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Post-Operative Patient Handbook

How to give yourself the best possible recovery

Heart surgery is a serious, usually frightening event. Modern technology has advanced the surgical treatment of heart disease where to day most heart surgery patients do well and are able to return to their usual work and activities. Your surgery can improve the quality of your life, but surgery does not work by itself. You must do what you can to keep heart healthy.

Introduction

Every patient is different: therefore, your physicians' recommendations are the most important guidelines for your recovery. You must make sure you understand all instructions. Ask questions if you do not understand. It is very important that you know you medications (name, what they are used for, amount to take, when and how the medication is to be taken). You will also need to know your diet, exercise program, and your risk factors to heart disease with the recommended changes you need to make to reduce these risks. By making the recommended life-style changes you can have a positive influence on your life.

Heart surgery can be physically and emotionally draining. You will need time to recover, usually 4-8 weeks after going home. This Web page is mainly to discuss your recovery period after heart surgery and to serve as a guide to help you keep heart healthy.

It is not unusual to feel a little frightened about leaving the hospital. Just remember the doctor will not let you return home until he feels you are ready. Talk to the doctor or the cardiothoracic surgery nurse coordinator about your concerns in returning home. This will allow the doctor to set up a means of further support for you at home if needed. 

Welcome Home

Once you are home, try to resume a normal routine. It is important to get up in the morning after good nights sleep, shower, shave (males), apply makeup (females), get dressed in street clothes, and stay active as possible within your limitations. Individuals recover at different rates. Normally, the initial healing of the sternum (breastbone) and incisions takes approximately six to eight weeks. Full recovery of your strength may take up to three months. Each day you will make progress. Your activity level will increase and you will feel better. We expect you to gradually return to all the usual activities you enjoyed before your operation.

Heart surgery brings about many changes in the family situation. Your lifestyle and goals may be temporarily or permanently changed. You and your family may experience feelings of frustrations, anger, guilt, resentment, and grief. It is important for you and your family to know these feelings are normal. Talk with someone, your spouse, partner, friend, or doctor. Expressing how you feel helps to work through these feelings and answers questions.

Following heart surgery, it is normal for you to have emotional ups and downs. The downs can include unexpected bouts of sadness and crying. These mood swings will pass. If these depression-like feelings last more than 4-6 weeks, ask your doctor about professional counseling.

You will be given pain medication to take at home. After about one week at home, Tylenol or (acetaminophen) type medication may be all you will need for your discomfort. Maintaining good posture can help relieve soreness by taking pressure off the chest.

Your recovery period at home will last about 4-6 weeks. During this time you will be building up your strength. You also need to be thinking about your lifestyle and the risk factors that helped cause your heart problem and learn the ways to change your lifestyle to manage these risks. 

Cardiac Risk Factors

Risk factors are those lifestyle habits or characteristics of the body that tend to increase the chances of causing and speeding up the development of coronary artery disease.

Risk Factors You Cannot Control

heredity

You are at increased risk of heart attack if you have close relatives (mother, father, sister, brother) who have had heart attacks before the age of 55 years.

 

Sex

More men have heart disease than women.  However women, after the age of menopause, have an equal chance of getting heart disease as men.

 

Age

As we get older, our chance of heart disease increases.

Risk Factors You Can Control

Diabetes

Diabetes is a disorder that prevents the body from using glucose or sugar it needs for energy.  It is caused by the lack of the hormone insulin, which is needed to make energy from glucose or sugars.  Diabetes is often associated with increased lipids (fats) in the blood, being overweight, and high blood pressure.  A doctor in Endocrinology or Internal Medicine should follow you for your diabetes.


What you can do:

  • Maintain your ideal body weight.
  • Follow your diabetic diet.
  • Have regular medical checkups.
  • Take your medication as your doctor ordered.

  

High Blood Pressure

Anything above 140/90 is considered high blood pressure.  High blood pressure (hypertension) causes your heart to pump (work) harder and is thought to increase the process of heart disease.  A doctor in Internal Medicine should follow you for your hypertension.

  • Check your blood pressure often.
  • Stop smoking (if you smoke).
  • Follow a low sodium (salt) diet.
  • Maintain your ideal body weight.
  • Learn to relax.
  • Take your medication as your doctor ordered.

  

Smoking

A person in their 40's who smokes have a three times greater chance of having a heart attack than the non-smoker. Smoking or using any type of tobacco increases the process of blockages in the blood vessels in your body. Also, when you smoke, your heart needs more oxygen because the nicotine makes your heat beat faster and narrows your blood vessels, which raises your blood pressure. The carbon monoxide in the smoke decreased the supply of oxygen in your lungs, which decreases the supply of oxygen to the heart. So not only is your heart working harder when you smoke, at the same time it is not getting the oxygen it needs to do the added work.

