Resting heart rate after surgery

Hi all, I am four weeks out from mechanical MVR (plus tricuspid repair, Maze procedure, left atrial appendage clip, and a pacemaker).

I’m curious about people’s experiences about heart rate after surgery. Although I am on metoprolol tartrate 50 mg twice a day, resting heart rate is still about 85 bpm edging to 95 or occasionally over 100 at the “end” of doses.

Do you remember if / when this gets better? Is this concerning?

Prior to surgery on metoprolol tartrate at half the dose my resting heart rate was 58 - 60.

Blood pressure in both cases ranges from 90/58 to 100/60 at rest.

Thanks!

Hi

dornole said:

Hi all, I am four weeks out from mechanical MVR (plus tricuspid repair, Maze procedure, left atrial appendage clip, and a pacemaker).

I’m curious about people’s experiences about heart rate after surgery. Although I am on metoprolol tartrate 50 mg twice a day, resting heart rate is still about 85 bpm edging to 95 or occasionally over 100 at the “end” of doses.

Do you remember if / when this gets better? Is this concerning?

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for whatever reason I did not gather and document my HR data, but I can say that even a few months after my #3OHS (but equally, the "when I got a mech" valve) I had elevated HR above where I felt was my prior level. I would have bouts of 'over 100' which I would try to control with breathing exersizes, and in the main this was successfu.

I can't say when it went to more like 70 or 60, but I think it was somewhere about when I was cycling more, lengthy beach walks (soft sand is a killer) and some jogging (I hate jogging).

By about a year or so IIRC I would be around 60 (58~62) on wake up and 70 something when doing things. For reference its 64 right now (9pm and dinner was 7pm, had a beer in the afternoon after mowing and other lawn related obligations).

I've recently (last few months) decided to do a different cardio vascular operation of 15min of higher intensity (not high by me at 25) cycling about every other day. I'm pretty sure that exersize (and when you can do it, don't push too hard too early) slowly allows the muscle and nerve system to "find" that it doesn't need to push as hard as it did. That may be something that falls into "remodelling"

Also, just getting over a flu.

So yes, it gets better (or I got better).

As to concerning .. keep an eye on it, make some notes (better than I did) and discuss with your cardiologist.

Try the breathing exersize too.

dornole said:

Blood pressure in both cases ranges from 90/58 to 100/60 at rest.

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I'm no specialist there, but that seems a little low to me ... 127/76 : 65 right now.

You didn't mention this, but I wanted to just add that the feeling of the 'beat' or 'pulse' was much more pronounced ... in hospital I felt it rocking me. I notice that it still does, but I'm just no longer usually aware of that (unless trying to take a picture of something with my 600mm lens.

I hope it starts to return to priors soon

Best Wishes

dornole said:

Do you remember if / when this gets better? Is this concerning?

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My resting heartrate was around 50 bpm before my heart issues (endocarditis) started. A month after open heart surgery (mitral valve repair and installation of an On-X mechanical aortic valve) my resting heart rate was in the 60s. 6 months after surgery it started dropping. Now, 14 months after surgery, my resting heartrate is back to the low 50s.

Hopefully I just need to be patient and keep building fitness slowly. I am definitely frustrated by only being able to go maybe 2.8 mph on flat ground for 30 mins. Not even close to pre surgery fitness. Cardiac rehab seems to think I am doing ok.

My blood pressure has been on the low side my whole life (100/60 without any medication, I am only 5’4” and this runs in my family) so I am used to that and don’t get lightheaded or anything. But with it being quite low they’re not keen to further increase dosage to control rate because the BP will further decrease.

I am also wondering about the low sodium diet they put me on because my BP is so low. I have a meeting with the dietician at cardiac rehab on Monday and will ask about that as well. Follow up with cardiology is in 3 weeks.

dornole said:

Hopefully I just need to be patient and keep building fitness slowly. I am definitely frustrated by only being able to go maybe 2.8 mph on flat ground for 30 mins. Not even close to pre surgery fitness. Cardiac rehab seems to think I am doing ok.

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I believe yes, and I recall those days of my doing slow shuffles around the block.

Keep at it ... also, you're older now too ... small steps forward no slides back from over stepping

Best Wishes

My heart rate was in the 90s and 100s for months after my surgery, but eventually came down to the 60s. My surgeon said the heart is "irritable" after surgery. The process definitely takes patience.

Zoltania said:

My heart rate was in the 90s and 100s for months after my surgery, but eventually came down to the 60s. My surgeon said the heart is "irritable" after surgery. The process definitely takes patience.

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And the body is in the stress mode for a few weeks as it adjusts to being healthier.

My resting heart rate was higher than before the surgery for many months before it settled down. It went up to high 90s with any move I made despite the metoprolol I was taking.
Some hearts need more time to readjust/heal from the trauma of what they went through!

4 weeks is too early but it would slowly revert back towards the pre-surgery baseline in the coming weeks. Mine is actually a bit lower now than pre-surgery which may be because I'm now on beta-blocker while I wasn't before. Otherwise, I think I'm technically back where I was. I'm 4.5 month post-op. Here's my RHR chart from fitbit (peak correspond to surgery or days immediately after).
Note that the numbers are averaged over 1 month (i.e. average of average). Days immediately after surgery my RHR was in high 80s.

Note: I was not wearing the watch for ~2 weeks after the surgery, so the average around then is lower for the month. I remember having as high as ~90 bpm as RHR those few days.

This chart shows actual numbers (daily averages):

Do you normally make a difference between RHR while awake and during sleep? I ask that because the numbers are different for me - while awake the number would be around 45-55, and during sleep 36-40. Interestingly, even before I sleep, normally my RHR will already go down to the low forties, which may have to do with the circadian rhythm, I guess?

