Doctor Q&A: High Heart Rates & Loud Heartbeats After Cardiac Surgery
Published: June 8, 2020
I just received two great questions about the heart after cardiac surgery. Tyler asked me, “Are high heart rates common after surgery?” Lisa wrote in, “Adam – I had surgery three days ago. My heart is beating very loudly at night, almost like it’s beating out of my chest. Is this normal?”
To provide Tyler and Lisa expert responses to their questions, I interview Dr. Junaid Khan, a leading cardiac surgeon from Alta Bates Summit Medical Center in Oakland, California. As you may already know, Dr. Khan is a heart valve specialist having performed over 2,500 heart valve procedures during his career. Here are the highlights of my interview with Dr. Khan specific to high heart rates and loud heartbeats.
Key Patient Learnings from Dr. Khan
Dr. Kahn shared several important points during this interview that I wanted to write down and remember:
Dr. Junaid Khan
- High heart rates are common after cardiac surgery and normal as patients recover from heart surgery.
- Up to 25% of patients may experience atrial fibrillation, an abnormal or irregular heart rhythm after heart surgery. Atrial fibrillation needs to be monitored as it can cause an elevated risk of stroke. Medications can be used to manage atrial fibrillation.
- Most of the time, higher heart rates and atrial fibrillation are temporary cardiac conditions for patients and go away over time.
- Loud heartbeats are a common experience for patients following heart surgery. Patients may experience a feeling that their heart is beating out of their chest.
- Patients who have heart valve surgery through different access points – sternotomy, minimally-invasive (thoracotomy) and transcatheter approaches – may experience loud heartbeats.
- Those patients who receive a mechanical heart valve may hear their heart valve “tick” as the valve opens-and-closes.
Thanks Tyler, Lisa & Dr. Khan!
I hope that helped you learn more about high heart rates and loud heartbeats after heart surgery. I want to thank Tyler and Lisa for their questions. I also want to extend a special thanks to Dr. Khan for sharing his clinical experiences and research with our patient community!
Keep on tickin!
P.S. For the hearing impaired members of our community, I have provided a written transcript of my interview with Dr. Khan below.
Adam Pick: Hi, everybody, it’s Adam with heartvalvesurgery.com, and we’re answering your questions on the Ask Adam Anything series. I am thrilled to be here today with Dr. Junaid Khan. Dr. Khan, are you there?
Dr. Junaid Khan: I’m here with you, Adam, good to be with you.
Adam Pick: Yeah, well, as everybody knows, Dr. Khan, you’re a long-time supporter of our community. You are a leading cardiac surgeon at Alta Bates Summit Medical Center up north of me in Oakland, California. Dr. Khan has performed over 2500 heart valve procedures. Dr. Khan, we’ve got some great questions for you today that we’re going to be talking about all about the heart after surgery.
To begin, can I ask you, obviously valve therapy is a huge part of your practice. Can you share with our community what it is about fixing valves, repairing and replacing them, that’s so exciting for you?
Dr. Junaid Khan: I think, Adam, that’s a good question. I think the valve repair part of the business is really the art of cardiac surgery. No two surgeries are alike. You try to go in and see what’s left or what the problem is inside the heart, and then you move the internal parts around. Sometimes you put in new hinges, put in a ring. I think I like it because it’s very artistic. It allows us to really protect the patient’s own anatomy and it has the best long-term outcomes. That’s why it’s so appealing to me.
Adam Pick: Great, and when it comes to the questions, Dr. Khan, we’ve got two great ones for you from our community members, and I got to – I can’t – I got to once again thank you for your support of our community, whether it’s Mildred Burns or Derrick Daniels or Doug Olsen, you have really taken care of the folks from heartvalvesurgery.com, and I want to thank you for that before we get into them. Thank you for your work and your team.
Dr. Junaid Khan: I’ll tell you, Adam, not a week goes by that one of my patients doesn’t thank me for introducing them to your book. We give your book to every one of our patients before surgery, and they find it to be so helpful, not only for them as they plan for surgery but also in the recovery from surgery.
Adam Pick: Wow, that makes me feel great. It’s been a great team effort, Dr. Khan. Speaking of the team, the patients are obviously a big part of our team, and let’s get to their questions. The first one is coming in from Tyler, and Tyler asks, “Is it common to have a high heart rate after heart valve surgery?”
Dr. Junaid Khan: Well, Tyler, that’s a great question. It’s one of the most common questions we get asked. The way I answer that is there are two ways to look at it. First, controlling the heart rate we know is one of the most important components of having a good recovery after heart surgery. We don’t necessarily want you to have a high heart rate. However, sometimes when people are recovering from heart surgery, particularly when they get home, they exercise more. They may be a little bit conditioned, so it’s not abnormal to have a little bit of a high heart rate for a period of time, but it is something that you want to discuss with your doctor.