Decide to stop  - the best method is to quit all at once, since you have not been able to smoke in the hospital, avoid the temptation to take "just one puff!"

  • Avoid activities where you are most likely to want to smoke.
  • Don't carry cigarettes or lighter with you.
  • Your doctor can help to arrange Smoking Cessation classes.

 

High Cholesterol and/or High Lipids

Cholesterol is a fatty substance made by your body. You also get cholesterol in food that you eat from animal sources, such as: eggs, butter, milk, cheese, meats (especially organ meats). Your body requires a certain amount of cholesterol; the excess cholesterol builds up along the inside lining of your blood vessels.

  • The total amount of cholesterol intake should be less than 200mg a day.
  • HDL (called the "good cholesterol"). The higher the HDL levels the better for your heart. To protect your heart, the HDL level should be greater than 40mg/dl. A ratio of total cholesterol to HDL should be less than 4:1, greater than 4:1 increases the risk of heart disease.
  • Triglycerides and LDL (low density lipoprotein). Triglycerides are the storage form of excess fat in the body. Most of it is stored in the liver. If this fat is very high, it can lower the levels of HDL. LDL are the proteins that carry the cholesterol which builds up in the vessel walls. Your ideal LDL level should be 100mg/dl (between 100-129). Sometimes diet is not enough to lower the cholesterol level. Some people need medication to lower the cholesterol level and should be followed by a doctor in Endocrinology or Internal Medicine. It is recommended that anyone one with risk factors for heart disease or history of heart disease should be on a lipid lowering medication.

Reduce your intake of saturated fats. Fats that are solid at room temperature: lard, butter. Animal fats: red meat, pork, lamb, whole dairy products, such as whole milk, cheese, cream, ice cream. Vegetable fats: coconut oil, cocoa butter found in most chocolate and many commercially baked foods. Also in whipped toppings and coffee creamers.

Limit alcohol intake to no more than two drinks per day (2 ounces of liquor or 2-4 ounces of wine, or two 12-ounce beers a day). Alcohol will raise your blood pressure and is high in fat.

  

Sedentary Lifestyle

Evidence has shown lack of regular aerobic exercise increases the risk of heart disease. Aerobic exercise includes anything that is continuous, rhythmical, oxygen dependent, and uses large muscle groups; such as brisk walking, jogging, bicycling, tennis, swimming, and skiing. To benefit your heart it is necessary to reach and maintain a steady state of your target heart rate for 30-45 minutes, exercising 4-5 times a week.

Talk to your cardiologist about a referral for cardiac rehabilitation.

 

Stress

Stress is a normal part of daily living. Not all stress is bad. When stress gets out of control it can cause the body to produce adrenalin. This makes the heart work faster and harder and also causes the blood vessels to narrow as in smoking, causing increased blood pressure.

  • Learn to RELAX - Make special time for you, read a book, listen to music, go to a movie, etc.
  • Keep your sense of humor
  • Accept what can not be changed.
  • Avoid situations that make you feel tense.
  • Learn to say "No" without feeling guilty.   

Restrictions and Limitations

The time it takes for full recovery following heart surgery will vary with each person.  Initially, feeling tired is normal.  This is due to the muscular inactivity during your hospitalization.  Physical activity is important to your recovery.  By gradually increasing your activity, you will prevent problems with your muscles, your heart, and your mind.

In order to do your surgery it was necessary to open your sternum (the bone in the middle of the chest).  You will be restricted in your activities to give the sternum time to heal.  Although stainless steel wires or cables are holding the bone together, healing takes six to eight weeks.  During this time, excess movement of the bone may delay healing.  Do not resume any of the activities listed until your doctor says it is okay.

1. DO NOT lift more than 10 pounds for six weeks, such as:  lifting children, suitcases, large purses, boxes, groceries, garbage, tools, pets, etc.

2.  DO NOT push or pull anything where you must exert more than 10 pounds, such as:  moving heavy objects, opening a stuck window,  pushing open a heavy door, unscrewing a stuck jar lid, etc.

3. DO NOT hold your breath during strenuous activity, especially when exercising, lifting or when using the restroom.

4. Getting out of bed - roll onto your side and lower your legs off the bed as you push yourself to a sitting position using your upper arm (elbow to shoulder, held close to your chest). Standing from a chair - Scoot yourself to the edge of the chair, position your feet under you, and stand up using your leg muscles. DO NOT lift yourself with your arms. DO NOT allow anyone to pull up from under your arms or pull forward on your arms. Sit with your back straight and both feet on the floor or elevated on a stool. Picking up an object from the floor - bend at the knees (not the waist) keeping your back straight.

