“I could no longer focus on complex issues“
Recovery after open-heart surgery may be complicated by personality and a temporary cognitive impairment of memory, that may include trouble remembering, and concentrating, sometimes called “Pumphead”. However, some new research suggests that the Pumphead Effect may have long-lasting negative impacts.
What is Pumphead?
It is thought that the primary cause of Pumphead is caused by blockage (called emboli) produced during surgery by microscopic pieces of plastic debris, fat particles into the bloodstream that can migrate to the brain and cause these changes. Unfortunately, open-heart surgery patients may experience some degree of this blockage during surgery, and result in permanent damage.
However, there is growing evidence that patient-related factors such as the presence of (cerebro)vascular risk factors play an important role in both early and late postoperative cognitive dysfunction.
The result is that patients may experience flashes of anger, tearful sadness, anxiety, depression, and sometimes frequent nightmares, sometimes mood swings and serious depression, even. suicidal thoughts.
Brain injury after cardiac surgery still occurs despite improvements in surgical techniques over the years and the usage of effective protective strategies. Patients undergoing cardiac surgery are older and often present with other diseases that include impaired blood-flow to the brain. However, a far more common form of brain injury is cognitive dysfunction, with clinical manifestations such as deterioration in memory, attention, (psycho)motor speed, and visuospatial ability. The incidence of cognitive dysfunction varies considerably but may be as high as 70 % early after surgery, declining to 30 % to 50 % after 2 months. Many of these cognitive changes are transient have been found as late as 5 years after surgery:
The New England Journal of Medicine reported In 2001 that 42% of patients showed a measurable decline in mental function as long as 5 years after recovering from surgery. Another study published in 2008 in the Annals of Thoracic Surgery showed that 51% had a measurable degree of brain damage.
A patient’s Tale
“I had an open heart triple bypass in 2012. In 2014 I had to stop working as I could no longer focus on complex issues – I was in software testing. Over the years my aggression and wish to do harm to those who pray on the vulnerable – I’m never aggressive with my family, we all get on good, has increased. Where once I would have walked away from violence now I would get stuck in no matter who it was. I get angry very easily over minor things and things in the news. I get into a rage when I do things like stumble or trip on stuff. Yet like I said earlier, never with my family, I am so blessed to have such great people in my life. Prior to surgery I was very sociable and always up for a laugh. Now I have no friends, none at all, and that’s through personal choice. I have become very much a loner and spend most of my time in my home office reading stuff, watching stuff, playing games and listening to music.”
Diagnosis
Cognitive dysfunction can be detected by neuropsychological testing, using measuring levels of cognitive malfunctioning. Studies in the first week after cardiac surgery have demonstrated brain swelling, decrease of brain metabolism and cerebral blood flow changes. New brain lesions were detected in 25 % to 50 % of cardiac surgery patients.
Prevention
With candidates for cardiac surgery becoming older and less healthy, adjustment of the surgical approach might be the only option to reduce the risk of postoperative cognitive dysfunction in these high-risk patients. In patients with severe atherosclerosis, for instance, preoperative carotid artery screening and/or scanning of the aorta at the beginning of surgery should be considered.
To achieve reduction in late cognitive decline, control of modifiable patient-related risk factors, such as hypertension and diabetes, will become more important.
Treatment
Cognitive rehabilitation can lead to a significant improvement in the cognitive functions that have been trained in patients receiving heart surgery.Treatment for lasting personality and cognitive impairment changes after open-heart surgery may include Couples Therapy and sessions with attention and working memory training tasks to improve divided attention and memory.