Medical Oncologist
CION Cancer Clinics
Heart rhythm problems after a lung is removed | CION Cancer Clinics
Atrial fibrillation, an irregular and often fast heartbeat, is one of the most common events in the first days after a pneumonectomy. The heart has been moved slightly, is pumping against a changed pressure, and is irritated by the surgery. It is expected, watched for on the monitor, and almost always brought under control in hospital. This page explains what you might feel, what the team does, and what needs care at home. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- Why does the heart go into an odd rhythm after a lung is removed?
- What you, or the person beside the bed, might notice
- From the monitor alarm to going home
- Atrial fibrillation and an ordinary fast pulse after surgery
- What this page cannot tell you
- Four things families say, and what is actually true
- Common questions about heart rhythm after lung removal
The short answer
Why does the heart go into an odd rhythm after a lung is removed?
Because the heart has had a shock. Removing a whole lung changes the pressure the heart pumps against, moves the heart slightly in the chest, and irritates the nerves and tissue around it. The commonest result is atrial fibrillation, an irregular and often fast heartbeat that usually starts in the first few days after the operation. It is common, it is expected, and it is almost always brought back under control in hospital.
What atrial fibrillation actually is
The upper chambers of the heart stop beating in a steady pattern and quiver instead. The lower chambers, which do the real pumping, then beat irregularly and often too quickly. Blood still circulates, but less efficiently, and blood can pool in the upper chambers and form a clot. That clot risk is why the team takes it seriously even when you feel little.
Who is more likely to get it
Older people, people who already had a heart problem or high blood pressure, and people who have had the right lung removed rather than the left. A large operation, a long anaesthetic and low levels of potassium or magnesium in the blood after surgery all add to it. Your team checks those levels for exactly this reason.
Many people notice nothing at all. It is picked up on the monitor in the intensive care unit before they feel a thing.
!
At home, these cannot wait
A racing or irregular heartbeat together with chest pain, fainting, sudden breathlessness, or one side of the face or body going weak or numb needs an emergency department the same hour, not a clinic appointment. Say a lung was recently removed. A fast heartbeat on its own, without those, still needs a call to the ward or the helpline the same day.
Not sure whether this applies to you?
Ask an oncologistWhat it feels like
What you, or the person beside the bed, might notice
A fluttering or thumping
The most typical feeling. The heart seems to skip, race or bang in the chest, sometimes felt in the throat. It can come and go over a few hours.
Sudden breathlessness or dizziness
With only one lung, a heart that is pumping less efficiently is felt sooner. Standing up to walk to the toilet can suddenly feel much harder than it did that morning.
Tell the nurse if
- Breathing changes without exertion
- The room seems to sway on standing
Confusion or drowsiness
In older people the first sign is sometimes not the heart at all but a change in how alert they are. Families often notice this before staff do, so say something.
Nothing
A good share of people feel entirely normal and learn about it from the monitor alarm. That does not make it less real, and the treatment is the same.
A pulse that feels irregular when you check it at the wrist is worth reporting even if it is not fast.How it usually goes
From the monitor alarm to going home
-
The rhythm is confirmed
An ECG, a quick tracing of the heart from stickers on the chest, shows the pattern. Blood is checked for potassium, magnesium and signs of infection or a low haemoglobin, because any of those can set the rhythm off.
-
The rate is slowed
Medicines through the drip bring the heartbeat down to a safer speed, even if the rhythm is still irregular. Oxygen and fluid are adjusted. Most people feel better within hours of this.
-
The rhythm is corrected, or allowed to settle
Many hearts return to a normal rhythm on their own once the rate is controlled and the blood chemistry is corrected. If not, a medicine such as amiodarone may be used. Rarely, a brief electric shock under sedation is used to reset it.
-
Going home
Some people leave hospital on a tablet to keep the rate steady, and some on a blood thinner to lower the clot risk. Your discharge letter says which, and for how long the team wants you on them. Do not stop either without asking.
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Follow-up
A repeat ECG at the first clinic visit, and sometimes a heart scan. If the rhythm has settled, the tablets are usually withdrawn by your doctor over the following weeks.
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Side by side
Atrial fibrillation and an ordinary fast pulse after surgery
Atrial fibrillation
A fast but regular pulse
Irregular: no steady gap between beats
Regular: quick, but evenly spaced
Often starts suddenly in the first few days
Usually present from the first day and eases
Common causes: the operation itself, low potassium, infection
Common causes: pain, fever, dehydration, anxiety
Needs rhythm or rate medicine, sometimes a blood thinner
Usually settles with pain relief, fluid and rest
Confirmed by an ECG tracing
Also confirmed by an ECG, which shows a normal pattern
Being straight with you
What this page cannot tell you
It cannot tell you whether the rhythm will come back. For most people it is a one-off event of the recovery period. For some, particularly those with an existing heart condition, it returns or stays, and becomes something a cardiologist manages long term. Which group you fall into only becomes clear over the first months.