5. DO NOT drive any type of automobile or truck for six weeks. This also includes bicycles, motorcycles, riding lawn mowers, horses, etc. You may ride in a car. Wear your seat belt and sit up straight. If there are air bags in the front, passenger side, deactivate the air bag or place a thick pillow in front of your chest with the seat belt in place. Some people like to stretch out in the back seat to travel, still using a seat belt. Avoid long trips. If you have to take a trip lasting over one-hour travel time, dress comfortably, move your legs, and paddle your feet frequently. Do not sit or stand in one position for more than one hour. Stop every hour, get out of the car, walk around and rest for a few minutes before continuing the trip. If traveling by air, make sure the airplane is pressurized, reserve a wheelchair at all airports and have baggage lifted and carried by a porter or companion. Always carry your medications with you instead of having them checked with your luggage.

6. DO NOT climb on ladders or step stools. It is ok to climb stairs, go slowly (2-4 steps) then rest etc. Rest if you become tired, short of breath, lightheaded, or dizzy. You should limit climbing stairs to two or three times a day for the first two weeks.

7. DO NOT keep your arms extended above your head for longer than three to five minutes. Keep your arms below shoulder level and do not extend your arms back behind center of your chest. It is OK to do your exercises, wash your hair, etc. Keep you feet and legs uncrossed. By doing these things your heart does not have to work as hard and you decrease swelling and the risk of blood clots in your legs.

8. DO NOT engage in any sport or activity which will cause stress, unusual movement, twisting or rotating of the chest - such as: tennis, golf, bowling, skiing, etc.

9. DO NOT engage in strenuous work - such as: mowing the lawn, gardening, carpenter work, automobile repair, vacuuming, heavy housework as changing linen on beds, etc.

10. Avoid excessive straining during a bowel movement. Use a laxative and /or stool softener if necessary. 

11. Sexual activity can usually be resumed after two to four weeks. Some guidelines to follow:

  • Avoid positions which cause pressure on the breastbone or tension on the arms and chest.
  • Pick a time when you are rested and relaxed.
  • Wait two hours after a meal or drinking alcohol.
  • The temperature of the room is comfortable.

It is normal for your heart to beat faster and your breathing to speed up during sex. These should return to normal within three to five minutes after sex. If you feel short of breath, have pain or discomfort in your chest or arms, you may need to change position, if the symptoms continue, stop what you are doing.

You may experience a change in desire and/or sexual function after a major illness or surgery for several reasons, one may be your medication, if you are have difficulty talk to your doctor.

Consult your doctor if you notice any of the following symptoms:

  • Rapid heart rate (above your target heart rate) or palpitations.
  • Shortness of breath which last more than 3-5 minutes following sex.
  • Chest pain (like your previous angina pain) during or after intercourse.
  • Extreme fatigue on the day following intercourse.

CAUTION: Women who have recently had heart surgery should avoid pregnancy. 

Exercise Program

Your exercise program is to help you to achieve a gradual recovery and rehabilitation. It is to take you from the point of activity you were doing in the hospital to full recovery and help decrease the progression of heart disease. Remember, heart surgery is a treatment for coronary artery disease and/or valvular disease, not a cure. You will need to make those lifestyle changes necessary to help decrease your risk of disease recurrence.

Medicare, Tricare, and most insurance policies cover cardiac rehabilitation programs. If there is not an outpatient cardiac rehabilitation program in your area, you will need to follow the exercise program outlined here. The Cardiac Rehabilitation program is designed to help you return to your optimal physical condition and psychological well-being through medically
supervised exercise, education, risk factor modification, counseling, and behavior modification. Medical research shows being active in a cardiac rehabilitation program makes your recovery easier and more complete.

Exercise helps your heart and body get into shape. People who are physically fit benefit by:

  • The heart pumps blood and oxygen to the body with less effort
  • Lowers blood pressure
  • HDL (good cholesterol) increases and LDL (bad cholesterol)
    and triglycerides decrease
  • Body fat is lost
  • Helps with feeling less anxiety or feeling depressed
  • Helps lower blood sugar, decreases clotting risks, and decreases
    adrenaline
  • Cardiac rehabilitation is designed to help you return to optimal physical
    condition and psychological well-being through medically supervised
    exercise, education, risk factor modification, counseling, and behavior
    modification.

Cardiac rehabilitation is designed to help you return to optimal physical condition and psychological well being through medically supervised exercise, education, risk factor modification, counseling, and behavior modification. Family support is important in your recovery therefore, you are encouraged to bring your spouse, partner, or any other family member or significant other to the educational sessions. You will be placed on a monitored exercise program and be given an exercise program and level of exercise to do at home on the other days.

