Heart Surgery: What to expect

Your Admission to the Hospital

Patients are admitted to the hospital the day before surgery or, in some cases, on the morning of surgery. The night before surgery, you will be asked to shower to reduce the amount of germs on your skin. On the morning of surgery you will again shower with antiseptic soap (Hibiscrub which can be obtained from a pharmacy without a prescription).
 
The ward has four rooms with 2 beds in each room. You will only be in this room until you are taken to the operating room for surgery. Following surgery you will be admitted to the Intensive Care Unit (ICU).
 
A medicine (anesthetic) will make you sleep during the operation. This is called "anesthesia." Because anesthesia is safest on an empty stomach, you will be asked not to eat or drink after midnight the night before surgery.
 
You will be asked to remove all jewelry (including your wedding ring) so it is best to leave it at home.

What you will need to bring

You will wear a patient gown that can accommodate the monitoring, so you will not need to bring any extra clothes. You do not need to bring pajamas or towels. Post operatively; ladies will need a good support bra.
 
You will need to bring any toiletries you would normally use. Toothbrush/Toothpaste, Deodorant, and Slippers.
 
Bring a list of your current medications, the dosages and number of times taken daily or bring the medication for review.
 
You will need to bring your denture cup if you wear dentures as you will be asked to remove them before going to theatre.

What tests you will have

  • Blood tests
  • ECG
  • Chest x-ray (if no prior film available)
  • Measurement of height and weight
Physical preparation for surgery

  • Continue light exercise as able
  • Try to stop smoking. At least 15 days before surgery (smoking increases the risk of complications e.g. pneumonia)
  • Try to lose excess weight under guidance
  • Follow a low fat diet
Try to cut down on your alcohol intake if needed
What to Expect Each Day After Surgery

Your length of stay in the hospital will vary as will your experiences but these will give you some indication of what to expect.

Surgery
You will be given something to help you relax (a mild tranquilizer) before you are taken into the operating room.
Once in the operating room, small disks called electrodes will be attached to your chest. These electrodes are connected to a cardiac monitor, which will monitor your heart's rhythm. You will receive a local anesthetic to numb the area where a plastic tube will be inserted in an artery in your wrist. This arterial line will be used to monitor your blood pressure, and to sample blood for oxygen and electrolytes. An intravenous (IV) line will be inserted in a vein. The IV line will be used to give you the anesthesia before and during the operation.

Following surgery you will be moved to the Intensive Care Unit (ICU) where you will be closely monitored. You will wake up in the ICU. A breathing tube will be in your throat, connected to a respirator to assist breathing until you are awake enough to have the tube removed. Drains called chest tubes will be in place removing blood collecting from the surgical area. A catheter or tube will also be in place to collect and measure urine.
 
Most patients do not remember these hours following surgery. Your family will be able to see you once you are settled in the ICU, following the surgery.

The visiting in the ICU is limited to immediate family, for a short period of time (about 5 minutes) during the following times:

ICU visiting hours:
08:00 – 08:30
11:00 – 11:30
14:00 – 15:00
17:00 – 17:30

19:30 – 20:00


Day One
When you are awake enough and breathing on your own, the breathing tube is removed. This may be on the evening after the surgery or the following morning. You will then have oxygen with a nasal cannula or facemask.
 
Pain
Everyone’s level of pain will vary. However most patients experience some discomfort in their chest, they may also experience pain or discomfort in the leg where the grafts were taken from. On the first day, you will receive pain medication through your IV. Once you are able to drink and eat you will be given tablets for pain relief as needed.
 
Nausea
Some patients may experience the feeling of nausea. Again the level of nausea and vomiting will vary between patients but is normal to experience this. If you are feeling nauseated there is medication that can be given to help relieve this feeling.
 
Eating and Drinking
If you do not feel nauseated then you will start with a clear liquid diet. Your diet will then be advanced to regular food as tolerated. You will be allowed to drink water but the amount of water will be monitored to maintain an adequate balance of fluid.
 
Sleep
You may still feel quite drowsy, which is normal. This is a side effect of the anesthetic and pain medication.
 
Monitoring
You will be attached to a monitor and your heart rate, blood pressure and the oxygen content of blood will be closely observed. You may be on continuous IV infusions of medications. Some of this monitoring may be removed on the first postoperative day, and you may then be moved to the nursing ward.
 
You will still have the chest tubes in place draining the blood collecting from the surgical area. Also, the central intravenous catheter and the urine catheter will remain in place.
 
