Download Your Heart Surgery - Harefield Hospital

Royal Brompton & Harefield
NHS Foundation Trust
Harefield Hospital
Your heart surgery
Contents
Understanding the heart
3
Problems with the heart
4
Heart surgery
Coronary artery bypass grafting
Heart valve surgery
Aortic valve replacement
Mitral valve replacement or repair
Other types of heart surgery
5-15
6
10
12
13
15
Before your surgery – the pre-admission phase
16-19
After your surgery
20-24
Back on the ward
24-26
Going home
27-38
Who you can contact for further information
39
2
This booklet gives you information about preparing for your
heart surgery, the operation itself and your recovery. It is not
intended to replace the information and explanations given to
you by our staff. We hope you will find it a helpful guide to
use before, during and after your visit to hospital. Our aim is
to prepare you for your operation, to reduce any fear or
uncertainty you may have and to make your stay as
comfortable as possible.
Please ask if you have any questions or need further
information. Useful contact details are included at the end of
this leaflet.
Understanding the heart
The heart is a muscle that
pumps blood around the
body. The left side of the
heart receives oxygen-rich
blood from the lungs and
then supplies this to the
rest of the body.
Blood that is low in
oxygen then returns to the
right side of the heart
where it is pumped back
to the lungs to receive
fresh oxygen.
The ‘heart rate’ is the number of times the heart fills with and
pumps out blood each minute. What is considered a ‘normal’
heart rate varies from person to person, depending on things
like age and fitness. An average heart rate is 60-100 beats per
minute.
3
The coronary arteries
All living tissues and
organs (of which the
heart is one) need blood
that is rich with oxygen to
work. There are millions
of arteries all over the
body that carry oxygenrich blood from the heart
to organs and muscles so
they can stay healthy. The
coronary arteries supply
oxygen-rich blood to the
heart muscle itself. These
arteries lie over the surface of the heart. There are three main
arteries – a right coronary artery and two left coronary
arteries. These then branch off into smaller arteries.
Problems with the heart
Coronary artery disease
Coronary artery disease is also known as ischaemic heart
disease. It occurs when a fatty substance called atheroma
develops on the inside of an artery. The build up of atheroma
in an artery means that it becomes narrower. A narrowed
artery will only let a limited amount of blood reach the heart
muscle, which can cause angina.
Angina
Angina is the term given to a cramp-like pain or heaviness felt
mainly in the chest and left arm but sometimes in both arms,
the shoulders, back, jaw or throat. You may also feel short of
breath and tired. Angina occurs when not enough blood is
reaching the heart. Although it can happen when at rest,
4
angina often occurs during exercise, after a heavy meal, in very
cold weather, during sexual intercourse or during angry or
excited moments.
These activities may cause your heart to beat faster or your
coronary arteries to become even narrower than usual. When
this happens the narrowed arteries let even less blood and
oxygen reach your heart muscle. This causes pain but does not
usually damage the heart. Angina can be relieved by taking
Glyceryl Trinitrate (GTN) tablets or using a GTN spray under
your tongue. The heart muscle is not usually damaged.
Heart attack
You may also hear a heart attack described as myocardial
infarction, coronary occlusion or coronary thrombosis. A heart
attack occurs when a coronary artery becomes completely
blocked and blood cannot reach a certain part of the heart
muscle. When blood cannot reach a muscle it becomes
damaged. A heart attack can occur at any time, whether you
are resting or exercising.
The pain associated with a heart attack is usually quite severe
and you may feel dizzy, sweaty and sick, become pale in colour
and feel cool to touch.
Heart surgery
You may have been diagnosed with a heart problem some
time ago and already been helped by medication and lifestyle
changes. However, your doctors may think you are at a stage
where surgery is the best way to treat your condition and
suggest you have an operation. There are different types of
heart surgery and the one recommended for you will depend
on your condition.
5
Coronary artery bypass grafting (CABG)
In coronary artery bypass surgery (CABG, and commonly
known as heart bypass surgery) any blockages or narrowing in
your coronary arteries are bypassed. A surgeon takes a vein,
usually from your leg, and attaches one end of it to where the
main artery that supplies blood to the body leaves the heart.
The other end is then connected below the blocked or
narrowed part of your coronary artery. This then allows blood
to go around (or bypass) the blockage or narrowing and so
improves blood supply to your heart muscle. If you have
several blockages, then several bypass “grafts” can be used. An
artery from the chest wall (called the internal mammary artery)
or one from your lower arm (radial artery) can also be used.
Coronary artery bypass grafts do not cure the heart disease
that caused your arteries to become blocked or narrowed. That
means that it is important to live healthily to help your grafts
work well and prevent narrowing of your other arteries.
Traditional heart bypass surgery involves
making a cut (incision) of about 25cm (10
inches) long down the middle of your
breastbone. The ribcage is then opened to
get access to the heart.