Your exercise program consists of three parts:



1 . Type of activity

Aerobic exercise or exercise that is continuous, rhythmic, oxygen dependent, and uses large muscle groups, such as: brisk walking, jogging, bicycling, swimming, tennis, aerobic dancing, or cross country skiing (walking or exercise bicycling only for the first 8 weeks). While doing one of these, you are moving your arms and legs continuously. This movement exercises the heart and helps the lung to take in more oxygen.

 

2. Intensity

The intensity of the activity is normally determined by the heart rate. Moderate intensity is needed to achieve maximum benefits of exercise. Moderate intensity is a level in which you can hold a normal conversation but not sing. Another way to determine moderate intensity is rate perceived exertion (RPE) using your heart rate. You will be given your target heart rate based on your age, heart and other medical conditions.

Your heart rate is a guide to how hard the heart is working. A normal response to exercise is an increase in your heart rate. For the first 2-4 weeks after surgery your heart rate should not increase more than 30 beats over your resting heart rate during exercise. Some of the cardiac medications you may be taking (especially beta blockers) may decrease your heart rate and it will not increase as much as it normally would with exercise. In that case you must rely on rating your perceived exertion, i.e., how much effort does it take to perform an activity.

Scale of Perceived Exertion
6
7 very, very light
8
9 very light
10
11 fairly light
12
13 somewhat hard
14
15 hard
16
17 very hard
18
19 very, very hard
20

 

3. Frequency and Duration

To work, the exercise has to be done for a certain period of time. Our recommendation is to start out slowly two times a day. Each time you walk, try to increase the distance or time, until you have reached one mile a day at one time. Once you can walk one mile, then start to increase the pace to reach your target heart rate. Your goal is to exercise 45-60 minutes at one time, at least 5 times a week. This time can include your time for stretching, warm-up and cool-down periods.


Exercise Guidelines:

1. Dress appropriately. Wear clothes that fit loosely and are made of cotton or nylon. In the summer wear light colors which reflect the heat. In cold weather wear layers of clothes, as you warm up a layer can be removed before you sweat too much. As you cool down a layer can be put back on. Wear shoes that go with the sport. They should not feel uncomfortable in any way. If you buy new shoes, buy then in the afternoon when your feet may be the biggest.

2. Avoid extremes of heat or cold. The heat the body produces balances body temperature and the heat it loses. In hot weather the body temperatures goes up, blood vessels become larger, and blood moves to the skin's surface. As you sweat, heat leaves the body and the skin and blood is cooled. Just as hot weather expands blood vessels, cold weather narrows them. As the blood vessels get smaller, the heart must pump harder to move the same amount of blood through the smaller vessel. This can cause your blood pressure to go higher. Cold weather also decreases how much air the lungs can exchange, which reduces the amount of oxygen going into the working muscles. Do not exercise outside in very hot or very cold weather, i.e.; if it is over 80 degrees F., or less than 30 degrees F. (including the wind chill factor), or greater than 70% humidity. In the summer when it is hot and humid walk in the early morning or late in the day, when it is cooler. In cold or bad weather, walk in an enclosed area such as a shopping mall or long hallway.

3. When you exercise against wind, slow down or exercise for a shorter period of time than is normal for your. Wind makes you work harder and makes the body feel cooler than it may be.

4. Each exercise session should begin with a warm-up-stretching and 5 minutes of slow walking. End with a cool-down of 2 minutes slow walking then stretching. If you stop after a workout without cooling down, the muscles get stiff and blood tends to pool in the veins, which can cause light-headedness or even fainting.

5. Do not eat large meals or drink alcohol before exercising. Eating too much puts added strain on the heart. Alcohol, marijuana, and/or cocaine increase the heart rate. They may also hide symptoms that are telling you to stop. Over-the-counter decongestants can also cause your heart rate and blood pressure to increase during exercise and should not be taken while exercising.

6. Check with your doctor before using health club facilities and equipment. Do not use saunas, steam baths, hot tubs or Jacuzzi's for 6-8 weeks following surgery, also before or immediately after exercise or eating.

7. Persons with claudication (leg pain or cramping with walking) need to walk as far past the start of the pain as possible and may need to alternate short bouts of walking or cycling of 1 - 10 minutes with equal rest periods.


 


Exercise Intolerance:

Exercise should be comfortable and enjoyable. There will always be times when your body will tell you to stop exercising. Know when to stop. Listen to your body. If you are having any abnormal symptoms, it is because your body is telling you to stop. If you continue to exercise past these signals you health could be in danger.

