Slower Heart Rate after OHS

[The Thief]

As some of you may know, 6 weeks ago I had an AVR re-do due to bacterial endocarditis. My recovery has been normal from my 2nd surgery, however I am experiencing a strange phenomenon.

After my 1st surgery (in November 2013), my heart rate went up afterwards, into the 90's at first, then dropping a few beats per minute every week until I was close to normal, but still a bit higher. This seems typical to most AVR patients.

After the 2nd surgery (6 weeks ago), my heart rate has been slower. It is only slightly slower than normal. It is usually around 60 bpm, but can be as low as 54 bpm. I know that there is a whole range of heart block that people can have, but I havent been diagnosed with anything like that. My doc says that I am in sinus rhythm. I was on a 2 week course of amioderone after discharge, and I know this drug can stay in your system for weeks-months. I am also on a low dose (25mg) of metoprolol, which I was on before my 2nd surgery.

This is probably not an emergency; I am just wondering if others have experienced this drop in heart rate WITHOUT it being heart block. Thanks y'all!
-Anthony

 

[tom in MO]

I blissfully did not check my heart rate before or after surgery. Was not asked to by any doctor or nurse. I did monitor it during cardiac rehab and was of no concern to me, nurses, cardiac rehab staff or cardiologist.

Per NIH metoprolol works by slowing heart rate to improve blood flow and decrease blood pressure. I know as my heart healed, I began to occasionally get dizzy upon getting up. My cardiologist took me off the metropol. Maybe the slower beat is what you need to heal.

I know you are an athlete and are used to monitoring your heart rate. I would gently submit that there is no "normal" for you anymore. You just had major heart surgery twice and you will find a new "normal", maybe just not yet. Be holistic about your health, if you feel good...you are good. If you have concerns, run them by your cardiologist or surgeon.

 

[newmitral]

....
After the 2nd surgery (6 weeks ago), my heart rate has been slower. It is only slightly slower than normal. It is usually around 60 bpm, but can be as low as 54 bpm.
... I am just wondering if others have experienced this drop in heart rate WITHOUT it being heart block. Thanks y'all!
-Anthony

Hi Anthony,


I think I have experienced a similar lowering of my resting heart rate post-surgery, but I really don't have a lot of pre-surgery heart rate numbers to compare it with.

After my OHS (an emergency mitral valve replacement as a result of endocarditis), my resting heart rate was, and has remained, between 55 and 60 bpm. I am now approaching my 3 year valversary and this lower resting heart rate is my new normal. I think that my resting heart rate pre-surgery was typically more like the high 60's to low 70's, but I really can't say for certain since I didn't pay that much attention to it.

Although I am in reasonable shape and exercise somewhat regularly I would not be considered an athlete. My brother is a serious runner, and my resting heart rate is now lower than his, which I find interesting, but certainly not a cause for concern. I never took any beta-blockers or any medication other than the 6 week course of antibiotics post-surgery to kill off the endocarditis bacteria, and now warfarin and a baby aspirin for my mechanical valve.

In my case, there is no heart block, and my doctors see no problems. I personally attribute the lowering of my heart rate to the fact that my heart was working much harder to pump blood while my valve was infected and slowly deteriorating in the months before the surgery - possibly much longer if my mitral valve was regurgitating asymptomatically even before the endocarditis. This was likely much more of a workout than any treadmill would offer. There was evidently a significant enlargement of my left ventrical due to the strain. Now, post surgery, with a working and efficient valve, my heart can pump enough blood at a slower heartbeat - at least that's my rationalization.

So, unless your doctors see something worrisome on your EKG, I wouldn't be concerned at all.

 

[Mentu]

Just as the other guy said, the Beta Blocker is slowing your heart. The indication that I no longer needed the Metoprolol was that my pulse rate was falling into the 50s and I started feeling sluggish. I would say that there is no problem if you are feeling alright. If you are feeling as though you have no energy and your pulse rate is very low, you should talk with you cardiologist about reducing or eliminating the Beta Blocker. They can do their job too well.

Larry

 

[MarkU]

Prior to my AVR my resting heart rate (RHR) was 72bpm, my BP was in the pre-hypertensive range and I had left ventricular hypertrophy.

Even though I had no background in endurance sports, post-op I started doing a lot of aerobic training, leading to my first triathlon three years post-op. In the past ten years I've completed +20 triathlons and four half marathons, plus numerous 5K's and other running races.

Now 14 years post-op, my RHR is 41 bpm, my BP is 118/70 and my enlargement has reversed itself to normal range.

No meds other than my Coumadin.

I think my case is an example of how a heart can remodel itself once a defective valve is corrected.

I also feel very lucky & blessed to have experienced such a positive outcome.

Mark

 

[dick0236]

About ten years ago, I was put on meds(20mg Lisinopril and 25mg Atenolol) to lower my blood pressure and I have periodically monitored my BP and HR since that time. My resting HR runs between 45 and 55. My docs are well aware of my slow HR and apparently do not consider it a problem.....at least they have never mentioned any concerns to me.

FWIW, even during strenuous exercise it is almost impossible for me to get my HR above 115.

I figure it is a good thing......less wear and tear on my valve.

 

[TheGymGuy]

Anthony,
My resting heartrate was in the mid-50s before surgery and in the at least high 70-80s after. With metprolol it was closer to 70, as my dose was reduced the HR was slowly going up, however, I was walking lots daily and giving that ticker lots to tick about. Still, with all the drugs that you have, the HR muscles might just be relaxed enough to not freak out and beat sensibly. With such a nice resting HR I would not worry about it and actually embrace it.