Different procedures used
British Heart Foundation
‘On pump’ surgery
CABG surgery has been performed for many years using a
special heart and lung bypass machine.
This machine takes over the work of the heart and lungs and
means that oxygen-rich blood can continue to flow around the
body while the heart itself is repaired.
6
‘Off pump’ surgery
You may also hear ‘off pump’ surgery called the ‘octopus
procedure’. It is a technique where CABG surgery is performed
without using a heart and lung bypass machine. The method
involves attaching the grafts while the rest of the heart
continues working as normal. The actual procedure of artery
grafting is carried out in the same way as standard CABG and
so recovery after the operation is very similar.
Your surgeon will discuss with you which procedure he/she
thinks is best, taking into consideration your health and
medical condition. During this time you will have the chance
to ask any questions you may have.
MIDCAB (“minimally invasive direct coronary artery
bypass”)/MINICAB (“minimally invasive coronary artery bypass
grafting”)
If your condition means that you only need one bypass graft to
the artery at the front of your heart, an operation called
“MIDCAB” or “MINICAB” may be performed. Unlike a CABG
procedure where the chest is fully opened up to perform the
operation, a MIDCAB or MINICAB operation only involves a
small cut (incision), usually under the left breast area of your
chest. Through this cut, small instruments are inserted and
used to carry out the surgery. This is carried out under a
general anaesthetic.
Patients who have these types of procedures tend to spend a
shorter time in the intensive therapy unit (ITU) and a shorter
time in hospital overall before going home. However, most of
the information in this booklet about recovery from surgery
still applies. The rehabilitation team, physiotherapists, doctors
and nurses on the ward will give you advice before you go
home.
7
What are the benefits of CABG?
A successful operation will reduce symptoms such as angina
and shortness of breath and improve your overall quality of
life. Surgery also reduces the risk of future heart attacks and in
patients with severe coronary heart disease (also called ‘threevessel disease’) may also improve life expectancy.
What are the risks of CABG?
No medical or surgical procedure is entirely without risk.
However, it is important to remember that we would not
recommend an operation if we did not believe the benefits
outweighed any risks to your health.
Stroke occurs in one to two per cent (one to two in every one
hundred) of cases. This risk is higher in those patients who
have already suffered strokes and transient ischaemic attacks
(TIAs).
Renal (kidney) failure after the operation, needing dialysis,
occurs in one to two per cent (one to two in every one
hundred) of cases. It is more common in patients who already
have kidney problems.
Atrial fibrillation, a type of heart rhythm in which the heart
beats quickly and irregularly, occurs in as many as 30 per cent
(30 in every one hundred) of cases. This is often short-lived and
does not cause a major change to how the heart works or to a
patient’s overall progress.
A further operation due to bleeding is needed in two to three
per cent (two to three in every one hundred) of cases.
Deep sternal (breastbone) wound infection occurs in one to
8
four per cent (one to four in every one hundred) of patients. It
is more common in patients with poorly controlled diabetes
and other conditions that make a patient more vulnerable to
infection.
Coronary artery bypass surgery does carry a one to two per
cent (one to two in every one hundred) risk of death. The risk
will be slightly higher in those patients who have had very
recent heart attacks or whose lungs and kidneys are not
working well.
The risks involved in surgery are increased if both valve
replacement and CABG are needed at the same time and also
if you have had one or more previous heart operations.
What are the alternatives to CABG?
Drugs will only control the symptoms of your heart disease and
will not solve the underlying problem.
It is sometimes possible to treat heart disease with
percutaneous (“through the skin”) techniques such as
angioplasty and stenting. This is when a small cut is made in
the groin and a catheter passed into the heart. Unfortunately
your doctors believe that your heart disease is now too
advanced to be treated in this way.
What will happen if I don’t have the operation?
Without CABG your symptoms (such as angina and shortness of
breath) will increase in frequency and worsen with time. In
addition, the risk of future heart attacks is higher and in
patients with severe coronary artery disease (‘three-vessel
disease’), the chance of long-term survival is likely to be
reduced.
9
Heart valve surgery
The valves of the heart are
like the valves in any pump.
They work by making sure
that blood only flows in
one direction. Inside the
heart there are four
chambers, two at the top
(called ‘atria’) and two at
the bottom (called
‘ventricles’).
Blood returning from the body to the heart is low in oxygen.
Blood returns from the body to the right atrium, passes
through a valve in the heart called the ‘tricuspid valve’ and
into the right ventricle.
The blood then passes through the ‘pulmonary valve’ to the
lungs, where it picks up its new oxygen supply. The blood is
returned from the lungs to the left atrium, passing through
the ‘mitral valve’ into the left ventricle and then through the
‘aortic valve’ into the aorta (a major artery).
From here the blood
travels around the
body to deliver oxygen
to various organs.