  • Chest discomfort (angina-pain, burning sensation, pressure, squeezing in the chest) with or without radiation to arms, neck, jaw, or stomach
  • Lightheadedness or dizziness
  • Shortness of breath lasting more than 10 minutes
  • Loss of balance
  • Nausea or vomiting
  • Leg problems-weakness, swelling, or unusual pain
  • Fatigue beyond ordinary tiredness
  • Pallor-pale or mottled skin
  • Palpitations-very fast or irregular heartbeat or feeling your heart
 

Counting Your Pulse

Every time your heart beats, blood is forced through certain blood vessels called arteries, causing them to expand then contract. You can count the rate of your heartbeat by feeling certain places on your body where arteries are close to the skin. One place that your can feel your pulse is on the wrist. Hold your arm with your palm up facing you. Bend your hand slightly away from you. Place your index and middle fingers of your other hand on the thumb side of your wrist, about 2 inches from the center of the wrist. Apply gentle but firm pressure for the pulsation. It may take practice to take your
pulse. Sometimes it is easier on the opposite wrist.

Another place is the carotid artery in the neck. To do this, place two or three fingers on your windpipe and move them 2-3 inches to the left or the right. Feel for the pulse point low on your neck. Do Not press hard and Do Not press on both sides of the neck at the same time. You can interrupt blood supply to the brain by applying pressure on both dies at the same time, too high or too hard on the carotid artery. Count the beats for 6 seconds; then add a zero to that number.

Know your resting heart rate (pulse taken during inactivity). Each morning take your pulse for one full minute - this way you can pick up any irregular or skipped beats. The ideal resting heart rate is between 60-90 beats a minute.


Heart Rate

You can measure how hard your heart is working by taking your heart rate (counting your pulse). Everyone has a peak heart rate and a target heart rate. Your peak heart rate is how fast your heart can beat during an exercise test. You will not be exercising at this rate. Your target heart rate is 70-85% of your peak heart rate. To get the best cardiovascular results with minimal risk of injury, you will need to exercise at your target heart rate for 30-45 minutes four to five times a week.

A simple (but not exact) way of finding your target heart rate (THR) is to subtract your age from 220 and then take 65-80% of that number. This method does not work if you are taking medicine that slows down your heart rate.

Target Heart Rate (THR) Example

 AGE  30  35  40 45  50  55  60  65  70  75  80
 THR (75 %)  145  143  142 140  138  136  135  133  132  130  125

 


When exercising, follow these steps:

Take your pulse before starting your exercise. Count your pulse for 6 seconds and add a zero to that number. Example you count 8 beats in 6 seconds, your heart rate would be 80. You can also count your pulse for 15 seconds and multiply the number times 4.

  1. Exercise
  2. Count your pulse immediately following exercise. Your heart rate should reach your target heart rate, or 10 to 30 beats higher than your resting heart rate.
  3. Rest 3-5 minutes, then count your pulse again. Following rest your heart rate should return back to your pre-exercise heart rate.

Example:

If your resting heart rate is 70, with exercise it should go to 80-100. If your heart rate does not go up at least 10 beats higher (80), you need to exercise more to increase the heart rate.

If your resting heart rate is 70, with exercise it goes over 100, you are exercising too hard and would need to decrease the level of exercise.

If your resting heart rate is 70 and goes up to 95 with exercise, then returns to 70-80 after 3-5 minutes rest you are doing well, continue at this pace. If your heart rate does not return to within10 beats of your resting heart rate, in 3-5 minutes following exercise, you need to decrease the exercise and gradually increase your activity level.

If you're your target heart rate never matches your target heart rate, you may need to use the RPE scale, or talk to your doctor or exercise counselor at the cardiac rehabilitation center.

You may want to check your pulse several times at first during exercise to be sure that you are still within your target range. Unless you are being monitored, your heart rate should not go over 10% of your target heart rate.

 


Click for printer-friendly version of the warm-up sheet.




Warm-up / Cool-down Exercises

  1. Head Tilt (side to side)
  2. Arms
  3. Bends (hold 10 seconds)
  4. Shoulder Shrugs
  5. Calf Stretch (hold 10 seconds)
  6. Reach
  7. Side Reach (wide stance - reach arm across body)
 

Sample Walking Schedule - Start on flat surface

Week Distance Length of Time
1 2 long blocks (1/4 mile) 10 minutes
2 2 1/2 long blocks 13 minutes 
3 4 long blocks (1/2 mile) 15 minutes
4 3/4 mile 18 minutes
5 1 mile 20 minutes
6 1 mile 20 minutes


At this time you may start walking on any surface. When changing surfaces, (i.e., walking on hills or inclines) cut your distance back to 1/2 mile. Continue to increase the distance walked.

Week Distance Length of Time
7 1/2 mile 20 minutes
8 3/4 mile 25 minutes
9 1 mile 30 minutes


At this time you will want to increase the pace in which you are walking.

