. Left main intramural coronary artery unroofing

3. Sternal plating”

And since day 2-3 I have been having constant sinus tachycardia at rest (100-110bpm) and rising up to 130-135 with walking.

Doctors don’t seek concerned and have continued to up my Beta Blocker dose but I wanted to see if anyone else has experience with this? Doctor said it’s more normal in younger patients (I’m 27) and I’ll likely need the blocker at home for an undetermined amount of time (maybe forever it it doesn’t resolve).

They just got me disconnected off my heparin drip as my PTT was 82 overnight (64 this morning) and my IRN is 1.9 so they are going to manage with just Coumadin now.

Still having some shallow breaths due to a lot of pain with inhalation. Chest X-Ray shows a small left pleural effusion but they say that will resolve with more time and walking

Thanks for all the input!

Overall, this sounds pretty good!

ncw3642 said:

Sternal plating

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Did they use a plate with screws to close your sternum instead of wires? If so, why?

3mm said:

Overall, this sounds pretty good!

Did they use a plate with screws to close your sternum instead of wires? If so, why?

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Yes!

My surgeon has been following a lot of research regarding early healing and mobility. Plating is used to reinforce wires so both are still used.

Pending symptoms, here are the updated guidelines approved by our 4 hospital surgeons for plating at discharge and the weeks following.

It allows me to, in theory, be more active and get back to my old activities including caring for my newborn.

ncw3642 said:

My surgeon has been following a lot of research regarding early healing and mobility. Plating is used to reinforce wires so both are still used.

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interesting, are they (the plates) removed or do you have two sets of junk inside now?

My junk inside, this is from 3 OHS over quite a number of years:

the yellow areas circle some staples (got knows why they're there) ... you can find more.

ncw3642 said:

And since day 2-3 I have been having constant sinus tachycardia at rest (100-110bpm) and rising up to 130-135 with walking.

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not so bad ... I think I was 120 a lot in my first days back on the ward. I actually developed full sinus tachycardia (just over) 10 years after OHS #3 and remain on metoprolol as it creeps back without it.

ncw3642 said:

They just got me disconnected off my heparin drip as my PTT was 82 overnight (64 this morning)

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surprised anyone bothers reporting PTT anymore, its means pretty much nothing anyway.

ncw3642 said:

and my INR is 1.9 so they are going to manage with just Coumadin now.

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INR of 1.9 is the bottom end of ok range, I expect it'll be up to 2.5 sooner or later.

ncw3642 said:

Still having some shallow breaths due to a lot of pain with inhalation. Chest X-Ray shows a small left pleural effusion but they say that will resolve with more time and walking

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sounds like the usual stuff ... in a few weeks it'll most likely all just be a dim memory.

Best Wishes

pellicle said:

interesting, are they (the plates) removed or do you have two sets of junk inside now?

My junk inside, this is from 3 OHS over quite a number of years:
View attachment 890351
the yellow areas circle some staples (got knows why they're there) ... you can find more.


not so bad ... I think I was 120 a lot in my first days back on the ward. I actually developed full sinus tachycardia (just over) 10 years after OHS #3 and remain on metoprolol as it creeps back without it.


surprised anyone bothers reporting PTT anymore, its means pretty much nothing anyway.


INR of 1.9 is the bottom end of ok range, I expect it'll be up to 2.5 sooner or later.



sounds like the usual stuff ... in a few weeks it'll most likely all just be a dim memory.

Best Wishes

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Hi!

Plates will remain in my body as more ‘junk’ forever but hoping it allows continued stability for anything higher impact down the road.

They just bumped up my metrapolol to 50mg 2x a day and it’s still running 100-110- seems to have some relief upon initial intake- worse towards end of medication time.

Yes. Hoping they give some formal directions on how frequent to monitor INR/how to change dose prior to discharge tomorrow but I also know if I have questions- this is a pretty good community to loop back to!

Hoping my HR stabilizes soon honestly. But open to it taking weeks or months.

ncw3642 said:

metrapolol to 50mg 2x a day and it’s still running 100-110- seems to have some relief upon initial intake- worse towards end of medication time.

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wondering if that is metoprolol tartrate or succinate (just interested) because both have different "release patterns"; seen here:



give that graph a careful look as the 50mg metoprolol tartrate line only goes half the width, but the 100mg does full length and the succinate does too.

ncw3642 said:

But open to it taking weeks or months.

