Recovery From Heart Surgery

What can you expect after your heart surgery?

Each individual patient responds to surgery differently. Recovery from each specific surgical procedure, whether a coronary artery bypass for clogged arteries or a valve repair/replacement for a narrow or leaky valve, is somewhat different as well. Despite these differences, however, some generalizations can be made.
It’s normal to…

• Not have much appetite. It takes several weeks for your appetite to return. Many patients notice that their sense of taste is diminished or almost absent. It will return. Some patients even complain of nausea at the smell of food for a week or two after surgery;
• Have some swelling, especially if you have an incision in your leg. That leg will tend to swell more for some time. Elevating your legs will help. Wear your elastic TED hose if they were prescribed for you.
• Have difficulty sleeping at night. You may find it difficult to fall asleep, or you may find that you wake up at 2 or 3 a.m. and cannot fall back to sleep. This will improve. Taking a pain pill before bed sometimes helps.
• Have problems with constipation. You may use a laxative of your choice. Add more fruits, fiber and juice in your diet.
• Have mood swings and feel depressed. You may have good days and bad days. Do not become discouraged. This will get better.
• Have a lump at the top of your incision. This will disappear with time.
• Notice an occasional clicking noise or sensation in your chest in the first days after surgery. This should occur less often with time and go away completely within the first couple of weeks. If it gets worse, call your surgeon.
• Experience muscle pain or tightness in your shoulders and upper back between your shoulder blades. This will get better with time. Your pain medicine will also help relieve this discomfort.

It takes four to six weeks to start feeling better. Remember to take all medication as prescribed by your doctor. If an artery in your chest, called the mammary artery, was used during your surgery, you may experience numbness to the left of your incision. This is normal. If you have steri-strips on your incision, you may remove any that have not already fallen off after one week. Follow the exercise program given to you by your physical therapist in the hospital.

Wound care of your incision:

While in the hospital, follow your doctor’s instructions. After discharge, most surgeons would agree that it is safe to wash your incisions daily (directly over the tapes) with mild soap and warm water. Avoid vigorous scrubbing. The tapes may even fall off on their own. Any remaining tapes can be removed seven days after discharge. You might go home with staples in your leg. The visiting nurse will remove the staples as ordered by your physician. Because incisions sunburn easily, be sure to protect them from overexposure to sunlight during the first year after surgery. The scar will pigment more (be darker) if exposed to the sun. Do not apply any lotions, creams, oils, or powders to your incisions unless prescribed by your cardiac surgeon.
Check your incisions daily. Notify your doctor if you notice any of the following:

• Increased tenderness of the incision line;
• Increased redness or swelling around the edges of the incision line;
• Any drainage from the incision line;
• A persistent fever.

If your surgery involved taking a vein graft from your leg, follow these guidelines:

• Care for your leg incision as described above;
• Avoid crossing your legs because this impairs your circulation;
• Avoid sitting in one position or standing for prolonged periods of time;
• Elevate your leg on a stool or coffee table when sitting. You can also lie on a couch and elevate your leg on the arm of the couch.
• Check your leg daily for swelling. The swelling should decrease when you elevate your leg, but it might recur when you stand. If you continue to have leg swelling or it becomes worse, notify your doctor.
• If elastic stockings (TED HOSE ) were prescribed for you, wear the elastic stockings while you are up for at least two weeks after discharge. The stockings help decrease swelling, especially if you have a leg incision.
• Remove your stockings at bedtime. Wash the stockings with mild soap and water, and dry them on a line.

Medicines:

The doctor will give you prescriptions before you leave the hospital. Take the medicine exactly as your doctor prescribes. Keep a current list of your medicines, dosages, and times to be taken in your wallet or purse. Do not take other medication without telling your doctor. Additional information about your medicines will be provided by your nurse or pharmacist before you are discharged.

It is important to understand that medicines can cause side effects. If you have any of the following side effects from medication, you should call your physician’s office.

• Excessive nausea, diarrhea, constipation, or stomach pain, Vomiting;
• Dizziness or lightheadedness when standing;
• Confusion;
• Tingling in hands and feet;
• Extremely slow or fast pulse;
• Skin rash;
• Unusual bruising or bleeding;
• Bright red stool

Other symptoms to watch for:

• Chest pain (angina-like) similar to pre-op
• Chills or fever
• Coughing up bright red blood
• Fainting spells
• Heart rate faster than 150 beats/minute with shortness of breath or new irregular heart rate
• New onset of nausea, vomiting or diarrhea
• Severe abdominal pain
• Shortness of breath not relieved by rest
• Sudden numbness or weakness in arms or leg
• Sudden, severe headache
• Acute gout flare-up
• Elevated temperature more than 100.0 F or 38.0 C two times within 24 hours
• Extreme fatigue
• Pain in calf that becomes worse when pointing toe up to head
• Persistent bleeding or oozing from incisions
• Sharp pain when taking in deep breath
• Skin rash
• Urinary tract infection: frequent urination, burning with urination, urgency with urination, bloody urine
• Weight gain of more than one to two pounds within 24 hours
• Worsening ankle swelling or leg pain
• Worsening shortness of breath symptoms.