Sometimes a valve can
become narrowed
(known as ‘stenosis’)
meaning that blood
flow is reduced or
slowed down. A valve
may also leak (known
10
as ‘incompetence’) and this lets blood flow backwards through
the valve (called ‘regurgitation’). Valve problems can be
present at birth or be caused by changes that develop later in
life. Rheumatic fever in childhood can sometimes cause valve
problems as can an infection of the valve.
The valves that most commonly need surgery are the aortic
and mitral valves. Occasionally it is possible to repair a
narrowed valve simply by opening it up (a ‘valvotomy’).
Sometimes a leaking valve can be repaired, but if it is badly
damaged it has to be replaced by a tissue or mechanical valve.
Mechanical valves
Mechanical valves are made from materials such as metal and
plastic and do not contain any biological tissue.
If you receive a mechanical valve, you will need to take
medication that slows the speed at which your blood clots
(anticoagulant medication) for the rest of your life. This stops
the blood from becoming too thick and sticking to the
mechanical valve and possibly forming a clot. The
anticoagulant medication most commonly used is Warfarin.
The doctors, nurses and pharmacist will give you advice about
this before you leave hospital.
Tissue valves
These are valves obtained from humans or pigs. Sometimes
tissue obtained from a cow’s heart can be made into a valve. If
you have a tissue valve, you may need to take anticoagulant
medication for a few months after surgery.
Your surgeon will discuss the type of valve that is best for you.
11
Aortic Valve Replacement (AVR)
Aortic Valve Replacement (AVR) is the surgical treatment for
aortic valve disease (‘aortic stenosis’ and ‘aortic regurgitation’).
What are the benefits of aortic valve replacement?
Most patients with aortic stenosis and symptoms such as
angina, shortness of breath and blackouts, live significantly
longer after AVR. Quality of life is also significantly improved
and the risk of heart failure is lower. Similar benefits can be
expected in patients with aortic regurgitation. Valve
replacement is also recommended for some patients without
symptoms to prevent future heart problems.
What are the risks of aortic valve replacement?
No medical or surgical procedure is entirely without risk.
However, it is important to remember that we would not
recommend an operation if we did not believe the benefits
outweighed any risks to your health.
• Need for a permanent pacemaker: Valve surgery can
sometimes disrupt the heart’s regular rhythm. Often this will
resolve itself in the days after surgery but in some cases, the
rhythm does not return to normal. Five per cent of patients
having aortic valve surgery (five in every one hundred) need a
permanent pacemaker fitted after surgery to regulate their
heart rhythm.
• Death: Aortic valve replacement carries a two to three per
cent risk of death (in other words, two to three in every one
hundred patients who have the procedure die). The risks will
be higher for patients who are already very unwell.
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What are the alternatives to aortic valve replacement?
Medical therapy (drugs) will only control symptoms and will
not improve the condition of your aortic valve disease. For
further information about alternatives, please speak to your
consultant.
What will happen if I don’t have treatment?
Without AVR, symptoms such as angina, shortness of breath
and blackouts will become more frequent and worsen over
time. Without surgery most patients will experience heart
failure and/or sudden death.
Mitral Valve Replacement or Repair (MVR)
Mitral Valve Replacement or Repair (MVR) is the surgical
treatment for mitral valve disease (‘mitral stenosis’ and ‘mitral
regurgitation’).
What are the benefits of mitral valve surgery?
Patients with mitral valve disease can have an improved quality
of life and better long-term survival following MVR. This
means fewer symptoms such as shortness of breath and fatigue
and a lower risk of developing heart failure. Valve replacement
or repair is also recommended for some patients without
symptoms in order to prevent future heart problems.
What are the risks of mitral valve surgery?
No medical or surgical procedure is entirely without risk.
However, it is important to remember that we would not
recommend an operation if we did not believe the benefits
outweighed any risks to your health.
13
• Need for a permanent pacemaker: Valve surgery can
sometimes disrupt the heart’s regular rhythm. Often this will
resolve itself in the days after surgery but in some cases, the
rhythm does not return to normal. One to two per cent of
patients having mitral valve surgery (one to two in every one
hundred) need a permanent pacemaker fitted after surgery to
regulate their heart rhythm.
• Death: Mitral valve replacement carries a three to four per
cent risk of death (three to four in every one hundred people
who have the operation die) and mitral valve repair carries a
one to two per cent risk of death (one to two in every one
hundred patients who have the procedure die). The risks will
be higher for patients who are already very unwell.
Please see the CABG risk section (on page 8) for details of
other risks that can be associated with this type of surgery.
What are the alternatives to mitral valve surgery?
Medical therapy (drugs) will only control symptoms and will
not improve the condition of your mitral valve disease. For
further information about alternatives, please speak to your
consultant.
What will happen if I don’t have mitral valve surgery?
Without MVR, symptoms such as angina, shortness of breath
and blackouts will become more frequent and worsen over
time. Without surgery most patients will experience heart
failure and/or sudden death.