The most important part, however, is something called atrial fibrillation. That can also lead to a high heart rate. Almost 25% of our patients can have atrial fibrillation. Usually that occurs while you’re still in the hospital, but sometimes it can also occur when you’re at home. It’s an irregular heart rate. This is something that is even more important, and we do want to correct that with medications. If you have a high heart rate and you’re exercising and it gets better once you stop exercising, that is probably okay, but if it’s continuously high, we do want to control that with medication.
Adam Pick: Junaid, a real quick follow-up for Tyler’s question. I’m guessing there’s some patients, Dr. Khan, who are wondering, is that something where, over time, the high heart rate normalizes? Also, you referenced AFib. Is that something that is maybe a temporary thing?
Dr. Junaid Khan: Yeah, so in about a quarter of patients get it. Almost for most of those patients, it’s temporary and it goes away. It’s just irritability in the heart, but we do want to control the atrial fibrillation because it can cause a host of problems. In terms of the high heart rate, we really don’t want a high heart rate for extended periods of time. Now if you’re exercising and the rate goes up, then that’s okay, but a resting high heart rate is problematic and we do want to address that and figure out the source.
Adam Pick: Great. I know that helped me; I hope that helped you, Tyler, and the second question, Dr. Khan, comes in from Lisa. She asks – and it’s funny because I remember this when I got home from my procedure. She asks, “I had surgery three days ago. My heart is beating very loudly at night, almost like it’s beating out of my chest. Is this normal?”
Dr. Junaid Khan: Yeah, I think what I would tell you – Lisa, it’s a great question It is very normal. It’s one of the things that we do tell patients about to expect after heart surgery. They can feel their heart beating, and sometimes people use the exact phrase that I’m feeling it beating out of my chest. Now, with everything, that’s usually normal. Sometimes when people have a mechanical valve instead of a cow valve, you can actually hear the valve sounds. If I’m going to put a mechanical valve, I tell patients that you may actually hear the valve sounds. That is also perfectly normal.
There is a difference, however, about feeling that the heart is beating really loudly and you can feel it versus a feeling of something is not right. It’s beating too fast. If you’re not feeling well, then let your doctor know, but feeling the heart beat now that you can actually sense it is fairly normal after heart surgery.
Adam Pick: Now then, Dr. Khan, a quick follow-up to that. Obviously when you’re doing surgery, whether a sternotomy – and I know minimally invasive approaches are very big in your practice – might a patient see this sensation more or less if it’s a minimally invasive procedure or sternotomy? Do you have any data about that?
Dr. Junaid Khan: Yeah, that’s a great question. I thought we would see it less because we do so much of the small incision heart surgery but even my patients with a small incision, they feel the heart beating louder. I think it’s a sense that people are more attuned to their heartbeat. That’s why they’re sensing it. There’s no data because it’s so subjective but definitely I was surprised when my minimally invasive patients were still feeling it beat more. Interestingly, I will tell you even some of the percutaneous aortic valve patients that we do say they can feel their heart beating louder. Really for them, the only thing we’ve done is a little puncture in the groin.
Adam Pick: Got it, so at Alta Bates Summit, you are doing the transcatheter procedures, the TAVR and the MitraClip, and I know that there are some other transcatheter mitral valve replacement procedures. Is that happening up in your practice?
Dr. Junaid Khan: Yeah, all the above, exactly. We’re part of several trials. We do lots of transcatheter aortic valves, and we’re doing a lot of patients who are low risk in part of the low-risk trial. We’ve done lots of MitraClips and we’re also doing transcatheter mitral replacement under certain circumstances. I think the book is still out as to who’s an appropriate candidate for that and also the tricuspid valve clips. Those are the things that we’re going to be part of trials on at Alta Bates Summit Medical Center.
Adam Pick: Great. Well, Dr. Khan, on behalf of all of the patients you’ve helped in the past and all the patients you’re going to help in the future, I want to extend a tremendous thank-you Your pursuit of healthy hearts and in particular, healthy heart valves is something that needs to be commended. On behalf of our community, again, we really appreciate all your support through the years that we’ve been doing this together going back, jeez, when we hosted some patient education events up there in Oakland. I still tell people about all the great patient-centric education work that you and your team are doing. Thanks so much.
Dr. Junaid Khan: Thank you, Adam. It was a pleasure talking to you and thanks for being such a great advocate for our patients.
Adam Pick: Yeah, and so for people who’d like to get into contact with Dr. Khan, we’re going to go ahead right now as we wrap up this video with his phone number so you can reach out to him. Again, Dr. Khan, thanks for all your time and thanks for all your great cardiac care.