Week    Distance    Length of Time   
10 1 mile 25 minutes
11 1 1/4mile 30 minutes
12 1 1/2 mile 35 minutes
13 1 3/4 mile 40 minutes
14 2 miles 45 minutes


Continue to walk two miles in 30-40 minutes at 3-5 times a week.

 

Stationary Bicycle Exercise Program (for beginners and heart patients)

In this program, your goal is to get your speed up to 15- 20 miles per hour and keep it there. This is the schedule:

Week Time Speed Resistance
1 5 minutes pedaling
2 minutes resting
5 minutes pedaling
15-20 mph  none
2 5 minutes pedaling
2 minutes resting
5 minutes pedaling
2 minutes resting
2 minutes pedaling
 15-20 mph  none
3 5 minutes pedaling
2 minutes resting
5 minutes pedaling
2 minutes resting
5 minutes pedaling
 15-20 mph  none
4 and 5 3 minutes pedaling
(warm up)
20 minutes pedaling
3 minutes pedaling
(cool down)
15-20 mph

15-20 mph
15-20 mph
 none

add slight resistance
none
6 and 7 3 minutes pedaling
(warm up)
25 minutes pedaling
3 minutes pedaling
(cool down)
15-20 mph

15-20 mph
15-20 mph
 none

add slightly more resistance than during week 4&5
none


15-20 mph = 24 - 32 km/hr = 60-80 rpm

With the 4th week, you add resistance. There should be a dial on you bike to add this. As you turn this dial, it will become harder to pedal. If you cannot pedal at this higher level, don't stop. Just turn the dial to 0 and keep pedaling for the remainder of the workout time.


When To Resume Usual Activities:

Week 1-2 After 6 Weeks

Light housekeeping

  • Dusting 
  • Setting the table
  • Wash dishes
  • Folding clothes

Light gardening

  • Potting plants
  • Trimming flowers/plants

Needlework
Reading
Cooking meals
Climbing stairs
Small mechanical jobs
Shopping
Restaurants
Movies
Church
Attend sports event
Passenger in car
Walking
Treadmill
Stationary bike (without movement of arms)
Shampooing hair
Playing cards and board games

Continue activities of weeks 1-6
(you should be able to tolerate more)

Return to work part-time  

Heavy housework

  • Vacuuming
  • Sweeping
  • Laundry

Heavy gardening

  • Mowing lawn
  • Raking leaves

Ironing
Business or recreational travel
Fishing
Light aerobics (no weight > 25 pounds)
Walking dog on leash
Driving
Boating

 

Exercise Record Sheet

Click here for a printer-friendly pdf of an Exercise Record Sheet.

 

Things to Remember

1. Take a shower every day, using warm water. Caution: Very hot water or a hot bathroom may cause your blood vessels to enlarge, causing dizziness or possibly causing you to pass out. Use a non-deodorant soap such as Dial or Ivory to wash your incisions. Gently pat the incisions dry. If you have strips of tape over the incisions, pat them dry, then using a hair dryer, on the lowest temperature setting, holding it at least 12 inches away from the skin, dry the tape strips; or let them air dry. You may remove the tapes 3-5 days after going home. Look at the incisions closely each day as you shower.


Notify your doctor if you notice any:

  • Redness greater than 1/2 inch out from the incision
  • Swelling to the area
  • Increased tenderness
  • Increased skin temperature around the incision
  • Opening of the skin edges
  • Drainage or fluid from the incision which is not clear or is a large amount

A little redness, itching, and soreness is normal but usually goes away after a few weeks. Do Not use any lotions, creams, ointments, or powder on your incisions.

If a mammary artery was used for a bypass graft (left internal mammary artery-LIMA, most commonly used) you may have numbness in the lower right chest wall area.

You may have a lump at the top of your incision; this will disappear in time.

You may notice an occasional "clicking noise" or sensation in your chest in the first few days after surgery. This should occur less with time and go away completely within 1-2 weeks. If it gets worse call your doctor. The leg incision usually takes longer to heal. You may have some swelling and have some yellowish drainage. You may also notice numbness around the incision most common at the ankle area.

Female patients should wear a soft elastic bra (no under wire, usually a size larger around is more comfortable - we recommend the Playtex Eighteen Hour Posture Bra) 24 hours a day for the first six weeks following surgery. This is to prevent the weight of the breast from pulling on the incision and sternum, which decreases the scarring and places less weight on the sternum.

Be sure to protect your incisions from over exposure to the sun during the first year after surgery. The scar will darken with sun exposure. 

2. If you notice swelling in you feet or legs, make sure to keep your legs elevate while you are sitting. Lie sown with your legs elevated above your heart level for one hour 2-3 times a day. (Good times are following your meals). If you have continued swelling you will need to wear TED hose (support hose-make sure you get 2 pair before leaving the hospital). You may also need to cut back on the fluids you are drinking to 2 quarts a day, and reduce your salt intake.

