Variable/pounding heart rate following AVR/Aorta graft

[gpr100rs]

I am 5 months post-AVR (Edwards Inspiris Resilia) and ascending aorta graft. I had a bout of "A-flutter" just before discharge that did not respond to 2 rounds of cardioversion but on day 9 did spontaneously resolve. 3 weeks ago and for the first time since discharge, per my I-Watch, HR was 130 resting and I was in a-fib; resolved in about a half hour. Cardiologist said if no symtoms (shortness of breath, dizzines, etc.) likely nothing to worry about, but he did perscribe Eliquis. I consistently have episodes of heart pounding, what feels like extra heart beats randomly, elevated resting heart rate up to 130 at rest, but always goes down to 60 pretty quickly. While I sit here pecking out this post, my HR is 58 but I can feel each beat. Blood pressure, per home cuff, is usually normal. I am on 100 mg's Metoprolol per day, a beta blocker and works by blocking the effects of the hormone epinephrine, also known as adrenaline. I work in a high stress job (trial lawyer and managing partner of my firm) and it seems that as work stress increases, and so does my heart rate variability, pounding,etc. My amateur diagnosis also includes that the dacron aorta graft is stiffer than my dilated aorta and, consequently, more dynamic flow force is going through the aorta and is transmitted upstream, thus causing the pounding feeling in my chest, etc.
My questions: Has anyone had similar experiences? Will it resolve with time or is this the new normal? Should I drop the trial lawyer gig and take up bee keeping? Alernatives to Metoprolol? Maybe try an antianxiety? Thx

 

[carolinemc]

I am 5 months post-AVR (Edwards Inspiris Resilia) and ascending aorta graft. I had a bout of "A-flutter" just before discharge that did not respond to 2 rounds of cardioversion but on day 9 did spontaneously resolve. 3 weeks ago and for the first time since discharge, per my I-Watch, HR was 130 resting and I was in a-fib; resolved in about a half hour. Cardiologist said if no symtoms (shortness of breath, dizzines, etc.) likely nothing to worry about, but he did perscribe Eliquis. I consistently have episodes of heart pounding, what feels like extra heart beats randomly, elevated resting heart rate up to 130 at rest, but always goes down to 60 pretty quickly. While I sit here pecking out this post, my HR is 58 but I can feel each beat. Blood pressure, per home cuff, is usually normal. I am on 100 mg's Metoprolol per day, a beta blocker and works by blocking the effects of the hormone epinephrine, also known as adrenaline. I work in a high stress job (trial lawyer and managing partner of my firm) and it seems that as work stress increases, and so does my heart rate variability, pounding,etc. My amateur diagnosis also includes that the dacron aorta graft is stiffer than my dilated aorta and, consequently, more dynamic flow force is going through the aorta and is transmitted upstream, thus causing the pounding feeling in my chest, etc.
My questions: Has anyone had similar experiences? Will it resolve with time or is this the new normal? Should I drop the trial lawyer gig and take up bee keeping? Alernatives to Metoprolol? Maybe try an antianxiety? Thx

You need to get with a professional that can help you learn how to manage the stress of your job better. You do not have to give up the job unless the Cardio says otherwise. There are many professional stress helpers out there. Ask your Cardio or PCP about a referral to one. And another great stress reliefer, exercise like walking, or working out in a gym Sometimes it takes more then medication to help relief your on the job stress, which carries into the home life. Good luck.

 

[tom in MO]

I'd discuss it with my cardio. I can't help specifically, but not everyone tolerates metoprolol the same. Make sure your other drugs including OTC ones are not effecting things (e.g. allergy medications can contain pseudoephedrine). Your blood pressure is just as important as your heart rate. Measure that as well. Routine walking and getting up from the desk can help some people.

 

[Brinntache]

My cardiologist got me off Metroprolol at about four months post-op. I agree with Tom and Caroline, exercise is mandatory to manage stress. Like at least 30 minutes pushing yourself and sweaty a day. (which is measured by where you are at, not what others are doing. Don't die now.)