Activity
When ready the nurse will help you to get out of bed to the bedside chair. The first day you will sit up in the chair then as you progress will be up in the chair longer until you are ready for walking. The nurses will show you how to perform deep breathing and coughing exercises. These help you to clear any secretions from your lungs and help to prevent chest infections. You will be given a pillow to hold or hug to your chest while performing this coughing exercise or when coughing to help support the chest. We recommend practicing these exercises hourly while you are awake.


Day Two
Your day will follow much of the same routine as day one with an increase in your activity. The nurse will help you to get out of bed, sitting up in the chair for each of your meals.

Monitoring
Once on the ward you are placed on a monitor that allows you to walk around but still have your heart rate and rhythm monitored by the nurses. This is called telemetry. The chest tubes draining the surgical area are removed on the second post op day.
 
Incision
Your incision will remain covered while you are in the hospital. After the chest tubes are removed the incisions will be inspected, painted or cleansed with a Betaisodonna solution and redressed. Each day the incision will be painted, inspected and redressed. The chest incision will be redressed until you are discharged home. If you have an incision on your leg it will also be painted with betaisodonna, however after the second postoperative day the nurse may leave this incision uncovered.
 
Palpitations
Following surgery some patients experience palpitations. Palpitation is the sensation of feeling the heart beat in your chest. The heart beating in a different rhythm, such as atrial fibrillation, can cause this sensation. This may happen because the heart is manipulated and bruised during the surgery. It is generally not life threatening and is reversed or controlled with medication.


Day Three
At this point most of you lines will have been removed.

Your heart rate and rhythm will continue to be monitored by the telemetry monitor as you increase your activities. You will continue to have a peripheral intravenous catheter or IV in place until you are discharged home. The urine catheter will have been removed and you will be using the bathroom as needed.
 
You will start walking in the room and then into the hallway of the ward. Gradually increasing the distance you walk. It is important to take periods of rest after activities, as even these simple activities will tire you during the days after surgery.

Day Four / Day five

Your day will follow much of the same routine as day three with an increase in the amount of your activity. Most patients can expect to go home by day four or five.


Going home after surgery

First Week
Activity
Walking is the easiest way to exercise. Walk everyday 2-4 times a day. Begin with 5 minutes at a time or the same amount you were able to walk in the hospital before discharge. Increase time (not speed) by one minute each day. Your goal after one week is 10-12 minutes per day. Best time to walk is when rested and 60-90 minutes after meal, shower, or stress. Walk on flat surface. You should be able to walk and talk. Walk with someone and keep medical information with you.
 

Lay all your clothes out and dress while sitting. Prepare light meals or clean, but don’t do both. Don’t lift anything greater than 5 kg (about the weight of ??? comparable in Cyprus?). Use electric appliances; don’t scrub.

Bathing / Showering
Do not take baths until your incisions heal. Rest and wait 60-90 minutes after eating, exercise, or any stress before showering. Use soap and lukewarm water. Support arms when washing above shoulders. Shower daily for 5-7 minutes and sit to dry yourself. Keep incision clean and dry. Leave it open and do not apply lotion, powder or ointment. Check your incision daily in the mirror to see if it is healing properly.
 
Emotional outlook
You may feel very tired. Listen to your body and give yourself time to recover. Feelings of depression are common after open-heart surgery. Being active helps prevent complications – including depression.
 
Transportation
Do not drive.  Take short car rides and place a towel under the shoulder seat belt.  Stop every hour if you must take a longer ride.
 
Visitors and Social Plans
Encourage friends to phone.  Limit visitors and avoid those who might upset you. Avoid parties.
 
Special Attention
Chest discomfort or palpitations, shortness of breath, dizziness, nausea, or excessive sweating may be signs that you are overdoing it.  Call the doctor if symptoms persist longer than 5 minutes after resting.  Call the office if you have a fever above 38.5 C, wound redness, warmth, tenderness, drainage or separation of the edges of your incision.


Week Two

Activity

When you can walk for 20 minutes, decrease to 2 walks a day. Your goal is a 30-minute walk.
 
Do light housekeeping: make beds, tidy up, sort and fold laundry, shop for groceries.
 
Do not push or pull furniture or grocery carts, vacuum, or reach for things on high shelves.
 
Work between shoulder and knee level. Sit for tasks and support arms. Elevate legs when resting but don’t cross them.
 