3. Space your activities to allow time for rest. Plan a 10-15 minute rest period between each of your activities. Gradually remove the rest periods as you tolerate. Rest after meals, this allows time for your food to digest. You do not have to go to bed to rest, sit in a chair with your legs elevated.

4. Try to get at least 6-8 hours of sleep each night. If you plan to stay up late, take a nap before hand. You may take naps during the day if you desire, but remember a nap is when you lie down for one hour or less.

5. Avoid straining to have bowel movement. For constipation you may take a laxative of your choice. You will need to take your stool softener 1-3 capsules a day as needed to keep your stools soft. You can buy stool softeners over-the-counter at the drug store or grocery store, such as Surfac or Colace.

6. Limit visitors or visits to how you feel. Never hesitate to excuse yourself and rest when you become tired.

7. Following heart surgery you may experience difficulty remembering, especially recent happenings. You may have trouble with concentrating. It is common to experience visual changes, more frequent or unusual dreams or nightmares. You may experience changes in temperature, feel hot in a cold room, feel cold in hot room, or have unexplained sweating. These changes are most likely due to the combination of; use of the heart-lung machine during your surgery, anesthesia and medications. These things usually go away within 4-6 weeks.

8. It is normal not to have much appetite following surgery. Your sense of taste can be diminished or almost absent. Food may not taste the same to you or you may have a metallic taste in your mouth. For the first 2-3 weeks following your surgery, eat whatever tastes good. Do not try to follow any specific diet unless you are on a diabetic calorie count or dialysis diet. After this first 2-3 week period, it is necessary to follow a heart healthy diet low in cholesterol, low in fat and reduced sodium, to help prevent the recurrence of the blockages. It is sometimes better to eat 4-6 small meals a day rather than 3 large meals. To reduce the metallic taste in your mouth, brush your teeth or gargle before eating.

9. Your doctor can advise you on the best plan in returning to work. Usually 4-6 weeks following surgery. 


10. Additional things to remember if you have had heart valve surgery.

  • Do Not use any drugs, even over-the-counter drugs (nonprescription) drugs such as: aspirin, Motrin, cold or cough
    preparations without asking your doctor.
  • Do Not take vitamin preparations containing vitamin K (clotting vitamin).
  • Never stop or change the amount of anticoagulation medication without consulting your heart surgery doctor.
  • Notify all other doctors of dentist caring for you of your heart valve surgery.
  • Do Not have any elective dental procedure for six months following your valve surgery. Dental and other surgical procedures can release bacteria into your blood, causing infection and possible damage to your heart and valve. To prevent bacteria from causing infection to your valve, you must always take an antibiotic before any dental work, surgical procedure, or placement of a tube or catheter inside your body.

11. Keep all doctors' appointments to check the valve function or your anticoagulation therapy.

Use caution to avoid high-risk activities such as contact sports, using power tools, climbing ladders, etc.



When to Notify the Doctor

Contact your doctor immediately if you have:

  • Unexplained bruising or bleeding.
  • Temporary blindness in one eye or observing a gray curtain coming over an eye.
  • Weakness, clumsiness, or numbness of the face, arm, or leg on one side of the body even if only temporary.
  • Slurred speech, even if it lasts only a short while.
  • Coughing up bright red blood.
  • Pain in the calf of leg that becomes worse with pointing toe up to the head.
  • New onset of nausea, vomiting or diarrhea.
  • Severe abdominal pain.
  • Urinary tract infection-frequent urination, burning with urination, urgency with urination, bloody urine.

Do Not hesitate to call if you have any questions or concerns!

Regular office hours are 9AM to 4:30PM, Monday through Friday. Please call (210) 495-4200 in advance to schedule or reschedule appointments.

In the event of an emergency call 911 or go to the nearest emergency room and then have us notified at (210) 495-4200. 

Medications

When you are discharged home a list of medicines your doctor wants you take on a daily basis will be supplied. Your medications may be different from those you took before your heart surgery. It is important that you take only the medications you are instructed to take when you go home. Listed below are some commonly prescribed classes of medications, their actions and some examples in each class.

 

Anticoagulants:

Anticoagulants interfere with blood clotting by preventing clot formation. (Example: Coumadin, Warfarin) Too much Vitamin K in you diet will make this medication less effective. Some foods are high in Vitamin K. You do not have to avoid these foods, just eat normal amounts.

Foods High in Vitamin K:

  • Broccoli
  • Cooked onions
  • Turnip Greens
  • Green Tea
  • Cabbage,
  • Liver
  • Lettuce
  • Spinach
  • Mustard Greens.


