Post-Thymoma Surgery: Symptoms and Heart Rate Changes

Postoperative symptoms related to thymoma?

About a year ago, I was diagnosed with a thymoma through an X-ray examination, which was not accompanied by myasthenia gravis.
A CT scan showed that the tumor was approximately 3x5 cm in size and had invaded the pericardium.
The doctor arranged for a sternotomy to remove the tumor, excise the invaded pericardium, and replace it with a synthetic pericardium.
The tumor was sent for pathology, and the result was Type B3.
The doctor advised that I needed to undergo adjuvant radiation therapy.
After a three-month recovery from surgery, I received radiation treatment five times a week for a total of 30 sessions.
I now have regular follow-up appointments.
I would like to ask the doctor the following questions:
1.
After the surgery and radiation therapy, I have noticeably felt that my heart rate has increased.
At rest, it is about 90 beats per minute, and when walking, it reaches around 120 beats per minute (this is what I measured recently; I have tried jogging, but I become too breathless after 400 meters).
I previously asked my doctor about this, and he mentioned that my preoperative ECG looked similar and was not a concern.
Recently, I asked again, and the doctor said as long as my heart rate is not fluctuating, it is fine.
However, I am certain that my heart rate was not this fast before the surgery.
Over the past year, I have experienced some chest tightness, and I am a bit worried it might be related to the pericardium.
What could be causing my increased heart rate?
2.
Occasionally, I feel internal pain between my left clavicle and breast (closer to the sternum), but it usually resolves after a while.
The doctor said it might be a postoperative sequela that can be affected by weather changes.
However, since I had a sternotomy, I would expect it to be sternum pain.
What is your opinion on this?
3.
Sometimes, I experience a strange sensation in the area of my heart, as if there is air bubbling inside, but it does not feel uncomfortable.
What could be the cause of this sensation?
I apologize for the disturbance, and thank you for your assistance.

Xiao Yan, 20~29 year old female. Ask Date: 2016/06/01

Dr. Lai Yicheng reply Oncology

Dear Miss Hsiao-Yan,
In response to your inquiry, I would like to provide the following information:
1.
Based on the symptoms you described, including the rapid heartbeat and pain located between the left clavicle and breast (closer to the sternum), which varies with weather changes and feels like air bubbles moving inside, I personally suspect that these may be sequelae of mediastinal fibrosis resulting from postoperative radiation therapy.
2.
If your symptoms have not worsened, it indicates that the mediastinal fibrosis is not progressing.
Currently, you may take analgesics and muscle relaxants to alleviate discomfort.
3.
Please ensure to have regular follow-up CT scans to monitor the status of the thymoma and the condition of the mediastinal fibrosis.
Changhua Hospital is concerned about your health.
Sincerely,
Dr.
Lai Yi-Cheng
Department of Radiation Oncology

Reply Date: 2016/06/01

More Info

Post-thymoma surgery, it is not uncommon for patients to experience changes in heart rate and other symptoms. Your concerns regarding the increased heart rate, chest discomfort, and unusual sensations in the heart area are valid and warrant a thorough understanding.

1. Increased Heart Rate: After undergoing surgery and radiation therapy for thymoma, it is possible to experience an elevated heart rate (tachycardia). This can be attributed to several factors. First, the body undergoes significant stress during and after surgery, which can lead to an increase in sympathetic nervous system activity, resulting in a faster heart rate. Additionally, the physical recovery process can be taxing, especially if you are engaging in activities like running, which may lead to increased heart rates due to exertion. It's also important to consider that anxiety and stress related to your health condition can exacerbate these symptoms. If your heart rate is consistently elevated at rest or during minimal exertion, it may be worth discussing with your healthcare provider to rule out any underlying issues such as post-surgical complications or cardiac concerns.

2. Chest Discomfort: The sensation of pain or discomfort in the area between the collarbone and breastbone can be a common post-operative symptom. This discomfort may arise from the surgical procedure itself, particularly if the sternum was cut, as the healing process can lead to muscle tightness or irritation of the nerves in the area. Weather changes can also influence how you feel, as barometric pressure changes can affect the body, particularly post-surgery. If the pain is intermittent and not worsening, it may be a benign post-operative symptom. However, if it becomes more frequent or severe, further evaluation may be necessary.

3. Unusual Sensations in the Heart Area: The feeling of "air bubbles" or unusual sensations in the heart region can be perplexing. This could be related to anxiety, which is common after significant medical procedures, or it could be a result of changes in the heart's rhythm or function post-surgery. Sometimes, patients report sensations that feel like palpitations or irregular heartbeats, which can be benign but should be monitored. If these sensations are accompanied by other symptoms such as shortness of breath, dizziness, or chest pain, it is crucial to seek medical attention.

In summary, while some of the symptoms you are experiencing may be typical after thymoma surgery and radiation, it is essential to maintain open communication with your healthcare provider. Regular follow-ups, including echocardiograms or Holter monitors, may be beneficial in monitoring your heart's health. If you have concerns about your symptoms or if they worsen, do not hesitate to reach out to your medical team for further evaluation and reassurance. Your health and peace of mind are paramount, and addressing these symptoms proactively can help ensure a smoother recovery process.

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