14
Other types of heart surgery
Surgery is often needed to treat other types of heart disease.
These include:
Congenital heart disease
Congenital heart disease is a heart problem that has been
present from birth. An example is a hole in the heart (known
as a ‘ventricular septal defect’).
Constrictive pericarditis
This occurs when the outer lining of the heart (called
‘pericardium’) becomes thick and rigid, causing problems with
how the heart pumps. This is normally treated by removing the
pericardium.
Aortic aneurysm or aortic dissection
A bulge or a tear sometimes forms in the wall of the main
artery out of the heart (the ‘aorta’). This can be repaired with
a patch of synthetic material called ‘dacron’.
Ventricular aneurysm
This can sometimes occur after a heart attack. A bulge can
form in the ventricle that affects how the heart pumps. This
bulge can be removed and a dacron patch used to make a
repair.
Whatever type of surgery you have, your recovery will be very
similar. We hope these explanations have helped you
understand about your condition and your forthcoming
operation.
15
Before your surgery – the pre-admission phase
Hospital appointments
After your consultation with the cardiac surgeon and once you
are on the waiting list, you will get two appointments:
• A pre-operative information day where you will get advice
and support about your forthcoming operation, details
about recovery from heart surgery and information on how
you can reduce your risk of further heart problems.
• An outpatient clinic where we will carry out a number of
tests to check your condition and make sure you are ready
for surgery. These may include a chest x-ray, ECG
(electrocardiogram) to monitor your heart rhythm, and
various blood tests. Other tests may also be carried out
depending on your health and medical condition. All the
tests will be explained to you. We will do our best to carry
out all the tests on the same day. However if this is not
possible, you will get an additional appointment to attend
the hospital at a later date.
If you are unable to keep these appointments, it is important
that you contact us immediately using the contact number on
your letter. This means we can give you another appointment
and give your original slot to someone else.
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Coming to hospital for your operation
What should I bring to hospital?
Please do not bring too much with you when you first come to
hospital. When you are in theatre and recovering in ITU we
will have to store your belongings.
We suggest that you bring the following items with you when
you first come to hospital for your operation:
• One pair of pyjamas or a nightdress
• Dressing gown
• Slippers (these should fit you comfortably, have a good grip
and if possible, offer support to the foot and ankle)
• Toothpaste and other personal items (please note that we
will provide you with wash items such as towels and liquid
soap)
• Any medication you are currently taking
• For women we also advise bringing a soft, comfortable
support bra
Please don’t bring anything of value such as large amounts of
money, credit cards, expensive jewellery or other valuable
personal items.
When you are back on the ward after your operation, your
family and friends can bring in other items that will make your
stay more comfortable (such as books and magazines). There
are day rooms on most of the wards where you can watch
television. If you prefer, you can hire a television with
headphones to watch in your bed area.
Your family should also bring in comfortable day clothes and
shoes for you. Most people feel much better if they get
dressed a few days after their operation.
17
Staff members involved in your care
You will come across many staff during your time in hospital.
Our staff are trained to give you the best care possible, to
treat you with courtesy and consideration at all times and to
listen to you and answer your questions. As well as our nursing
and medical staff on the ward, the following staff will visit
you:
Surgeon or senior doctor – He/she will talk to you about your
operation and answer any questions you may have.
Junior doctor or cardiac nurse practitioner – He/she will take
an update of your medical history, check that this update is
recorded in your notes and repeat any tests that are needed.
Anaesthetist – He/she will be responsible for giving you an
anaesthetic for the operation. The anaesthetist will look at
how well your lungs are working and will explain to you about
the medication you will be given before your operation. Please
let the anaesthetist know if you have had surgery before and
if you are allergic to any medication.
Physiotherapist – He/she will play an important part in your
recovery. Physiotherapists are highly trained in techniques of
breathing, coughing and exercising, which are important after
your operation.
Other members of staff who will visit you during your hospital
stay include:
Cardiac rehabilitation team – You may have already met
members of the cardiac rehabilitation team in the outpatient
department or on your pre-admission day. They will visit you
during your stay in hospital, help you prepare for going home
and give you information about your rehabilitation.
18
Pharmacist – A pharmacist visits the ward every weekday.
He/she will review your medication chart and supply
medication if necessary. If you have any questions about your
medication, please ask the pharmacist when he/she visits the
ward. The pharmacist works closely with the nurses and
doctors to make sure that your medication treatment runs
smoothly while you are in hospital and when you go home. If
you miss the pharmacist and you would like to speak to
him/her please ask your nurse.
Eating and drinking before surgery
It is very important that you don’t eat or drink for
approximately four hours before your operation. The nurses
will remind you about this as it is important not to accidentally
eat or drink as this may affect the anaesthetic.