Bathing / Showering
If steri-strips were placed on your incisions in the hospital allow hem to loosen and falloff on their own. Check your incision in the mirror daily to see that it is healing properly.
 
Emotional outlook
Do not drive for a t least 4 weeks while your sternum (the bone in your chest) is healing. You may be a passenger only during this period of time.
 
Transportation
Do not drive for at least 4 weeks while your sternum (the bone in your chest) is healing. You may be a passenger only during this period of time. Do not drive for a t least 4 weeks while your sternum (the bone in your chest) is healing. You may be a passenger only during this period of time.

Visitors and Social Plans
Don’t over do it by making too many plans or commitments.
 
Special Attention
Constipation often occurs due to a decrease in activity and from taking medication for pain. Avoid it by eating foods with fiber and drink 6-8 glasses of water each day.
 
Watch for signs of depression, which may include loss of appetite, problems with sleep, and not taking care of yourself.


Weeks 3-5
Activity

Choose an aisle seat at the movies and at church. You should be ready for sexual activity if you can climb 2 flights of stairs without difficulty or complete daily tasks without fatigue. Wait 60-90 minutes after alcohol, stress or exercise; stay relaxed; be with a familiar partner; use comfortable positions; and realize that your partner often feels the most fear.
 
Bathing / Showering
If your incisions have healed completely by your follow-up visit, your doctor will give you the okay to start taking baths.
  
Emotional outlook
Continue to talk to others about your concerns and feelings.
 
Transportation
Check with your doctor after 4 weeks to see if driving is okay. Don’t sit too close to the steering wheel. Wear your seat belt!
 
Visitors and Social Plans
You should be getting back to a more normal routine.
 
Special Attention
Address any concerns you have with the doctor during your follow-up visit. Please call the office if anything comes up after the visit.


Week 6
Activity
You may now be able to lift over 5 kgs. Limit housekeeping to one room per day – mopping, scrubbing and vacuuming are okay. It’s okay to do light gardening, carpentry and car maintenance but avoid extreme temperatures, excessive bending, and pulling and vigorous arm work. Recreational activities such as fishing and putting in golf are okay but limit excessive stretching and strenuous activity for an additional 6 weeks. 

Bathing / Showering
Keep checking your incisions and call if an area becomes reddened, warm to the touch, or begins to have drainage.
 
Emotional outlook
Depression may last 4-6 weeks. Talk to your doctor if it continues to be a problem.
 
Transportation
Be careful and avoid driving in heavy traffic. Always wear seat belt!
 
Visitors and Social Plans
Discuss work and travel plans with your doctor
 
Special Attention
Your nurses and doctors always like to know how you’re doing after surgery. Stay in touch.
 
Activities
Progress your activities gently and gradually according to how you feel. Be aware of warning signs: pain, feeling tired or unwell, chest pain or pressure, shortness of breath, rapid heart beats or feeling dizzy or faint. If you experience any rapid heartbeat, feel dizzy become breathless or feel excessively tired, then you must rest immediately. If these signs do not go away after resting, then you must contact your local doctor or general practitioner.

FIRST WEEK

Do's

Don'ts

Gradually increase your activity.

Lift objects greater than 10 kg

Walk daily – increase walking gradually

Hold your arms above shoulder level for long period of time

You may do light household chores, but do not stand in one place longer than 15 minutes.

Push or pull heavy objects

Washing up/ drying up

Heavy one-sided work or activities

Dusting

Prolonged ironing

Cooking a meal (half fill pans and lift with both hands)

Vacuuming

Light gardening

Carrying heavy shopping

Resume intimate activity

Digging in the garden

 

Golfing

 

Walking the dog on a leash

 

Mowing the lawn

 

Lifting children

 

Hanging out the wash

Washing the car

 

SECOND WEEK

Do's

 

Continue first week activities

 

Flying – check with your doctor

 

 

FOURTH WEEK

Do's

 

Low-impact aerobics

 

Dancing

 

Bowling

 

Jogging

 

Cycling

 

Swimming

 

Return to work for light work

 

 

EIGHTH WEEK

Do's

 

Badminton

 

Tennis

 

Golf

 

Gardening

 

Digging

 

Fishing

 

Return to work for manual work

 

 

AFTER TWELVE WEEKS

Do's

 

Horse back riding

 

Football

 

Squash


Follow up and Stay Healthy

Since you have heart disease, all the "healthy-heart recommendations" apply to you more than ever.  No matter what type of heart disease you have, your overall level of physical fitness will determine how well your heart can compensate. 

