Life After Open Heart Surgery
Frequently Asked Questions
Many questions arise as to what you should do or should not do after discharge. The following are answers to the most common concerns and questions.
While the sternum (breastbone) is healing, avoid lifting greater than 10 pounds, or pushing/pulling activities with your arms.
Showers are permitted but tub baths are discouraged for 4-6 weeks or until your incisions are healed. Avoid extremely hot water which may cause you to feel dizzy or weak. You may gently wash (don't rub) your incision with soap. Do not use creams or lotions on incisions until they are healed.
Avoid driving a car for 4-6 weeks after surgery. Your reaction time will be delayed due to weakness, fatigue, and/or medication. You do not want to risk hitting the steering wheel and reinjuring the sternum. When riding in a car for long distances, stop every 1-2 hours to stretch your legs. This will improve circulation in your legs and help prevent swelling.
Do not cross your legs while lying in bed or sitting. This puts pressure on the veins under the knees and slows blood flow. If your legs or feet swell, you should put them on a chair or stool while sitting.
Avoid isometrics: straining to move your bowels, pushing/pulling heavy objects, or working with your arms overhead. These activities disproportionately elevate blood pressure and put an added strain on a healing heart.
It is important to space and pace your activities to minimize fatigue. If your feel tired, STOP, and rest for a while. Don't push yourself to finish a task.
A rest period should be taken at least once a day for a few weeks and, initially, preferably twice, morning and afternoon. Napping is not necessary, but resting is. Be sure to dress daily in street clothes. You are on your way to recovery!
Stair climbing is not discouraged. Avoid pulling yourself up with a handrail, and go slowly.
Use your elastic stockings during the day and remove them at night. You should wear the stockings for at least 2 weeks after discharge or more if your ankles are still swollen. The stockings aid blood flow and help reduce swelling in the legs. It is easiest to put the stockings on before you get out of bed in the morning for the day, however most people put them on after a morning shower. They should fit snugly.
Your may notice a swelling or lump at the top of your chest incision which could take several months to disappear.
Most patients experience incisional discomfort in the sternum. This discomfort will decrease in time, but may reoccur when there is as adverse change in the weather or when you overextend yourself. Do not hesitate to use pain relieving medication as you need it.
It is important to distinguish incisional discomfort from chest pain (angina) you may have experienced prior to surgery. Contact your physician if you are experiencing chest pain.
If your chest or leg incisions do not appear to be healing (i.e., redness, drainage, swelling, or tenderness is present), notify your physician.
Take your temperature every morning for one week after discharge. Notify your physician if your temperature stays above 101 degrees F for more than a day.
Check your weight every morning for the first two weeks. If you notice a sudden weight gain, notify your physician.
When you are upset, your heart works harder. It is best to anticipate and avoid situations, people, or topics of conversation that make you tense or angry.
Remember that your diet, medications, and exercise are prescribed specifically for you. Do not expect your friend or neighbor who has a heart condition to have the same prescriptions.
Keep a record of your medications and medical history with you when traveling.
Reasons to Call Your Surgeon's Office
If you experience any of the following symptoms, report them to your surgeon's office:
- Temperature above 101 degrees F on more than one occasion or chills for 24 hours.
- Excessive oozing, redness, swelling or tenderness at your incision sites.
- Increased fatigue or shortness of breath.
- Abnormal pain or other symptoms not relieved by your medications.
Remember... IT'S BETTER TO CALL YOUR SURGEON/DOCTOR OR NURSE WITH A QUESTION THAN WORRY ABOUT IT ALONE.
If You Had Valve Surgery...
Tell any doctor or dentist who treats you that you have had your valve repaired or replaced. They may prescribe antibiotics before procedures, especially dental work, to prevent an infection from settling in your heart.
It is possible that you may be taking Coumadin, an anticoagulant, commonly called a "blood thinner." Coumadin causes blood to take a longer time to form a clot.
There are several points you should know about Coumadin:
You will need regular blood tests (prothrombin time) to regulate the dosage of Coumadin. Your physician will arrange these test for you.
