From the Guidelines
Radical hysterectomy is associated with an elevated risk of subsequent cardiovascular disease, and patients should be monitored for potential cardiovascular complications during recovery and long-term follow-up. The surgery itself involves removing the uterus, cervix, part of the vagina, and surrounding tissues, which does not directly impact heart function. However, any major surgery carries cardiovascular risks including blood loss, fluid shifts, and stress responses that can affect the heart. Patients with pre-existing cardiac conditions should receive thorough preoperative cardiac evaluation 1. During recovery, patients may experience temporary tachycardia or blood pressure changes due to pain, medication effects, or fluid status changes.
Key Considerations
- Long-term cardiac effects are a concern, with cohort studies and registries reporting increased risk of cardiovascular disease 1.
- The risk of cardiovascular disease is higher when hysterectomy is performed at a young age 1.
- Alternative treatments to hysterectomy should be considered first-line, unless there are other indications for the surgery 1.
- The least invasive route for hysterectomy should be performed, with vaginal and laparoscopic approaches associated with shorter hospital stays, faster return to normal activities, and lower rates of complications compared to abdominal hysterectomy 1.
Postoperative Care
- Monitoring vital signs and maintaining appropriate fluid balance are crucial in preventing cardiovascular complications.
- Providing adequate pain control and encouraging early mobilization can help prevent complications like deep vein thrombosis that could indirectly affect the cardiovascular system.
- Patients should report any chest pain, palpitations, shortness of breath, or unusual fatigue during recovery as these could indicate cardiac complications requiring immediate attention.
From the Research
Radical Hysterectomy and Cardiac Effects
- Radical hysterectomy is a surgical procedure that can have various effects on the body, including cardiac effects 2, 3.
- A study published in 2021 reported two cases of cardiac arrest occurring in medically fit patients undergoing radical hysterectomy for cervical cancer, highlighting the potential for cardiac complications during the procedure 3.
- The causes of cardiac arrest in these cases were attributed to preoperative emotional stress, Takotsubo cardiomyopathy, and a vasovagal episode during the exploration of the abdomen 3.
Cardiac Complications and Hysterectomy
- Research suggests that hysterectomy may be associated with an increased risk of cardiovascular disease (CVD), including ischemic heart disease and hypertension 4, 5.
- A meta-analysis published in 2022 found that hysterectomy was positively related to CVD, with a pooled relative risk of 1.16 (95% CI 1.03-1.30) 4.
- Another study published in 2011 found that hysterectomy in women aged 50 years or younger substantially increases the risk for CVD later in life, and oopherectomy further adds to the risk of both coronary heart disease and stroke 5.
Management and Prevention of Cardiac Complications
- The use of renin-angiotensin system blockers has been suggested as a potential strategy to reduce cardiovascular complications in cardiac surgery, although further studies are needed to examine their effectiveness 6.
- Surgical and anaesthetic teams should be aware of the importance of countering severe preoperative stress to prevent cardiac complications during radical hysterectomy 3.