The feeling of heart palpitations, often described as a fluttering, pounding, or skipped beat, is a common symptom signaling an irregularity in the heart’s rhythm. When surgery is necessary, these irregular heartbeats raise questions about safety. Having surgery with palpitations is generally possible, but it requires a thorough pre-operative assessment to determine the rhythm’s cause and stability. The risk depends entirely on the specific underlying cardiac condition causing the abnormal rhythm.
The Required Cardiac Clearance Process
The first step in preparing for surgery involves consulting a cardiologist to obtain cardiac clearance, a process designed to stratify the patient’s risk for perioperative complications. This evaluation begins with a comprehensive review of the medical history and a physical examination, checking for signs like an irregular pulse or heart murmurs. The goal is to identify existing conditions that could destabilize the heart during the stress of the operation.
A standard diagnostic tool is the 12-lead Electrocardiogram (EKG), which records the heart’s electrical activity at rest to identify the current rhythm and any signs of prior damage. If palpitations are intermittent, a Holter monitor or heart patch monitor may be used to record the heart rhythm continuously over 24 hours to two weeks, capturing transient irregularities. An echocardiogram, an ultrasound of the heart, is often ordered next to assess the heart’s structure, valve function, and pumping effectiveness (ejection fraction).
If a patient has risk factors but cannot undergo an exercise tolerance test, a pharmacological stress test may be performed to simulate surgical stress. These test results help the cardiac team understand the cause of the palpitations—whether they are benign or symptoms of a serious issue like structural heart disease or coronary artery disease. Clearance is granted when the risk of a major adverse cardiac event is deemed acceptable for the necessary procedure.
How Surgical Stress Impacts Heart Rhythm
Palpitations are a concern during surgery because the procedure imposes significant stress on the cardiovascular system. The body’s response to surgical trauma activates the sympathetic nervous system, causing a surge of catecholamines like adrenaline and noradrenaline. These hormones increase heart rate and blood pressure, which can trigger or worsen pre-existing arrhythmias by lowering the electrical threshold for an irregular beat.
Anesthesia agents also affect the heart directly; some general anesthetics can depress heart muscle function or make the heart more susceptible to rhythm changes. Common fluctuations during surgery—such as changes in blood pressure, oxygen levels, and fluid balance—also contribute to electrical instability. This combination of acute stress response and anesthetic effects increases the likelihood of rhythm disturbances during the procedure.
Stabilizing Palpitations Prior to Operation
If the pre-operative assessment determines that palpitations pose a high risk, medical management is implemented to stabilize the patient before the scheduled operation. A common strategy is the adjustment or initiation of anti-arrhythmic medications, such as beta-blockers, which slow the heart rate and reduce sensitivity to stress hormones. This medication is often titrated to achieve a resting heart rate of 50 to 60 beats per minute for a protective effect.
Correction of electrolyte imbalances is also standard, as low levels of potassium or magnesium can directly trigger abnormal heart rhythms. Underlying systemic conditions contributing to palpitations, such as severe hypertension or hyperthyroidism, must be controlled to reduce the burden on the heart. For elective procedures, surgery is often postponed until the patient’s heart rhythm is medically stable and blood pressure is within an acceptable range, typically below 140/90 mmHg.
What Happens During Post-Operative Monitoring
The risk of developing new or recurrent arrhythmias continues after the operation; the first 48 to 72 hours post-surgery require heightened cardiac vigilance. This sustained risk is due to the lingering effects of anesthesia, significant fluid shifts, and the body’s inflammatory response to surgical trauma. Patients with a history of palpitations or those who underwent major surgery are typically placed on continuous cardiac monitoring (telemetry) in the recovery room and throughout their initial hospital stay.
This surveillance allows the medical team to detect and immediately treat post-operative arrhythmias, with atrial fibrillation being one of the most common irregularities. Aggressive management of post-operative pain is a priority, as unrelieved pain acts as a physiological stressor that can trigger or exacerbate palpitations. Preventing infections and maintaining careful fluid balance are also important, since sepsis and fluid overload can quickly destabilize a vulnerable heart and lead to serious cardiac complications.