Look for signs of bleeding while you are taking Coumadin. Notify your physician if you have:
- any abnormal bleeding
- red or black bowel movements
- pink or red urine
- severe headaches, abdominal or lower back pain
- faintness or dizziness
- red or "coffee ground like" vomitus
- excessive bruising
- excessive nose bleeds
- yellow or jaundice skin
- any symptoms that concern you
Take your Coumadin at the same time every day. NEVER make up for a missed dose by taking double the dose.
Don't take aspirin, any medication containing aspirin or any "over-the-counter" medications without first checking with your physician as this can cause bleeding while taking Coumadin.
Excessive alcohol intake may also cause bleeding while taking Coumadin. Check with your physician about drinking alcohol.
It is a good idea to carry a wallet identification card indicating that you are taking Coumadin.
Returning to Work
Returning to work is individualized based upon the nature of employment, desk job versus manual labor, the severity of your disease as well as your activity tolerance. Toward the end of your convalescence your physician will be better able to evaluate your progress and set a specific date for returning to work. In general, it is necessary to be out of work for 4-8 weeks after surgery.
Exercise for Your Heart
Aerobic exercise is the type of exercise recommended to strengthen the heart and cardiovascular system. Studies have shown that exercising aerobically 3-4 times a week, for at least 30 minutes, is enough to accomplish this. However, since you will be recovering from surgery for the next 4-6 weeks, the intensity and frequency of the aerobic exercise needs to be modified to ensure safety and benefit.
While you are rehabilitating at home following surgery, you are encouraged to engage in a low level exercise program to aid in your recovery. Similar to your walking during your hospital stay, you need to walk several times a day in order to build your endurance safely. As you progress through the next four to six weeks you will be able to gradually increase the exercise time while decreasing the frequency of your daily walking.
The pace of your walk is determined by your heart rate (pulse) and how you are feeling overall. Check your heart rate before and at midpoint during your walk. You should not allow your heart rate to exceed twenty beats above your resting heart rate taken before walking. The Rate of Perceived Exertion (R.P.E.) also aids you in determining how hard your heart is working. Choose a number below that best describes how the exercise feels to you. Be sure to consider your overall sensations and feelings of physical stress, effort, and fatigue. You can use the R.P.E. scale for any kind of activity and it should be in the range of "very light" to "light" # 1-2.
|R . P. E . Scale
1 1/2 very, very light
1 very light
4 somewhat heavy
7 very heavy
8 very heavy
9 very, very heavy
10 very, very heavy
Once you are able to walk for twenty minutes without stopping, you should begin incorporating a warm-up and cool-down. The warm-up and cool-down are important because they prepare the body for a change of activity level by slowly altering body temperature, blood pressure, heart rate, and respiration. The warm-up and cool-down are a minimum of five minutes in duration and consist of slow walking. Your heart rate should be taken before you warm-up, at midpoint during the aerobic phase, and again after the cool-down. Again, your heart rate should not exceed twenty beats above your resting heart rate. If this should occur, slow down. Conversely, if your heart rate is not elevated (and the activity feels "light"), pick up the pace a little for the remaining time, then proceed with the cool-down. After the cool-down, your heart rate should return close to the heart rate taken before the warm-up. If it has not, then a longer cool-down is indicated to slowly bring your heart rate down. The progression of the walking program is outlined below.
PROGRESSIVE WALKING PROGRAM
Remember, your heart rate and Rate of Perceived Exertion should be monitored at midpoint during your walking. Your exercise heart rate should not exceed 20 beats above your resting heart rate and your R.P.E. should be in the very light, light (1-2) range. Your walking should be done indoors or outdoors (weather permitting) on flat, level ground.
Week 1: Walk 3 - 5 minutes three to four times daily. Total 12-20 min.
Week 2: Walk 7 - 10 minutes two-three times daily. Total 21-30 min.
Week 3: Walk 10 - 15 minutes two times daily. Total 20-30 min.
Week 4 - 6: Walk 15 - 20 minutes* one-two times daily. Total 30 min.
As mentioned earlier, once you have progressed your workout to 20 minutes then you need to incorporate a warm-up and cool-down into your exercise session. The frequency if walking is now once daily. These consist of:
Warm-up: Slow walking for 5 minutes
Exercise phase: Brisk walking for 20 minutes
Cool-down: Slow walking for 5 minutes
Consult your physician 4-6 weeks after discharge to determine the individual progression of exercise best for you. Often this is the time you will have an exercise stress test and enter an outpatient cardiac rehabilitation program.