The ‘pre-med’
Before leaving the ward for your operation, we like you to feel
relaxed. A ‘pre-med’ contains medication that will make you
feel quite sleepy and relaxed. This will be given to you an hour
or so before your operation is due to begin. You will need to
stay in bed after you have been given the pre-med and ring
for the nurse should you need anything. You may also be given
oxygen through a mask at this stage.
The anaesthetic
A family member can stay with you until you go to theatre.
You will be wheeled down to theatre on a trolley with a nurse
and a porter. When you arrive, the anaesthetic will be given to
you through a small needle in the back of your hand. This will
make you fall asleep until after the operation.
19
After your surgery
The intensive therapy unit (ITU) and the recovery unit
As you will be undergoing major surgery, it is important that
you understand exactly what will happen to you in the first
few days following the operation.
After heart surgery, most patients spend at least one night on
either the ITU or the recovery unit. Those close to you can visit
soon after you are back from the operating theatre, although
much of the time on ITU or the recovery unit will be spent
asleep. The ITU and the recovery unit use modern equipment
to record the actions of your heart and lungs. The equipment
can be noisy and appear frightening, but it is important to
your recovery. A nurse will explain each item of equipment to
your family when they visit. On the day of your admission, you
(and your partner) are welcome to visit our ITU. Hopefully
after a brief visit and an explanation of the different
equipment used there, you will feel more at ease about the
first few days following the operation.
Equipment on ITU
Please remember that everybody is different and no two people
recover in exactly the same way after heart surgery. Some
people need to be connected to the equipment for longer than
others and some patients stay in the ITU a few days longer.
Much of the equipment will be connected to you and put in
place while you are unconscious. After heart surgery, you will be
kept unconscious with sedative medication that makes you
sleep. This may be for a few hours or overnight. All patients are
different and some are ready to wake up from the anaesthetic
sooner than others.
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Ventilator
While you are sleeping, you will be connected to a ventilator
(artificial breathing machine) so that your body can rest after
the operation. This means that there will be a tube in your
mouth leading into your lungs. During this time you will not
be able to talk or swallow.
The nursing staff will use thin plastic tubes to clear your mouth
so that you don’t need to swallow; this may make you cough a
little. A nurse will always be nearby to observe your condition
and respond to any concerns that you may have talking to you
and giving you reassurance at all times.
As you gradually become more awake, the ventilator will be
disconnected and once the doctors and nurses are sure you can
breathe safely on your own, the ventilator tube will be
removed. An oxygen mask will then be placed over your nose
and mouth and you will be allowed to sit more upright in bed.
You will probably be allowed to drink at this stage. A
physiotherapist will visit you soon after the operation to help
you begin your breathing and leg exercises.
Chest drains
These are tubes which are put into the hollow space around
your heart to drain off any blood that collects there after the
operation. They will probably be removed one to two days
after your operation. The stitches that hold the drains in place
will be removed four days later.
Urine catheter
This tube is passed into your bladder to drain away any urine
that collects during and shortly after your operation. The urine
drains into a bag attached to the side of the bed. The nurse
who is looking after you can measure the amount accurately
and you don’t have to worry about using a bottle or bedpan
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again until you are feeling more awake. This tube is usually
removed one or two days after surgery.
Additional equipment is used on the ITU such as a monitor to
see your heart rate and pumps to make sure you receive the
correct amount of fluid after your operation. An intravenous
line (drip) inserted into a vein in your neck is used to give
antibiotics and to measure the pressure in your heart. This
information means that we know exactly how much fluid you
need to be given. You will also have an intravenous line in
your arm to help replace this fluid.
All this equipment is needed so that ITU staff can check your
progress and make sure that you recover properly after your
operation.
Visiting ITU
Close family can visit ITU or the recovery from 10am to 1pm
and from 3pm to 7.30 pm. Visitors should ring the bell at the
end of the corridor leading towards the unit and a member of
staff will then take the visitors through. The telephone
number for ITU is 01895 828 685. The recovery unit can be
contacted via switchboard (01895 823 737) on extension 5339
or ask for ‘Harefield Recovery’ on the voice recognition system.
Accommodation for relatives
If your partner/family would like to stay at the hospital there is
accommodation available. The hotel block is called Parkwood
House. A receptionist is on duty from 8am-6pm Monday to
Friday and 10am-2pm on Saturday and Sunday.
The receptionist can be contacted on 01895 828 823. For daily
charges, please ask for our separate information sheet.
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If you need any help in arranging accommodation, please
contact the rehabilitation team.
Your family is welcome to use the Pavilion coffee shop and the
Hungry Hare restaurant for meals and refreshments during
your time at Harefield.
Your wounds
Leg wound
If you are having bypass surgery, you may have a wound
running down the inside of your leg where grafts have been
taken. Your leg will be bandaged along its full length at first.
This will soon be replaced with an elastic stocking.
Some swelling around the ankle area of the leg that has been
used for the grafts is very common. Dissolvable stitches are
usually used to stitch up the incision made in your leg.