 

[Critter]

Yeah my cardiotron told me to drop my metoprolol to 25mg from 100. I am running 2.3 miles 4 to 5 times a week. My Aortic root was not dilated enough to warrant the Dacron graft, even thigh it was considered aneursmal at 4.5cm. I agree with Brintage on what he says, you have to do the rehab every day. As another poster says you should be monitoring your blood pressure and keeping track of it. If it’s high , make lifestyle mods and get on a hypertensive medication other than increasing your metoprolol for it. Go see your pcp and have him check you out.

 

[pellicle]

... Don't die now

please no !!

(and think of the surgeons stats ... you need to make it to 1 year at least ;-)

 

[gpr100rs]

Thx all. I have always been active, I've played squash for 25 yrs, an extremely demanding cardio sport where your heart rate can reach 190-200 bpm. And I look forward to getting back to that. My diet has always been decent and at 63, I weigh the same I did in high school. I can handle my job, but my point was whether others have experienced variable heart rhthyms post-surgery which, in my case, seem to have come to a head 5 months post-surgery. They have actually calmed down a lot in the last 2 weeks so I am hopeful, as my cardio explained, heart is still "rewiring" a little post-surgery and is sensitive to any adreneline rush. My cardiologist put me on a heart monitor for 2 weeks, so we'll know more after that, but said go ahead and engage in regular excercise, etc.

 

[pellicle]

but my point was whether others have experienced variable heart rhthyms post-surgery which, in my case, seem to have come to a head 5 months post-surgery.

I had difficulties (did I mention that) in the first 3 months and now and again since then. Mine were mostly (back then) simply high heart rate which I used breathing techniques to (apparently) assist my heart to re-train. I don't know for sure if they were useful or just associated.

now I get occasional irregular heart beats but on a suggestion from @leadville started drinking sports drinks (not the whole bottle at once) after doing hard work anad exersize instead of just water. This seems to have been the ticket because (with no other changes) it has fixed that issue and if I cease doing it, they come back (to be vanquished by resuming).

Happily I've found a drink that's low in sugar (I can't drink the sugar free ons because I can't stand the after taste) but higher in sodium (35mg/100ml) potasium (44mg/100ml) and magnesium (8mg/100ml) than (say) the big name brands GatorSomething while being less than half the price.

Other than that I can say that sometimes minor damage to the AV Node occurs during surgery (and may even be a matter of scar tissue pressing on it) and is of course the reason why (sometimes) people need a pacemaker post surgery. It and scar tissue factors also into why redo-surgeries are risky (for quality of life if not of life itself).

HTH

 

[tezza]

Thx all. I have always been active, I've played squash for 25 yrs, an extremely demanding cardio sport where your heart rate can reach 190-200 bpm. And I look forward to getting back to that. My diet has always been decent and at 63, I weigh the same I did in high school. I can handle my job, but my point was whether others have experienced variable heart rhthyms post-surgery which, in my case, seem to have come to a head 5 months post-surgery. They have actually calmed down a lot in the last 2 weeks so I am hopeful, as my cardio explained, heart is still "rewiring" a little post-surgery and is sensitive to any adreneline rush. My cardiologist put me on a heart monitor for 2 weeks, so we'll know more after that, but said go ahead and engage in regular excercise, etc.

I am now 6 months post AVR, and I am having similar issues as you. I am constantly aware of my heart beat and it feels as though my heart is hammering through my chest. I will often have an extra hard thump, which I feel through my stomach, my groin and my right shoulder. When I am sitting still, others will comment that they can see my heart beating. My resting heart rate is quite variable, from 60-100, and I frequently have skipped beats, followed by catchup beats, but don't have any racing, although I did a couple of times in the early weeks post surgery, which settled quickly. I have found that it has worsened considerably in the past 3 weeks, so I have tried altering my diet (keep blood sugars stable, reduce sugars, no alcohol, no caffeine) but haven't found any difference. I tolerate exercise well and find no difference in the way in which I feel my heart beat. I don't have any extraordinary stress in my life, and meditate daily, so I don't think stress is a factor. My cardiologist reassured me at my 2 month post-surgery check that it would settle down, and it did somewhat, although never completely, but has suddenly worsened in the past few weeks. It is starting to get very annoying.
I would be interested to hear what the outcome is from your monitor. I'm still undecided whether to follow up with my cardiologist, or whether to just get used to my new "normal".