ALWAYS CHECK WITH YOUR PHYSICIAN BEFORE STARTING ANY EXERCISE PROGRAM
COUNTING YOUR HEART RATE
Learning to count your heart rate (pulse) is a very positive step. It provides information on how your heart is working and enables you to gauge the intensity of your exercise program. For patients on medications which regulate the heart beat, taking your pulse aids in effective medication administration.
Learning to count your heart rate is simple and this skill can be learned quickly with a little patience and practice. There are two commonly used sites where you can feel your pulse:
The wrist pulse (at the radial artery) is located at the base of either thumb and is best felt with the finger pads (not the tips) of two or three fingers of the opposite hand.
When first learning to count your pulse, it is a common mistake to press the artery too hard. This occludes the pulse and you will not feel anything. A light but firm pressure will allow you to feel it well.
Count the number of beats you feel in 10 seconds and multiply that number by 6.
The carotid pulse (carotid artery) is located on either side of the windpipe. This is one of the largest arteries in the body and so it is one of the easiest to feel. It is best to use the right middle fingers to feel the left carotid or vice versa. Do not press both carotid arteries at the same time. This may cause you to faint or feel lightheaded, especially when pressing near the jaw bone as this can stimulate sensitive nerves. The right way to check your carotid pulse is to feel only one artery at a time.
POSTOPERATIVE ACTIVITY LIST FOR CARDIAC SURGERY PATIENTS
The following list will help you to determine when to resume certain activities after your discharge. If there is an activity in which you would like to participate that is not listed, contact your doctor for guidance.
Safe to Resume Immediately
- Playing cards/board games
- Walking/stationary cycling
- Washing dishes
- Light lifting (less than 10 pounds)
- Riding in a car
- Light housework/gardening
- Going to the store
- Eating out
Safe to Resume at Six Weeks
- Driving a car
- Using a self-propelled lawn mower (electric starter)
- Going in a swimming pool (zero depth or with stairs, no ladder that you must pull yourself up to get out of the pool)
- Tub bathing
Safe to Resume at Two Months
- *Riding a lawn mower
- *Driving a tractor
- *Carrying wet laundry in a basket
- *Riding an outdoor bicycle
- *Downhill skiing
Safe to Resume at Three Months
- *Hunting (bow/gun)
- *Rowing a boat/canoeing
- *Starting motors with pull cord
- *Chopping wood
- *Playing tennis
- *Participating in competitive sports
Points to Remember:
It is important to remember to space and pace your activities.
Avoid heavy one armed activity for three months.
Recovering after Open Heart Surgery: Speaking to the Heart of the Family
Open heart surgery is an event that affects the patient, spouse, children, and significant others. It is similar to the ripple effect in a pond when a stone is dropped. Many waves occur before the pond eventually calms. In addition to the physical recovery that the patient undergoes, there is an emotional aspect of adjustment that the patient, as well as family, experience.
Facing the possibility of changing one's lifestyle can be quite overwhelming. Some alterations take place immediately, such as diet changes and smoking cessation. Other changes may be more gradual, such as building up to and maintaining an exercise program, or incorporating long term stress management. Of importance to all those involved is realizing that the patient does have control in initiating the changes and in maintaining healthy new habits. This is the patient's responsibility. Spouses, children, and significant others often struggle with the impossible task of making sure the patient never deviates off course and stays on the "straight and narrow". Remember, others can assist and encourage, but only the patient can do!
Many lifestyle changes that occur as a result of having open heart surgery have a direct impact on the entire household. When a patient is forced to make changes for health reasons, very often all minds start to think along the same lines. This is especially true for others who might possibly be predisposed to coronary artery disease. Therefore, if the recovering patient has stopped smoking, family members who smoke are now motivated to quit. And when meals now need to be prepared in a heart-healthy fashion, chances are those who dine together will also be making these changes out of practicality for the cook resulting from a renewed awareness of the benefits to the heart.