Occasionally metal clips are used instead and the district nurse
will remove these after you have gone home.
Arm wound
If the radial artery has been used for one of the grafts, you
will also have a wound on the underside of your left or right
forearm. Small metal clips are used to close the skin. These are
normally removed 10 - 15 days after the operation by your
practice or district nurse.
As with all wounds you may experience some numbness caused
by bruising to the nerve endings for some months following
surgery, but this will improve.
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Pain
We want you to be as comfortable as possible after your
surgery and will do everything we can to control your pain.
At first, you may be given regular pain-relieving medication
using an infusion pump connected to a thin tube, which is
inserted into a vein in your hand. You will be able to control
the amount of medication you receive by pressing a button on
the handset (this is known as patient controlled analgesia or
PCA).
You may have an epidural instead – a small plastic tube
inserted into your spine delivering a constant amount of painrelieving medication.
As your pain reduces, this method of pain relief will be
replaced with medication taken by mouth. It is important to
your recovery that you have as little pain as possible and the
nurses will be constantly checking your pain level.
Back on the ward
High dependency unit (HDU)
From the ITU, you will be taken to the high dependency unit
(HDU) for a day or so. You will then move back to the main
ward where you will stay until you go home.
The first two to four days
You may feel very tired and find that you sleep a lot. This is
your body’s way of recovering after heart surgery. You will
need to concentrate on deep breathing and coughing at this
stage and a physiotherapist will help you with this. You may
still need a little extra oxygen for a few days. At this time you
may feel some discomfort in your chest as you cough and take
deep breaths – the pain-relieving medication will help. Holding
your chest to cough will also help relieve discomfort. Please
talk to your nurse if your pain is not controlled.
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Eating and drinking
At first you will be given fluid and nutrients through a drip - a
thin plastic tube that is fitted into a large vein (usually in your
neck).
Once you feel like eating and drinking again this will be
removed. Your appetite may be poor at this stage so please
eat what you can. If you have indigestion or you become
constipated please don’t worry, this is normal and we can help.
Hallucinations
During these first few days you may also feel a little vague at
times and find that you forget things easily. Bad dreams and
hallucinations are also common. These will gradually disappear
as your condition improves.
Palpitations (strong heart beats or ‘arrhythmias’)
Palpitations are very common following heart surgery. At times
your heart rhythm may feel different and you may experience
occasional extra beats. If your heart has a new blood supply or
a new valve, it may beat more efficiently and stronger than
before the operation.While in hospital you will be given extra
medication to control this. It is less likely to occur once you
have gone home, but if it does please contact the
rehabilitation team or your GP for advice.
Irregular heart beat (also known as ‘atrial fibrillation’)
An irregular heart beat is also quite common at this stage. The
heart rhythm may be irregular and beat a little faster than
usual. Medication may be given to control this if necessary.
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Getting up and about
Two or three days after your surgery you will be able to get up
and walk around your bed area. You will feel tired and some
muscles, especially those in your chest and neck, may ache. The
physiotherapist will teach you exercises to help relieve your
discomfort. The sooner you get up and about, the quicker your
recovery will be.
The exercises need to be done at least once a day for six weeks
after you have gone home. You may continue them for longer
if you like.
At first you may need the help of the nurses to wash, change
and move about. You may also need to wear special stockings
for the first few days after surgery. These stockings help the
blood flow to and from the legs until you are able to move
about more. However, by the third or fourth day after your
operation you will be able to walk to the bathroom and look
after yourself.
Before you go home, you will be able to dress in your normal
clothes and walk freely around the ward area and perhaps
take a short walk outside. You will also be able to climb a full
flight of stairs.
The rehabilitation nurses will visit you before you leave
hospital. A day or so before your discharge, they will discuss
with you and your family all the ‘dos’ and ‘don’ts’ for the first
three months after your operation.
You will also be given advice about your ‘risk factors’ for heart
disease and information about the rehabilitation programme
at Harefield or your local hospital.
26
Going home (discharge)
Preparing to go home
You may have some tests as a final check-up before you go
home, such as an ECG (electrocardiogram) to look at the
rhythm of your heart, or a chest x-ray to look at the size and
shape of your heart. The rehabilitation nurses, surgeons,
physiotherapists and the nurses who have cared for you on the
ward will make sure you are fully prepared for your return
home and will be able to answer any questions you may have.
You may need to take some medication for a few weeks or
more after you have been discharged – this may differ from
the medication you took before your operation. The hospital
will give you a week’s supply, together with a letter for your
GP. Please take this letter to your GP surgery or your GP may
want to visit you during your first week at home. Your GP will
organise a repeat prescription for your continuing medication.
This will normally be continued until your follow-up
outpatient appointment at the hospital.
An outpatient appointment date will be sent to you in the
post for you to attend the hospital about six weeks after your
discharge.