It cannot tell you which medicine, or for how long
Rate-control tablets such as a beta-blocker, rhythm medicines such as amiodarone, and blood thinners such as apixaban or warfarin are all used. Which one, at what dose and for how long is set by the surgeon and the physician looking after you, based on your own heart, kidneys and bleeding risk. Never change or stop any of them because a page or a relative suggested it.
It cannot say whether it was preventable
Some centres give a preventive tablet before surgery to people at high risk. Whether that was right for you depended on your own heart history and blood pressure. If it happened despite that, it is not a sign that something was missed.
Bring the ECG tracings and the discharge letter to every visit, including visits to a district hospital for anything unrelated. The rhythm history changes how other doctors treat you.Commonly believed
Four things families say, and what is actually true
"The heart is failing. The operation was too much
for him."
An irregular rhythm after a pneumonectomy is an irritation of the heart, not the heart failing. It is one of the most common events of this recovery and it is usually controlled within hours. It does not mean the operation was a mistake.
"He feels fine now, so the blood thinner can be
stopped."
Feeling well says nothing about clot risk. The blood thinner is there for the weeks when a clot could form even after the rhythm has settled. Only the doctor who prescribed it decides when it stops.
"An electric shock to the heart means things are
desperate."
A planned shock under short sedation is a routine way to reset a stubborn rhythm. It takes seconds, you are asleep for it, and it is nothing like the emergency scenes on television.
"Coffee and tea must be banned for life."
Ordinary amounts of tea and coffee are not what set this rhythm off after surgery. Ask your team about alcohol and about very strong stimulants, but nobody needs to give up their morning chai on this account.
Questions we are asked
Common questions about heart rhythm after lung removal
How common is this after a pneumonectomy?
Common enough that every patient is kept on a heart monitor for the first days specifically to catch it. It is more frequent after removal of a whole lung than after smaller lung operations, and more frequent on the right side. Your team will not be surprised by it, and neither should you be.
Does it damage the heart permanently?
Usually not. In most people it is a temporary disturbance that settles once the body recovers from the operation. The concern in the short term is a clot forming in the heart, which is why a blood thinner is sometimes used. A heart scan is arranged if the team wants to check the pumping strength.
Will I have to see a heart specialist?
Not always. If the rhythm settled quickly and the ECG is normal at follow-up, the surgical team manages it. If it keeps returning, or you had a heart condition before, a cardiologist is brought in. Either way the surgical and heart teams talk to each other rather than leaving you to carry messages.
Can I check for it myself at home?
Yes, roughly. Feel the pulse at the wrist for a full minute. A regular beat has an even gap between beats; atrial fibrillation feels chaotic, with no pattern. A smartwatch that reads rhythm can help but can also mislead. If it feels irregular, call the ward rather than trying to decide.
Does the blood thinner mean I cannot have other treatment?
No. Chemotherapy, radiotherapy and most procedures can go ahead, but every doctor involved must know you are on it, especially before any biopsy or dental work. Carry the name of the medicine in your phone and mention it at every appointment without being asked.
Why were my potassium and magnesium checked so often?
Because low levels of either make the heart far more likely to slip into an irregular rhythm. After a big operation both can fall, through drips, poor eating or some medicines. Topping them up is one of the simplest and most effective ways to keep the rhythm steady.
Can I climb stairs and walk once I am home?
Yes, and you should, at the pace your physiotherapist set. Gentle, regular walking helps the heart and the remaining lung. Stop and rest if the heartbeat suddenly races or feels irregular, and mention it at your next visit. Avoid heavy lifting until your surgeon clears it.
Is treatment for this covered under Aarogyasri or my insurance?
Treatment of a complication during the same admission is normally covered under the surgery approval. Longer-term heart tablets may or may not be. Aarogyasri, CGHS, ECHS and EHS are accepted at CION, and most cashless insurers are empanelled. Call the helpline with your card details and we will check what applies.
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
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Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Sources
- Cancer Research UK — Surgery for lung cancer
- NHS — Atrial fibrillation
- American Cancer Society — Surgery for non-small cell lung cancer
- NICE — Atrial fibrillation: diagnosis and management (NG196)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Left vs right pneumonectomy: why it mattersWhy the right side puts more strain on the heartTests to check you can tolerate losing a lungThe heart checks done before the operationRecovery timeline after pneumonectomyWhere the first days on the monitor fit inICU and the first days after surgeryWhat the monitors and drips are forMedicines around cancer surgeryBlood thinners and heart tablets before and after
Talk to us
A racing or irregular heartbeat after lung surgery?
If there is chest pain, fainting or weakness on one side, go to an emergency department now. Otherwise call the helpline and a CION surgical oncologist will tell you whether it needs to be seen today. One helpline serves every CION centre.