Still, I'm curious about what my numbers will be after the eventual surgery...

JoeWanderer said:

Do you normally make a difference between RHR while awake and during sleep?

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Yes. My 7 day Holter monitor test shows average heart rate during sleep is about 55 bpm. When I am awake my average is about 75 bpm. This varies as I sit by my computer, exercise, do housework, etc. While I am sleeping my hear rate varies between 50 and 75 bpm. I work hard while I'm dreaming!

I have an On-X mechanical aortic valve. The Holter monitor test was taken 8 months after the mechanical valve was installed. My heart rate has been decreasing during the last 14 months as my body heals.

JoeWanderer said:

Do you normally make a difference between RHR while awake and during sleep? I ask that because the numbers are different for me - while awake the number would be around 45-55, and during sleep 36-40. Interestingly, even before I sleep, normally my RHR will already go down to the low forties, which may have to do with the circadian rhythm, I guess?

Still, I'm curious about what my numbers will be after the eventual surgery...

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Yes it’s all normal. There is RHR (resting heart rate) when you are at “rest” during the day (but otherwise anxious or working on your desk etc), then there’s RHR when you’re really calm and relaxed watching TV or browsing leisurely on your laptop in the evening, and then there’s RHR when you are really resting i.e sleeping

The lowest of all these heart rates may be called real-RHR which’s generally during the sleep over night.

First few days and weeks after the surgery, it would be much much higher but over a few months time, it would trend down towards pre-op baseline. It can take different amount of time for different people depending on so many factors, and some post-op valvers continue to report somewhat elevated RHR even after several months but they seem to have no issues otherwise. I’m sure you can browse this topic on this site to read many personal stories valvers have.

Interestingly my RHR dropped like a rock after about 8-10 weeks post-op, coinciding with the time I started running which took my heart rate towards MHR (maximum heart rate) while running. It was jumpy initially but quite normal after a few weeks of running. So more I used my heart towards MHR while running, more it regressed towards RHR while resting. Interesting

your numbers are pretty similar to mine but:

3mm said:

While I am sleeping my hear rate varies between 50 and 75 bpm

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I'm interested to know if you get a different amount sleeping on one side or the other.

Thanks

tjay said:

Yes it’s all normal. There is RHR (resting heart rate) when you are at “rest” during the day (but otherwise anxious or working on your desk etc), then there’s RHR when you’re really calm and relaxed watching TV or browsing leisurely on your laptop in the evening, and then there’s RHR when you are really resting i.e sleeping

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Yes, that's what I was thinking - there are different levels of "rest", so to speak, and I wasn't sure about which one people are quoting when they mention RHR

Interestingly my RHR dropped like a rock after about 8-10 weeks post-op, coinciding with the time I started running which took my heart rate towards MHR (maximum heart rate) while running. It was jumpy initially but quite normal after a few weeks of running. So more I used my heart towards MHR while running, more it regressed towards RHR while resting. Interesting.

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That's what cardio training does, and I'm happy that you were able to start running relatively soon after surgery, and that it had such an immediate impact. Maybe because you used to run before? I would suspect that fit people would be able to recover faster, even from complicated procedures such as an AVR, but maybe it's me trying to justify my exercise addiction

One thing that makes me curious is that my exercise heart rate is consistently lower than of other people (even men at a similar age, running in similar conditions and pace) - about 20 to 30 bpm less. I suppose it's due to my enlarged heart compensating for the leaky valve, but who knows. If my heart rates stabilize on higher levels after surgery (whenever it comes, next evaluation in January), it may be a sign that it was indeed the case.

pellicle said:

I'm interested to know if you get a different amount sleeping on one side or the other.

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I don't know. I will have another Holter monitor test in January, and I will try to track this.

3mm said:

I will have another Holter monitor

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mine is so obvious all I have to do is lie on one side for 20 min and my HR goes from 60 to 80 (remaining on the couch watching a movie ... its even worse if I sleep on that side

JoeWanderer said:

Yes, that's what I was thinking - there are different levels of "rest", so to speak, and I wasn't sure about which one people are quoting when they mention RHR



That's what cardio training does, and I'm happy that you were able to start running relatively soon after surgery, and that it had such an immediate impact. Maybe because you used to run before? I would suspect that fit people would be able to recover faster, even from complicated procedures such as an AVR, but maybe it's me trying to justify my exercise addiction

One thing that makes me curious is that my exercise heart rate is consistently lower than of other people (even men at a similar age, running in similar conditions and pace) - about 20 to 30 bpm less. I suppose it's due to my enlarged heart compensating for the leaky valve, but who knows. If my heart rates stabilize on higher levels after surgery (whenever it comes, next evaluation in January), it may be a sign that it was indeed the case.

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Yes, I was running regularly (1 hour, ~2-3 times/week) before surgery too. I'm running more now
Endurance training does help before, during and after such heart-related (e.g. AVR) surgeries. I used to lift weights too but switched to running over the last decade to buy more time before AVR, and keep my aortic root and ascending aorta from dilating further. But I wish to return back to lifting weights, however I promised myself that I would keep running post-op until I reach a respectable level (say ~90%) cardio-vascularly compared to my pre-surgery baseline, or for at least 6 months before starting to lift, whichever is later. I believe there no substitute of cardiovascular activity during the initial post-op phases.

It's good that you're doing endurance activity, and your RHR or overall conditioning is great. Not sure what your overall situation is (e.g. LVH, EF etc) but enlarged heart shouldn't cause the RHR to drop further I would think (if not the other way around). May be it's your meds perhaps?? Or may be you're just too conditioned like Lance Armstrong

All the best. Keep running. You will detect your symptoms more proactively, as another aid in deciding the surgery timing.