Post-Surgical Sinus Tachycardia

[ncw3642]

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."

I’ll take some of the flack here!

I think Pellicle is frustrated because he has offered many times to go over the INR management spreadsheet with me. I have been busy with a wife and 2-month old newborn and will be the first to admit I haven’t made the time. I am planning on talking with him today- but I do empathize and understand him wanting to help and viewing my lack of decisiveness as not managing it properly.

I am 100% adherent to my ordered dose and Lovenox shots, at the same time, daily and am organized. I am confident that once it gets in range in time, I will have no issues managing it well and effectively with both the spreadsheet help and the add vice of my clinic assuming they make good judgement based on my level (see; also using spreadsheet to verify and double check doses).

Anyway, the good news is, I am on Lovenox until it’s above 2, which is giving me comfort and I realize these things take time being only 2-weeks post-op. So I’m trying not to ‘panic’ about the 1.4 level when I am discussing with my clinic. They are receptive to my suggestion to increase the dose to 8mg daily until Friday instead of the 1 time 8mg bolus and then 6mg daily thereafter. So hopefully we can work together to get it up.

 

[pellicle]

You must of missed

Correct

 

[tjay]

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!

I’m in a situation right now. Oral Coumadin last few days brought the INR to 1.2, then 1.4, back to 1.2.

I’ve same mechanical On-X as you. Thru bentall (plus root and ascending).

Today they’re injecting Heparin thru IV all day hoping to get to the desired level.

Hope your INR is stable/better now thru oral at home.

6th day post-op at hospital. Everything else looks great. Heart wires are only thing left which they would reattempt tomorrow.

 

[ncw3642]

I’m in a situation right now. Oral Coumadin last few days brought the INR to 1.2, then 1.4, back to 1.2.

I’ve same mechanical On-X as you. Thru bentall (plus root and ascending).

Today they’re injecting Heparin thru IV all day hoping to get to the desired level.

Hope your INR is stable/better now thru oral at home.

6th day post-op at hospital. Everything else looks great. Heart wires are only thing left which they would reattempt tomorrow.

Glad to hear the rest of everything is going well! Bummer about the low INR- but don’t worry!

My INR was 2.3 upon leaving the hospital. Home health checked it twice a week. It dropped during those readings from 2.3 to 2.1 to 1.7 to 1.4 to 1.8 to 2.3 to 2.7 to 3.4 and now it’s consistent (as of 2 readings) at 2.7.

Point of that confusing paragraph is that… it takes time and experimenting with dose to see what works for your body.

I do suggest getting in contact with @pellicle if you haven’t already. He has a LOT of great information about managing INR.

In the meantime, don’t sweat about it, I promise it will stabilize in time.

Wishing you all the best

 

[tjay]

Glad to hear the rest of everything is going well! Bummer about the low INR- but don’t worry!

My INR was 2.3 upon leaving the hospital. Home health checked it twice a week. It dropped during those readings from 2.3 to 2.1 to 1.7 to 1.4 to 1.8 to 2.3 to 2.7 to 3.4 and now it’s consistent (as of 2 readings) at 2.7.

Point of that confusing paragraph is that… it takes time and experimenting with dose to see what works for your body.

I do suggest getting in contact with @pellicle if you haven’t already. He has a LOT of great information about managing INR.

In the meantime, don’t sweat about it, I promise it will stabilize in time.

Wishing you all the best

Glad to hear. Honestly I’m not worried about INR level, it will find its way one way or another.

Yes Im aware @pellicle is the doctor of INR and many other things I’ll be having a lot of questions for him and everyone else coming up when I get home.

Only thing I’m anxious about right now is the only thing left overall which is chest wires because of the brief episode yesterday. I didn’t think anything about it earlier either. Heart’s electrical grid is sensitive it seems
Thank you

PS: they just pulled the tape around main incision. It looks beautiful. Mine was full strernotomy.

 

[pellicle]

Hi

Yes Im aware pellicle is the doctor of INR and many other things I’ll be having a lot of questions for him and everyone else coming up when I get home.

just to manage expectations, I'm experienced in INR (having managed myself for over 12 years, and educated in matters which helps me to understand things), but I'm not a Doctor.

PS: they just pulled the tape around main incision. It looks beautiful. Mine was full strernotomy.

great news ... live long and prosper

 

[pellicle]

Hi

thanks for the kind words

Point of that confusing paragraph is that… it takes time and experimenting with dose to see what works for your body.

it does indeed, and I can see why its all a bit confusing when one starts. All that matters however is to be regular in samples and certain of doses. The rest falls into place if you follow the system.

Happy to help teach a man to fish.