 

[pellicle]

Hey Tezza

I am now 6 months post AVR, and I am having similar issues as you. I am constantly aware of my heart beat and it feels as though my heart is hammering through my chest. I will often have an extra hard thump, which I feel through my stomach, my groin and my right shoulder. When I am sitting still, others will comment that they can see my heart beating.

I am nearly 10 years post op and would say that I experience simmilarly. I am mostly unaware of my heart beat but as soon as my attention turns to it I can pretty much hear / feel perceive it. However when I'm doing anything physical I am usually attending to that (mowing the lawn, riding motorcycle, driving car or building a steel shed) and it fades from observation. So its not "ever present" (unless you focus on it).

I noticed that soon after moved to the ward from ICU and typing a message to my wife that I observed I was rocking slightly in bed. This was pretty soon clarified to me as being my heart beat. My view was that now that a leaking valve and a piece of flexible (about to blow) hose had been replaced my inner hydraulic system was making itself felt.

I believe this is because

1. we notice new things or changes
2. that the change is also significant we tune into it
3. the change in hydraulics is actually significant

Indeed even during writing this my attention has wavered in and out of my heart beat.

So while its a very real change so too is the change my body has made between 45 and 55 ... just because its gradual doe not make it less observable (over time and with a reference bar).

I would be interested to hear what the outcome is from your monitor. I'm still undecided whether to follow up with my cardiologist, or whether to just get used to my new "normal".

On the up-side I now have an excellent bio-feedback system of my stress levels and can take my pulse while just looking at my watch.

With respect to the HR "flibbidy dibbits" a kind member here pointed me in the direction of "sports drinks" which I thought "why not" and tried. Now during the day I take a small glass of that and its been quite good. (See my post here)

Now I know you weren't expressing despair or sadness, however myself (and speaking generally), I see the only option that's good is to just adjust to these changes but not ignore them, to seek out the aspects which are worthy of investigation (so far none). I'm glad that all these indicators point to the very likely outcome that (aside from not being dead) "another surgery would leave me worse" after recovery was taken into account. So I am glad to have what I have than have the other thing.

When I was a younger man arthritis in my joints was a concern, now however its a reality and I just have to deal with it.

http://cjeastwd.blogspot.com/2020/10/another-example-small-procedure.html
An older than me guy in the lineup the other day was struggling to read something and I read it for him. He looked at me and said "Do you know what's good about getting old"

I said "nope"

he looked me in the eye and said plainly "Nothing"

Myself I'd say that I do my best to continue to learn and grow and learn means also learn to adapt to change.

Age is not just a number its an indicator and a very good predictor of state of health.

I hope your shoulder gets on the mend soon too mate.

Best Wishes

 

[tezza]

Hey Tezza

I am nearly 10 years post op and would say that I experience simmilarly. I am mostly unaware of my heart beat but as soon as my attention turns to it I can pretty much hear / feel perceive it. However when I'm doing anything physical I am usually attending to that (mowing the lawn, riding motorcycle, driving car or building a steel shed) and it fades from observation. So its not "ever present" (unless you focus on it).

I noticed that soon after moved to the ward from ICU and typing a message to my wife that I observed I was rocking slightly in bed. This was pretty soon clarified to me as being my heart beat. My view was that now that a leaking valve and a piece of flexible (about to blow) hose had been replaced my inner hydraulic system was making itself felt.

I believe this is because

1. we notice new things or changes
2. that the change is also significant we tune into it
3. the change in hydraulics is actually significant

Indeed even during writing this my attention has wavered in and out of my heart beat.

So while its a very real change so too is the change my body has made between 45 and 55 ... just because its gradual doe not make it less observable (over time and with a reference bar).



On the up-side I now have an excellent bio-feedback system of my stress levels and can take my pulse while just looking at my watch.

With respect to the HR "flibbidy dibbits" a kind member here pointed me in the direction of "sports drinks" which I thought "why not" and tried. Now during the day I take a small glass of that and its been quite good. (See my post here)

Now I know you weren't expressing despair or sadness, however myself (and speaking generally), I see the only option that's good is to just adjust to these changes but not ignore them, to seek out the aspects which are worthy of investigation (so far none). I'm glad that all these indicators point to the very likely outcome that (aside from not being dead) "another surgery would leave me worse" after recovery was taken into account. So I am glad to have what I have than have the other thing.