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if I recall correctly mine was somewhere in that range too

Best Wishes

@ncw3642 I also had pleural effusion while in the hospital. A follow-up appointment was made before I left the hospital. After that appointment, a thoracentesis was scheduled. This all took place within the first week or so after my release from the hospital. After the procedure, my breathing pain was immediately gone!!! That's when I was able to really start walking! It was a little scary reading about it, but outcome was amazing!!! I went to barely walking a few steps to walking around the block! I had a few afibs/tachycardia in the hospital and used metropole for 30 days. Everything to settle down during those 30 days. Yay! Metropole isn't my favorite medicine. (gave me horrible nightmares) About 6 months later, I started having tachycardia again, with heart rates going to 170 to 190's lasting 30 mins. It turned out my thyroid levels were out of range. Now I'll get them a few times a year, they last less than 3 mins. I track them for my doctor and so far he's not worried. It's been 3 1/2 years since my surgery and I'm really happy with my heart rate now!

It was interesting reading about your plate too.

Good luck with your recovery! You'll be holding your baby soon!

ncw3642 said:

Hi!

Plates will remain in my body as more ‘junk’ forever but hoping it allows continued stability for anything higher impact down the road.

They just bumped up my metrapolol to 50mg 2x a day and it’s still running 100-110- seems to have some relief upon initial intake- worse towards end of medication time.

Yes. Hoping they give some formal directions on how frequent to monitor INR/how to change dose prior to discharge tomorrow but I also know if I have questions- this is a pretty good community to loop back to!

Hoping my HR stabilizes soon honestly. But open to it taking weeks or months.

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Hope your heart rate has stabilized and settled downwards. Please keep us posted and all the best.

tjay said:

Hope your heart rate has stabilized and settled downwards. Please keep us posted and all the best.

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Hi!
It still ebbs and flows, honestly! Sometimes it rests in the 80’s and sometimes it still rests above 100 (but under 115) just depending on time of day it seems.

Still on 50mg metoprolol 2x a day and hoping as the weeks go on, I see more of the 80’s and not as much of the 100’s.

I also pre-surgery had a regular irregular sinus rhythm which is still the case post-surgery which the home health nurse commented on when she did heart auscultation. Cardiologists weren’t concerned beforehand as it again, was a regular, irregular rhythm but I’m not sure if that plays a role at all. Time will tell!

Still working on getting my INR within range. It was 2.3 leaving the hospital (last Monday) dropped to 2.1 last Tuesday, 1.5 last Friday (Warfarin dose increase by 1mg) and then unfortunately down to 1.4 today even with the 1mg dose increase. Waiting to hear back on what the dose increase will be this time. But have to also trust the process that it takes a bit and sometimes will always take a bit to adjust and it’s a normal part of the process!

@ncw3642 That's a dangerously low INR! You might not want to wait for the call but call them! You might need to go to ER? You might need Lovenox injection until you're in range. If it were me and 4 weeks Post-surgery. I go to ER if I couldn't talk to a doctor ASAP. @pellicle would have good info to tell you or there are a bunch of others that are more knowledgeable.

I had the problem of my INR going lower after my surgery, and I had to really push the clinic to up my dose more than 1mg at a time. Trust the process but you have to advocate for yourself too! 1.4 INR is low.

Beach77 said:

@ncw3642 That's a dangerously low INR! You might not want to wait for the call but call them! You might need to go to ER? You might need Lovenox injection until you're in range. If it were me and 4 weeks Post-surgery. I go to ER if I couldn't talk to a doctor ASAP. @pellicle would have good info to tell you or there are a bunch of others that are more knowledgeable.

I had the problem of my INR going lower after my surgery, and I had to really push the clinic to up my dose more than 1mg at a time. Trust the process but you have to advocate for yourself too! 1.4 INR is low.

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Thank you so much for your response and your concern!

They actually adjusted me up to 8mg today and 6mg every day after until they recheck on Friday.

In the meantime, I’ve been on Lovenox injections 1x daily (same time as my warfarin dose) until I am back in therapeutic range (>2.0 per the On-X post surgical guidelines). They feel confident that with the Lovenox I will avoid the risk of a clot while getting in range.

But I am also hopeful they will be more aggressive with the dosing given I am younger and obviously need more warfarin to get it back up.

ncw3642 said:

Thank you so much for your response and your concern!

They actually adjusted me up to 8mg today and 6mg every day after until they recheck on Friday.

In the meantime, I’ve been on Lovenox injections 1x daily (same time as my warfarin dose) until I am back in therapeutic range (>2.0 per the On-X post surgical guidelines). They feel confident that with the Lovenox I will avoid the risk of a clot while getting in range.

But I am also hopeful they will be more aggressive with the dosing given I am younger and obviously need more warfarin to get it back up.