Cardiac surgery discharge

Call the clinical nurse specialist/case manager wi th questions related to:

• Helpful community services or agencies
• Incisional care
• Postoperative recovery
• Discharge instructions
• Home health care
• Questions related to surgery
• Draining or reddened wounds
• Management of symptoms

What your doctor/nurse might ask if you call:

• How long have you had these symptoms?
• What medications are you currently taking?
• What was the date of your hospital discharge?
• Does the visiting nurse come to see you?
• Regarding incisional drainage: color of drainage, does it have an odor, how long has it been draining, is the drainage getting better or worse?

IF YOU NEED IMMEDIATE ATTENTATTENTION, Go to the Local Emergency Room or Call 911

URGENT PROBLEMS

• Call Local Doctor
• Stop any activity immediately if you feel short of breath, notice irregular heart beats, feel faint or dizzy, or have chest pain. Rest until the symptoms subside. If they do not subside within 20 minutes, notify your doctor.

NORMAL ACTIVITIES after discharge from the hospital:

• Showers: You can take showers after your pacing wires and staples are out. Avoid soaking in baths until your incisions are healed. Avoid extremely hot water.
• Dress: Wear comfortable, loose fitting clothes that do not put undue pressure on your incisions.
• Rest: You need a balance of rest and exercise for your recovery. Plan to rest between activities and to take short naps as necessary. Resting also includes sitting quietly for 20-30 minutes. Rest 30 minutes after meals before exercising.
• Walking: This is one of the best forms of exercise because it increases circulation throughout the body and to the heart muscle. It is important to increase your activity gradually. Walk at your own pace. Stop and rest if you get tired. Each person progresses at a different rate after heart surgery. Physical therapists will provide you with an individual plan for exercise before your discharge. It is important to pace your activities throughout the day. Do not try to do too many things at one time. In poor weather, lower than 40 degrees or above 80 degrees, you can walk at indoor shopping malls. In cold weather, wear a scarf or mask around your mouth and nose.
• Stairs: Unless your doctor tells you differently, you can climb stairs. Take them at a slow pace. Stop and rest if you tire. When using the handrail, do not pull yourself up with your arms. Use your legs.
• Sexual: You can resume sexual relations when you feel comfortable. For many people this is about two to four weeks after discharge unless instructed differently by your doctor. Please ask your nurse for more detailed information, if needed.
• Driving: You can ride as a passenger in a car at any time. Avoid driving, outdoor bicycling, or motorcycle riding for six weeks after surgery. This time period is recommended to allow your breastbone (sternum) to heal. Your movements might also be limited and slow before the six weeks are up. When traveling, be sure to get out of the car every two hours and walk around for a few minutes.
• Lifting: You should not put too much strain on your sternum while it is healing. Avoid lifting, pushing, or pulling anything heavier than 10 pounds for six weeks after surgery. This includes carrying children, groceries, suitcases, mowing the grass, vacuuming, and moving furniture. Don’t hold your breath during any activity, especially when lifting anything or when using the rest room.
• Work: Most patients will begin to feel like returning to light work six to 12 weeks after surgery. Check with your surgeon before returning to work.
• Visitors: Limit your visitors for the first couple of weeks. If you get tired, excuse yourself and lie down. Your visitors will understand.

Exercise guidelines:

• Stop any exercise if you experience shortness of breath, dizziness, leg cramping, unusual fatigue, and/or chest pain (angina). Notify your doctor if these symptoms persist.
• If your post-exercise pulse rate is more than 30 beats faster than your resting pulse rate you have exercised too hard.
• In order to correct these conditions, you will need to modify your next exercise session.
• Pulse assessment:
• Monitoring your pulse rate helps to keep your activities within a safe heart rate range.

DIET:

Your doctor will probably recommend that you follow a low fat, no added-salt diet after discharge. This may reduce your risk of a heart attack in the future and your risk for requiring angioplasty or surgery again. You should try to have less than 30 percent of your calories from fat. Try to control your weight and eat less saturated fat and cholesterol.

The American Heart Association recommends that saturated fatty acid intake should be 8 to 10 percent of calories. Polyunsaturated fatty acid intake should be up to 10 percent of calories. Monounsaturated fatty acids make up the rest of the total fat intake, about 10 to 15 percent of total calories. Cholesterol intake should be less than 300 milligrams per day. Sodium intake should be no more than 2,400 milligrams (2.4 grams) per day.
Avoid adding salt in cooking or at the table. Begin making changes to your diet when your appetite returns to normal.

DAILYLY WEIGHT

• Weigh yourself at the same time each morning after you urinate but before you eat breakfast. Use the same scale every day;
• Keep a record of your daily weight;
• Notify your doctor if you gain two pounds or more overnight;
• If you have questions following your surgery, please contact your doctor’s office.

(From: Discharge instructions for heart surgery patients by The Society of Thoracic Surgeons)