Surgery Risks

[Confused8]

I am scheduled to have a rhinoplasty procedure done next month due to a deviated septum and other breathing issues.  I have thickened mitral leaflets and mild mitral regurgitation.  I am currently taking Cardizem.  I have had issues off and on of tachycardia and PACs and PVCs and possibly a couple of episodes of afib that resolved on their own.  I had an appt with my cardiologist and he thought that I would be fine to have the surgery and prescribed me Toprol to take the night before surgery.  I was a little unclear on when he told me to take the Toprol and if I was supposed to continue the Cardizem.  I called his office today and spoke with a nurse and she said that the chart said I am supposed to take the Toprol the night before. I aksed if I was supposed to take the Cardizem that night too.  She said yes that they are totally different and I was to take both.  Does this sound right?

My other question is regarding the actual surgery.  It will be done in the doctor's office under conscious sedation.  The doctor has said that they will be injecting epinephrine to control the bleeding.  I am just wondering how this will affect my heart.  Is this why my cardiologist prescribed the Toprol?  I know that the epi will probably increase my heart rate and possibly increase the palpitations but how severe can I expect the effects to be?  Am I worrying about nothing?  Should I have I have concerns regarding my heart with this procedure?  My cardiologist and plastic surgeon do not seem too concerned.  Thanks in advance for your time and expertise!

[Cleveland Clinic]

Your doctor is probably following the ACC/AHA guidelines for non cardiac surgery, which dictate that for some patients with a moderate risk of death or myocardial infarction from surgery, and who undergo at least a moderate risk procedure ( yours is a low risk procedure), benefit from peri-operative beta blockers. No reference to cardiazem, which although slows down the heart is a calcium channel blocker. Hence he was simply trying to protect you from perioperative death or myocardial infarction by adding beta blockers to your regiment, which already included the cardiazem.
Some cardiologist would say that with an asymptomatic patient at low risk for any morbidity from non cardiac surgery undergoing a low risk procedure would not warrant anything but perioperative beta blockers.

[Confused8]

I forgot to add that I am a 27 year old female otherwise in pretty good health.  I also have rheumatoid arthritis and have had two episodes of pericarditis, which was extremely scary.  Would the surgery increase the risk of pericarditis occurring again?