When I was a younger man arthritis in my joints was a concern, now however its a reality and I just have to deal with it.

http://cjeastwd.blogspot.com/2020/10/another-example-small-procedure.html
An older than me guy in the lineup the other day was struggling to read something and I read it for him. He looked at me and said "Do you know what's good about getting old"

I said "nope"

he looked me in the eye and said plainly "Nothing"

Myself I'd say that I do my best to continue to learn and grow and learn means also learn to adapt to change.

Age is not just a number its an indicator and a very good predictor of state of health.

I hope your shoulder gets on the mend soon too mate.

Best Wishes

Hey Pellicle, thanks for your response.
Hmmm, 10 years and still feeling this...I guess that is what I thought might be the case...that this is my new normal and something I just have to adjust to.... I wouldn't say I am particularly worried about it, given no signs of any other symptoms as such, but I'm just bloody annoyed by it!
I do notice that for the most part, but certainly not always, that awareness does diminish slightly when I am involved in another activity but have to say it never goes away and I am always aware, so I guess I am stuck with it. Just have to take heart, pardon the pun, that it is still beating and doing its job! The alternative isn't pretty!
I think also that it becomes more pronounced when it is hot, and that perhaps the recent increase in temps have coincided with the apparent increase in sensation. I actually recall that prior to the surgery, any increase in climate temp resulted in some crazy beats, so perhaps that is just me.
Yes, I can take my pulse by just counting the beats in my chest lol! Handy party trick?

Would be interested to find out the brand of your sports drink...since you live in the same neck of the woods, would you mind sending me a message? I will give it a try and see what happens.

The shoulder is going reasonably well, thanks for asking. I am getting more and more movement back...now able to touch the top of my head and undress without assistance, so that is a win. Seeing improvement week by week, so happy with that. I think I am hitting a faster timeline for recovery than I was advised I would, but I am working at it everyday doing my own form of physio and using it as much as I can. So I'm not complaining about that and starting to do upper limb strengthening exercises...even starting to think about getting back into some gym work with it, although it will be pretty limited still. But definitely moving in the right direction....patience, patience...

 

[pellicle]

. Just have to take heart, pardon the pun,

I love puns like that

The sports drink is this one

My advice is that the more you dislike it the more your shadow will push it up at you like the little kid it is. My approach is to listen to it ... There was a time when it reminded me of 2012 , but thankfully I've managed to understand and accept that. Suppression is rather like squeezing a balloon with your fist; the pressure you exert on it will force it up through some other gap.

Best Wishes

 

[tezza]

I love puns like that

The sports drink is this one
View attachment 888152

My advice is that the more you dislike it the more your shadow will push it up at you like the little kid it is. My approach is to listen to it ... There was a time when it reminded me of 2012 , but thankfully I've managed to understand and accept that. Suppression is rather like squeezing a balloon with your fist; the pressure you exert on it will force it up through some other gap.

Best Wishes

thank you...will check out the drink next time I'm there. Yes, I guess I need to embrace it, make peace with it, and accept it.

 

[pellicle]

thank you...will check out the drink next time I'm there. Yes, I guess I need to embrace it, make peace with it, and accept it.

reminds me of a quote from a movie not everyone likes, its a bit melodramatic, but then so was the movie

to mix metaphors, every time go to cherry pick my history looking for sour grapes on what I've lost (perhaps attempting logically justifying why I'm feeling bad) my unconscious (who I give free reign to message me as it desires) throws the view that "God dealt me the hand to be dead by 15 or so, and it was science and the work of people that gifted me with what life I've had".

I then reflect on my life in a more holisitc way and find that I'm very well off, served very well by an excellent medical system, enabled with tools and technology to live a life that was denied even to Kings but a century or so before.

Years ago I went to a lecture by Bjorn Lomborg at UofQ (with my colleagues from Griffith Env Sci department), he made a lot of really good points about how life is getting better for humanity and its because of developments in science and politics. Sadly my friends were a bit closed minded on that.

He makes a lot of sense, I recommend reading his book the Skeptical Environmentalist.

In my life (probably since middle school) I've turned to Stoic views as a guide to how to run my life. They are evergreen, do not conflict with spiritual views nor science, preach nothing except humility and honesty.

I believe that I do what I can to make others lives around me better too (perhaps I am not always successful), sort of paying forward what I received.

