Heart palpitations are a sensation of the heart beating too fast, fluttering, or skipping beats. For anyone facing a surgical procedure, the presence of these irregular heart sensations raises concerns about safety under anesthesia. The simple presence of heart palpitations does not automatically mean surgery must be cancelled or postponed. A surgical team requires a careful evaluation focusing on whether the underlying cause introduces an unacceptable risk during the physiological stress of an operation.
Pinpointing the Underlying Cause
The first and most important step is determining the specific reason for the heart palpitations, as the cause dictates the risk. Palpitations can range from harmless reactions to external factors to symptoms of a serious electrical or structural heart issue. Common triggers include high anxiety, excessive caffeine intake, or temporary hormonal shifts. These non-cardiac causes generally pose a low risk during surgery.
However, palpitations can also signal an underlying cardiac arrhythmia, such as atrial fibrillation or ventricular tachycardia, or an issue like an abnormal heart valve. To distinguish between these possibilities, physicians rely on specific diagnostic tools. An Electrocardiogram (ECG) records the heart’s electrical activity at rest, while a Holter monitor provides continuous electrical tracking, often for 24 hours, to capture intermittent palpitations. Blood tests check for reversible, non-cardiac causes, such as imbalances in electrolytes like potassium and magnesium, or an overactive thyroid gland.
Assessing Cardiac Risk Before Operation
Once the cause is identified, the medical team, which includes the surgeon, cardiologist, and anesthesiologist, focuses on quantifying the risk before the operation. The probability of a major adverse cardiac event (MACE) during or shortly after surgery is the primary concern. This risk assessment involves considering both the nature of the palpitation and the type of surgery being performed. A sustained, rapid arrhythmia presents a much higher risk than isolated, premature heartbeats.
The type of surgical procedure is also a significant factor in the risk calculation. High-risk operations, such as major vascular surgery, place a much greater strain on the cardiovascular system than low-risk procedures like cataract removal. Physicians use established risk stratification tools to combine the patient’s underlying health conditions and the anticipated surgical stress into a probability score. Ultimately, the decision to proceed is based on whether the specific palpitation places the patient in a high-risk category for cardiac complications.
Strategies for Pre-Surgical Stabilization
If the palpitations are deemed to pose a significant risk, proactive steps are taken to stabilize the heart rhythm before the patient enters the operating room. This pre-surgical preparation focuses on achieving either rate control or rhythm control. Rate control involves using medications like beta-blockers or calcium channel blockers to slow a fast heart rate, reducing the workload and stress on the heart muscle.
Rhythm control aims to restore and maintain a normal heart rhythm, often through anti-arrhythmic medications. Reversible causes identified during testing are also corrected immediately, such as aggressively managing an electrolyte deficiency or treating underlying hyperthyroidism. In rare instances where a life-threatening or highly symptomatic arrhythmia cannot be controlled with medication, an electrophysiology procedure like catheter ablation may be considered to eliminate the abnormal electrical pathway before an elective surgery is attempted.
Managing Palpitations During the Procedure
Enhanced monitoring protocols are implemented throughout the operation to ensure patient safety, especially when there is a known history of palpitations. The anesthesiologist plays a central role in maintaining hemodynamic stability, keeping the patient’s blood pressure and heart function steady. Continuous, real-time monitoring of the patient’s heart rhythm via an enhanced ECG is standard practice.
The choice of anesthetic agents is strategic, as some drugs can either trigger or suppress arrhythmias, and the team selects those least likely to disrupt the heart’s electrical system. All necessary equipment and protocols are immediately available to manage a sudden escalation of the arrhythmia. This includes having anti-arrhythmic medications ready for immediate intravenous administration and the availability of a defibrillator for rapid electrical cardioversion if a life-threatening rhythm develops.