You should eat a balanced diet, maintain a reasonable body weight and stay at least moderately active physically (within any limits your cardiologist gives you).
 
Complying with the medical course of treatment your cardiologist gives you is your responsibility. Keep your follow-up appointments, take your medicines as prescribed, have the necessary tests done when needed and follow any physical activity restrictions. If you feel that any of the follow up therapy or treatments may be making you worse or are unnecessary, talk to your cardiologist.
 
One of the most important things that you can do to maintain your health is to learn about your heart disease and take steps to help reduce the risk of heart disease.
 
Healthy eating helps reduce the risk of heart disease.

Easy steps to follow:
  • Eat fewer foods containing fats especially animal fats.
  • Use oils and spreads high in monosaturates and polyunsaturates.
  • Eat as much fruit and vegetables as possible, at least 5 servings a day.
  • Avoid processed highly salted foods.
  • Read the food labels.
  • Bake or grill foods and avoid frying.
  • Remove skin and fat from meat before cooking.
  • Eat 2-3 servings of oily fish a week.
  • Do not use additional salt.
  • Steam vegetables.
  • Try different herbs and spices.
If you need lose weight
  • Set realistic goals.
  • Aim to lose half a quarter of a kilo a week.
  • Enlist the support of your family and friends.
  • Ask your doctor for advice.

Alcohol

  • Try to limit your alcohol during the first few weeks at home while you are taking pain medicine.
  • Do not drink if you are taking sleeping tablets or tranquilizers.
Guidelines for safe drinking:
Men
21 units per week
 
Women
14 units per week
(1 unit = half a pint of beer or a glass of wine or one measure of spirit) Try to spread your intake evenly throughout the week.

Smoking
You will have stopped in hospital, why start again? Instead of concentrating on the negative aspects of smoking focus on the positive aspects of giving up:

  • Reduces the risk of further coronary heart disease and cancers.
  • Reduces worry over damage to your health.
  • Increases self esteem.
  • Improves finances.
  • Your taste and smell improve.
  • Helps the environment.
  • Reduces your family’s exposure to passive smoking.

Notes to Families and Friends

Having heart surgery not only affects you the patient, it can also be a very stressful and anxious time for your family and friends. Here are a few ideas of things you might want to anticipate and ways that (you) family and friends can help.
 
Changes in Lifestyle
For most people, following heart surgery, there are some aims to change lifestyle such as giving up smoking, dietary changes or building up an exercise regime. These changes can seem quite overwhelming and for some quite depressing. Fundamentally it is only the patient that can make these changes but you, the family and friends could maybe join in on the new exercise program or experiment with healthier cooking ideas. Although you cannot actually make the changes for them you can be a source of morale and in some case practical support and encouragement. This could be a good time for you to make those changes that you have been meaning to in your own lifestyle!
 
Changes in Roles
When your family member or friend comes home from the hospital, you will find that there will be some physical and mental limitations, they may not be able to fulfill their life roles as they did before the operation. These roles will take time to resume. During this time of recovery, you, the friends and relatives can help by filling in these roles. Take people up on offers of help and plan ahead so there are no major jobs or work planned for the immediate recovery period.
 
Having Visitors at Home
You may find that other friends and neighbors will want to come and visit soon after the patient comes home from the hospital. This is obviously good for keeping spirits up and helping to re adjust to normal roles but it is important to remember that having lots of people around, chatting and asking lots of questions can be very tiring. Just like in hospital you may find it useful to only encourage short visits for the first few weeks after coming home.
 
Getting Support
Getting support - Recovering from heart surgery can be a real roller coaster of emotions for all involved. Your friend or relative may go through periods of frustration or depression; this may be especially difficult to deal with if you have taken on extra roles and responsibilities yourself. However difficult, you must try and find a little time for yourself. Try and do some ‘normal’ things, weed the garden or read your favorite magazines. Do not let your life focus around ‘the operation’; although it will affect your life for a short time it should not rule it. Talk to other people about how you feel, it some times helps to get things off your chest and get a different perspective on a situation.
 
If you really feel you are not coping there are professional people that can help over the telephone or by personal counseling.
 
Resuming a "Normal" Lifestyle
The recovery period is a slow steady process; it can be very difficult to imagine life being back to "normal". Try not to be over protective. Let them move back into activities and support their efforts when they feel ready.