If you are coming to Harefield for your rehabilitation
programme, the cardiac rehabilitation nurse will give you a
date for the first part of the programme. This will be about
one to two weeks after discharge.
If you would prefer to attend a rehabilitation course at your
local hospital, your rehabilitation nurse will arrange this.
Rehabilitation courses at most other hospitals will not begin
until after your first follow-up appointment at Harefield.
27
At home
It should take approximately eight to twelve weeks to recover
from heart surgery but this depends on the extent of your
operation and how active you were before your operation.
Your whole body will have slowed down following the
operation and so it is important not to overdo things in the
first few weeks.
Please remember that no two people recover at the same rate.
Some people feel very well after six weeks, others will not feel
back to ‘normal’ for three to six months or a little longer.
Pain
After your discharge, you may still experience some discomfort
- particularly around the wound sites, together with aches and
pains in your chest, neck, shoulders and back. This is quite
normal and we advise you to continue taking your painrelieving medication regularly.
Please do not be afraid to take the maximum dose, as advised,
if you are experiencing a lot of discomfort. Most patients are
able to reduce their pain-relieving medication within six weeks
of discharge. It is important not to suddenly stop your pain
medication. Instead, reduce the dose gradually.
If you have had bypass grafts, the surgeons will often have
used the right or left internal mammary artery for one of the
grafts. In this case, it is common to experience slightly
increased discomfort over the left or right side of your chest,
neck or shoulder area.
At first, you may feel numbness and as the muscles and nerves
heal, the area may become tender to the touch. The exercises
28
you have been taught will help reduce your pain so it is very
important to keep doing them for at least six weeks and for
longer if you wish.
If you are worried about pain or if you find that pain-relieving
medication is not helping, please do not take extra tablets but
contact the rehabilitation team, ward staff or your GP for
advice. Your pain relieving medication may need to be
changed to something more effective. You may also find that
warm showers or baths help relieve some of the discomfort.
Wounds
By the time you leave hospital, you will be able to get your
wounds wet. A daily bath or shower will keep them clean and
help healing. Please do not use highly perfumed soap along
the scars as this may cause irritation. The stitches along your
chest and leg wounds will dissolve (the stitches from the chest
drain will have been removed before you leave hospital).
Please check your wounds each day. If you notice any swelling,
discharge, or if the wounds are red and sore, you should let
your GP know as soon as possible, in case you have a mild
infection. If this is the case, a short course of antibiotics may
be needed.
Your wounds will gradually fade over the next few months.
Usually a thin white line is all that remains.
If you have had CABG surgery, it is common for your ankle to
swell for a few weeks afterwards in the area where the grafts
were taken. To help reduce the swelling please keep
exercising, avoid standing still for too long and keep your feet
raised when you are sitting in a chair.
29
If both your ankles swell, or if the affected leg swells up to the
knee or beyond, please contact us or your GP for advice.
Please do not expose your wounds to direct sunlight (such as
by sunbathing) for the first eight to twelve weeks after surgery
or until they are completely healed.
Shortness of breath
This is very common during the first few weeks after heart
surgery. You and your lungs will have become less fit because
of being less active.
As you become more active, any shortness of breath should
disappear gradually. If this is not the case, please telephone
the rehabilitation nurses or your GP for advice.
Unusual mood swings
In the first few days following your heart surgery, you may feel
‘down in the dumps’ and anxious about the future. You may
experience changes in your mood and feel very tired and
irritable. After any major operation, people often experience
poor concentration and loss of memory and a lot of people
find they become very emotional and cry a lot.
All these symptoms are normal and some people experience
them more severely and for longer than others.
To help you and your family and friends cope during this time,
please feel free to contact one of the cardiac rehabilitation
team or telephone the ward and speak to the nurses who
looked after you. Attending a rehabilitation course will also
help you and those closest to you to feel better at this time.
30
Sleep
It is a good idea to try to get back to your normal routine as
soon as you get home. If you have had difficulty with sleeping
whilst in hospital, you may have been prescribed medication to
help you sleep.
You will probably find that once you have settled back into
your familiar surroundings and you are back in your own bed,
this medication is no longer necessary. It may take you a few
nights to find a comfortable position in which to sleep. You
may have slept slightly raised in hospital, but it is safe to lie
flat if that is how you prefer to sleep. For the first few weeks,
most people find that they also need a ‘nap’ during the day,
usually after their walking exercise. Remember though, that if
you sleep for long periods during the day you may have
problems sleeping at night!
Visual disturbance
As it is quite common to experience some visual disturbance
during the first six to eight weeks, we do not advise you to
have an eye test during this time. Visual disturbances after
heart surgery are usually only temporary and go away
completely in time.
Appetite
Immediately after surgery, your appetite may be poor but by
the time you leave hospital you should be starting to enjoy
your food a little more. After a few days at home, you should
notice your appetite returning to normal. Some weight loss is
quite common at this time. If your appetite remains poor and
weight loss continues, please contact the rehabilitation nurses
or your GP for advice.