Recovering from open heart surgery creates temporary role changes and responsibility shifts among family members. When the recovering patient returns home, he/she will have temporary physical limitations and dependencies which the family members compensate. The husband will need to shop and carry packages for his recovering wife who can neither drive herself to the store nor lift heavy packages. The son or daughter will have to mow the lawn and take out the garbage for their recovering father, who now has to limit exertion while he rebuilds his strength.
Just as the family needs to coordinate efforts in assisting the patient during his limitation phase, so should they enable him to increase his independence and regain his level of self reliance. This proves to be a very delicate balance and can be a cause of friction. Staying informed of the doctors recommendations on how the patient should progress can minimize the stress of this transitional period for both the patient and family.
Recovery will be a challenge for the open heart surgery patient and his/her family. There will be days of high energy and of fatigue, accomplishments, moments of temptation, feelings of exuberance and even days of feeling blue or angry, all of which are a part of the physical and emotional healing process that takes place.
Here are some tips for your continued successful recovery:
Encourage each other to express and discuss your feelings. Open communication can minimize misunderstandings.
Seek support by talking with others who have experienced similar circumstances. Sharing common concern can be reassuring.
Reach out for help. Having to focus on changing several habits can be overwhelming. Behavior modification groups (i.e. Smoke Enders) provide structure as well as the mutual support helpful for success.
Become knowledgeable about your condition.
Be inquisitive, attend lectures, and explore literature. Being informed can reduce anxiety.
Begin and maintain an exercise program for your physical and mental well being. Exercising with others can create added motivation.
If you are feeling emotionally overwhelmed, seek professional advise. A trained counselor can help you to cope more adequately with your concerns. Consult your hospital social worker or physician for this service.
Remember, recovery takes time. All of those involved will adjust according to their ability to assimilate the lifestyle and role changes which inevitably take place. Sharing your feelings and discussing ongoing issues can make for a smoother transition for all.
There is a great deal of pleasurable sexual activity that is not sexual intercourse. Being near someone, holding, fondling, caressing, are all activities that enhance closeness and pleasure. Since these activities require very little energy, you may engage in these anytime after discharge from the hospital. Many couples find that this expression of love allows them to return slowly to a full sex life with confidence.
Sexual intercourse requires slightly more energy, therefore a waiting time of 1-3 weeks is generally recommended. Another consideration will be position. As the sternum has been cut, a modification may be necessary in order to prevent injury to the sternum or incisional pain. Exercise will strengthen the heart and overall physical condition. So as you engage in the home walking program and witness firsthand increased endurance and confidence, you will know when you are ready. The energy expenditure for intercourse is the equivalent of walking briskly or climb two flights of stairs. The heart rate rarely rises above 120 beats/minute and blood pressure elevations are similarly mild and transient.
The person recovering after open heart surgery may be more conscious of his or her heartbeat, breathing, and muscle tension. This awareness is normal and is no cause for alarm.
Fear of performance and general depression are two psychological factors that can greatly reduce sexual interest and capacity. These are considered normal during convalescence and in most cases disappear within 3 months. If depression continues after 3-6 months, professional counseling should be considered.
Various medications may affect sexual drive and/or function. If this occurs, consult your physician. Often a change in medication or dosage can remedy the problem. Never stop taking any prescribed medication without your physician's approval.
There are several ways to prepare for the resumption of sexual activity. The first step is to exercise as mentioned above.
The second step is to be tolerant of each others emotions. For a brief time following open heart surgery, emotions are delicately balanced and subject to rapid mood swings. Try to keep day to day events in perspective and remember that a good sense of humor is a good ally.
The third step is to try to adjust mutual sexual expectations. Emotional response as well as physical responses sometimes make the resumption of sexual relations fearful and that is normal. Therefore don't expect too much at first.
Some general guidelines:
Be relaxed and rested before intercourse. Avoid sex if you are fatigued or upset.
Choose a position that does not restrict breathing or require prolonged muscular support.
Maintain a comfortable room temperature and familiar surroundings and partner.
Speak with your physician if you are experiencing any chest pain, angina, shortness of breath, rapid heart rate, or extreme fatigue in relation to sexual activity.
Wait at least 1 hour after a meal or alcoholic beverages before having sexual activity.
Open communication is important between partners.