Some medications also may affect Coumadin making the blood levels of the medication very high or very low. Make sure all of your health care providers are aware that you are on this medication.

 

Antidysrhythmics:

Antidysrhythmics slow nerve impulses in the heart, helping to restore irregular heart beats to regular, normal heart rhythm. (examples: Digoxin, Procainamide, Quinaglute, Amiodarone).

 

Antihypertensives are divided into three groups:

1. Ace Inhibitors: Ace Inhibitors curb the action of angiotension converting enzyme (ACE), a blood pressure raising chemical in the blood. (Examples: Lisinopril, Prinivil, Zesteril, Vasotec, HCTZ). These drugs treat high blood pressure. One side effect of these drugs is that they keep potassium from leaving the body. If you eat too much potassium or use salt substitutes that have potassium, your blood level of potassium could get very high, which can affect the heart or even cause the heart to stop.

Foods High in Potassium:

  • Apricots
  • Artichokes
  • Asparagus
  • Avocados
  • Bamboo Shoots
  • Bananas
  • Broccoli
  • Brussels Sprouts
  • Cantaloupe
  • Carrots
  • Celery
  • Chocolates
  • Dates
  • Dried Beans
  • Dried Fruits
  • Figs
  • Greens
  • Honeydew Melon
  • Milk
  • Oranges
  • Orange Juice
  • Potatoes
  • Prunes
  • Prune Juice
  • Pumpkin
  • Raisins
  • Rhubarb
  • Spinach
  • Squash
  • Tomatoes
  • Tomato Juice
  • V-8 Juice

2. Beta-Blockers:

Beta-Blockers decreases the workload of the heart. They also help the heart to beat more slowly and regularly. (Examples: Lopressor, Atenolol, Toprol XL).

3. Calcium Channel Blockers:

Calcium Channel Blockers relax the blood vessels and increase the supply of blood and
oxygen to the heart while reducing the workload. (Examples: Cardizem, Norvasc).

 

Anti-Platelet Agents:

Anti-Platelet Agents prevent the platelets from clumping or sticking together to form a clot or build up blockages. (Examples: Enteric Coated Aspirin, Ascription, Persantine, Plavix, Ticlid).

 

Cholesterol Lowering Agents:

Cholesterol Lowering Agents work to help lower the lipid levels in the blood to decrease build up of blockages. (Examples: Lopid, Zocor, Pravachol).

 

Diuretics:

Diuretics work by acting on the kidneys to increase the amount of urine you make to reduce the amount of water in the body. (Examples: Lasix, HCTZ).

 

Histamine H2 Antagonists:

Histamine H2 Antagonists work to inhibit gastric secretions in the stomach. (Examples: Tagament, Zantac, Prilosec).

 

Mineral Supplements:

Mineral supplements are given to replace or restore minerals in the body for those who do not enough because they have lost too much due to illness or treatment with certain medications. (Examples: K-Dur, Potassium, Iron).

 

Non-Steroidal Anti-Inflammatory Agents:

Non-Steroidal Anti-Inflammatory Agents are used for pain relief. They reduce inflammation and fever. (Examples: Ibuprofen, Advil, Motrin, Aleve).

 

Pain Medication:

Pain Medication is used to control moderate to severe pain. Usually contains a narcotic and can cause constipation. (Examples: Tylenol #3, Percocet, Darvocet, Vicodin).

 

Stool Softeners:

Stool Softeners are given to establish normal bowel function. (Examples: Surfak, Colace).

 

Refills:

Refills for pain medications will be ordered by your heart surgery doctor. For all other medication or refills, please contact your primary physician or cardiologist. 


Community Resources:

American Heart Association (210) 614-4121 - The American Heart Association can provide information and pamphlets on diet, exercise, and heart disease. The AHA can also give you the telephone number to Mended Hearts - support group for heart surgery patients.
http://www.americanheart.org

American Diabetes Association (210) 829-1765 Toll free (800) 342-2383
http://www.diabetes.org

American Lung Association (210) 308-8978 Foundation Health Federal Services, Inc.
http://www.lungusa.org

Tricare (210) 281-7526, (210) 916-5943, (210) 916-2286
http://www.tricare.mil

 

San Antonio Malls Walking Programs

Ingram Park Mall: (210) 684-9570 for information

McCreless Morning Milers: (210) 534-8831 for information

Rolling Oaks Trendsetters: (210) 651-5513 for information

Windsor Walkers at Windsor Park Mall: (210) 654-1760 for information

 

Internet Sites:

American Heart Association
http://www.americanheart.org

Yahoo Health 
http://health.yahoo.com

Heart Center Online
http://www.heartcenteronline.com

WebMd health
http://my.webmd.com/

National Institutes of Health
http://www.nih.gov/health