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I should add…

Dose when it was 1.4 was 5mg. They had me take 8mg today, and then 6 following today until Friday. I already have a plan to call them tomorrow and see if I can continue the 8mg dose until Friday instead to see if that moves the needle more.

@ncw3642 Thats great news! Sorry I was freaking out! I tried really hard NOT to! LOL Glad you're being taken care of!

Best wishes as you continue your journey!

Beach77 said:

@ncw3642 Thats great news! Sorry I was freaking out! I tried really hard NOT too! LOL Glad you're being taken care of!

Best wishes as you continue your journey!

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No worries at all! That’s why I love this community- we all care about each other and get worried/want the best!

I appreciate the advice nonetheless! If I wasn’t on the lovenox, I too, would be concerned.

I do agree about advocating for a higher dose increase than 1mg (especially as my reading dropped from 2.1 to 1.5 from last Tuesday to last Friday and they just increased it by 1mg and today I got my 1.4 reading. Clearly I need more to raise it.

Anywho, that’s why I am calling tomorrow to advocate for taking the 8mg daily (a 3mg increase from my last dose) until the recheck Friday.

Sounds like you have a good start for advocating for yourself! I agree, this forum is really good about supporting each other! Plus I've learned a lot! Take care, Ellen

Beach77 said:

I go to ER if I couldn't talk to a doctor ASAP. @pellicle would have good info to tell you or there are a bunch of others that are more knowledgeable.

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in theory we're supposed to be working together, I wouldn't normally mention this (but as I was mentioned in here by you) I can say there has been basically zero engagement from his end.

Perhaps he's waiting for something to happen before he sees its important?

Chuck C said:

From the publication:

" She admitted to recent medication non-compliance, followed by taking higher doses of warfarin at onset of symptoms "

She was 24 years old. Previously, I would have said that any 24 year old should get a mechanical valve, with only a few exceptions.

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Chuck C said:

I don't feel that way anymore. Yes, most ...

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me neither

Oh and @ncw3642 the publication:
link is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202806/

ncw3642 said:

(especially as my reading dropped from 2.1 to 1.5 from last Tuesday to last Friday and they just increased it by 1mg and today I got my 1.4 reading. Clearly I need more to raise it.

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if you'd just allocate that time the whole set of answers you seek is before you ... including exactly how much to raise it by ... all you have to do is return to the conversation.



Meanwhile I hope you don't have any adverse events (losing a leg wouldn't be good, but perhaps its better than losing the ability to do things for yourself)

ncw3642 said:

But I am also hopeful they will be more aggressive with the dosing given I am younger and obviously need more warfarin to get it back up.

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for reference, I know old people on bigger doses. Its got almost nothing to do with your age and more to do with just your genetics. It takes what it takes. It may be 8 it may be 18 ... we just don't know without any data, just pulling a number out of my arse would be reckless.

However (being reckless here) 8 is likely to be in the correct direction...

ncw3642 said:

Hi!
It still ebbs and flows, honestly! Sometimes it rests in the 80’s and sometimes it still rests above 100 (but under 115) just depending on time of day it seems.

Still on 50mg metoprolol 2x a day and hoping as the weeks go on, I see more of the 80’s and not as much of the 100’s.

I also pre-surgery had a regular irregular sinus rhythm which is still the case post-surgery which the home health nurse commented on when she did heart auscultation. Cardiologists weren’t concerned beforehand as it again, was a regular, irregular rhythm but I’m not sure if that plays a role at all. Time will tell!

Still working on getting my INR within range. It was 2.3 leaving the hospital (last Monday) dropped to 2.1 last Tuesday, 1.5 last Friday (Warfarin dose increase by 1mg) and then unfortunately down to 1.4 today even with the 1mg dose increase. Waiting to hear back on what the dose increase will be this time. But have to also trust the process that it takes a bit and sometimes will always take a bit to adjust and it’s a normal part of the process!

Click to expand...

as long as they are not worried, you should be fine. Getting the INR ranges are hard at first. It will stabilize soon; you are just out of the hospital and will be getting into routine. When you are settled for a time, the INR will settle down also. Just relax and it will all be fine.

pellicle said:

...Meanwhile I hope you don't have any adverse events (losing a leg wouldn't be good, but perhaps its better than losing the ability to do things for yourself)

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WOW! You must of missed "In the meantime, I’ve been on Lovenox injections 1x daily (same time as my warfarin dose) until I am back in therapeutic range (>2.0 per the On-X post surgical guidelines). They feel confident that with the Lovenox I will avoid the risk of a clot while getting in range."