Best Wishes

 

[vitdoc]

My resting heart rate is quite variable, from 60-100, and I frequently have skipped beats, followed by catchup beats

Your resting HR shouldn’t be that variable. Suggest discussing with cardiologist and probably getting it monitored. May be nothing but needs to be better understood.

 

[AZ Don]

Aside from a couple short bouts of a-fib post surgery I have not had the variable heart rate, but I have had the pounding. For some it goes away within a year but I still have the pounding 7.5 years later but I'm pretty used to it now. Seems to be associated to the aneurysm graft rather than the valve. Here's my description of it from almost 7 years ago.

I had a root and ascending aneurysm repair last May and I have the same thing. When I take a deep breath, especially if I arch my back I feel like my heart is pounding against my sternum. At first I was told by the surgeon's assistant that it was probably due to the pericardial sac not being closed in the surgery, that it would scar over and the pounding would likely settle down after a couple months. I've seen comments from several people that have the same thing (search for pounding). One person had it pretty bad to the point they were having trouble sleeping. Anther mentioned it didn't go away until after 10 months. I spoke to my surgeon recently and he didn't seem to think it was necessarily related to the pericardial sac and suggested it could be the heart beat is transmitted differently due to the graft (perhaps the graft is touching the sternum in certain positions?). In any case, I asked my surgeon if it was anything to worry about. Should I avoid breaths/positions that cause it for fear it could harm my heart? He was quite sure that there was no risk from it. Aside from my scar this is really the only regular reminder that I had OHS. If it never goes away it is certainly something I can live with.

 

[carolinemc]

I am now 6 months post AVR, and I am having similar issues as you. I am constantly aware of my heart beat and it feels as though my heart is hammering through my chest. I will often have an extra hard thump, which I feel through my stomach, my groin and my right shoulder. When I am sitting still, others will comment that they can see my heart beating. My resting heart rate is quite variable, from 60-100, and I frequently have skipped beats, followed by catchup beats, but don't have any racing, although I did a couple of times in the early weeks post surgery, which settled quickly. I have found that it has worsened considerably in the past 3 weeks, so I have tried altering my diet (keep blood sugars stable, reduce sugars, no alcohol, no caffeine) but haven't found any difference. I tolerate exercise well and find no difference in the way in which I feel my heart beat. I don't have any extraordinary stress in my life, and meditate daily, so I don't think stress is a factor. My cardiologist reassured me at my 2 month post-surgery check that it would settle down, and it did somewhat, although never completely, but has suddenly worsened in the past few weeks. It is starting to get very annoying.
I would be interested to hear what the outcome is from your monitor. I'm still undecided whether to follow up with my cardiologist, or whether to just get used to my new "normal".

it is normal for one to see the heartbeat at certain places. If this did not happen, something would be wrong. it is the way the heartbeat travels through the body. It is very normal, before and after. And after in getting used to the tapping of the valve if you have a mechanical valve.

 

[Michael O]

With respect to the HR "flibbidy dibbits" a kind member here pointed me in the direction of "sports drinks" which I thought "why not" and tried. Now during the day I take a small glass of that and its been quite good. (See my post here)

Thank you for this suggestion. A powdered electrolyte solution is helping a great deal w/ the pounding heartbeats.

 

[pellicle]

Thank you for this suggestion. A powdered electrolyte solution is helping a great deal w/ the pounding heartbeats.

That's great ... and a nod to @leadville

I'll add that noting the sugar content in said "drinks" is important, because sometimes they're quite high ... better to have less pure sugars and get the glucose you need from more natural pathways (like from regular low processed "whole" foods) (@Chuck C , I can't believe I just wrote "whole foods")

 

[Michael O]

That's great ... and a nod to @leadville

I'll add that noting the sugar content in said "drinks" is important, because sometimes they're quite high ... better to have less pure sugars and get the glucose you need from more natural pathways (like from regular low processed "whole" foods) (@Chuck C , I can't believe I just wrote "whole foods")

Yep - the powder I use doesn't have any sugar. The only downside is that it has calcium which tends to block magnesium/zinc uptake. Its all a bit of a balancing act, and I've never run across clear rules for how to to optimize all of those things. Best I can do is to take my magnesium supplements in the afternoon, away from my dairy intake, which tends to happen in the morning.