31
Medication
You should make sure that you take only the heart medication
prescribed by the hospital on discharge and that you take it as
prescribed. If you normally take medication to lower your
cholesterol, please make sure you start taking this again.
Anxiety at home
You and those closest to you will probably have found this
experience very stressful. It is common for those closest to you
to be ‘over cautious’ when you first go home. Your partner or
family are encouraged to attend the talk before you go home
so that everyone is prepared for your return and understands
what is expected from you. The rehabilitation teaching
programme, which you and those closest to you are invited to
attend, will also help to put everything into perspective.
Driving
As a result of surgery the bones, muscles and tissues within the
chest area are temporarily damaged. It is important that you
do not drive until you are well enough to be able to cope in
an emergency situation. Your concentration and ability to
think clearly may not be as good shortly after surgery and this
could also make it dangerous for you to drive. Please do not
drive until you have had your first outpatient appointment.
You do not need to tell the Driving Vehicle Licensing Agency
(DVLA) about having heart surgery but you will need to tell
your insurance company. It is still compulsory to wear a
seatbelt as a front or back seat passenger. If this causes any
added discomfort to your chest, please try a small cushion or a
rolled up towel placed between your chest and the seatbelt to
help remove the pressure.
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Work
Around 75 to 80 per cent of people who worked before
having heart surgery (75 to 80 in every one hundred people)
return to their jobs afterwards. How soon you can return to
your job after surgery depends on the type of work you do
and the decision should be made in discussion with your
surgeon, GP and the rehabilitation team. It may be helpful to
start back part-time or to be offered lighter duties at first.
As a rule, patients with light occupations should consider
going back to work after two months. Those who have heavy
manual occupations may not be able to return to work for at
least three months. Your surgeon will be happy to discuss this
with you at your outpatient appointment.
Sexual relations
Sex can be resumed as soon as you feel able. Please apply the
same common sense approach you do to building up your
general physical activity. It is a good idea to find a position
that is most comfortable for you. Please try to avoid positions
that put weight on your breastbone or upper arms.
Before your operation, you may have felt less interested in sex.
This could be for various reasons, such as anxiety whilst
waiting for surgery or because some of the medication you
were taking may have had this effect. After your operation,
some of your medication will change and hopefully you will
feel less anxious and more positive about the future. Try to
adopt a relaxed attitude towards enjoying sex again and
please don’t worry if early attempts are unsuccessful or
difficult - you will soon be back to normal.
33
General advice for the first three months following surgery
Weeks one to six
Do:
•
•
•
•
•
Take a bath or shower each day and get dressed
The exercises you have been taught
Take a short nap mid-morning or afternoon if needed
Eat a healthy, well-balanced diet
Make a cup of tea/coffee or a light meal and wash up a few
dishes afterwards! You may also do anything gentle about
the house or garden.
• Get out for your walking exercise sometime during the day.
Walking is the best form of exercise in the first weeks
following your surgery and you can build up gradually. At first
this may be around the garden but once you feel more
confident you can walk away from the house. You may like to
go with a friend or family member at first to give you added
confidence.
It is normal to feel slightly breathless and a little tired when
you return from a walk, so take a short nap if you need one. If
you feel absolutely exhausted you have probably done too
much. Please avoid hills for the first few weeks and remember
to wrap up warm if the weather is cold.
We encourage you to walk further – anything from half a mile
to two miles or more – once six weeks have passed following
your surgery. Please remember everyone is an individual so the
amount of walking exercise you do depends on your age and
general fitness before surgery.
34
Please do not:
• Overdo your walking exercise
• Lift, push or pull anything heavy such as lifting children or
heavy pets, moving furniture or cleaning your car. You
should also avoid heavy housework such as vacuuming and
heavy gardening such as mowing the lawn, digging, etc.
• Drive
• Play any sports
• Carry out any DIY that involves stretching or heavy lifting.
Weeks six to eight
Do:
• Consider driving again after your check up with your
surgeon
• Mow the lawn and light digging in the garden
• Vacuuming and other moderate housework.
Please do not:
• Perform any tasks that are particularly strenuous.
35
Weeks eight to twelve
Do:
•
•
•
•
•
•
Some gentle swimming
Go cycling
Hit a few golf balls on the practice range
Start playing bowls
Play table tennis (gently)
Go back to work if you have a job that doesn’t call for a lot
of activity (our medical staff/rehabilitation team will advise
on this).
Please note that all the above should be started very
gradually and built up over a few weeks.
Please do not:
• Play contact sport such as football or rugby
• Play racquet sports such as squash, tennis or badminton
• Do weight lifting exercises.
Generally you should still avoid anything that would put a lot
of strain on your chest or upper body.
36
What can I do to reduce my risk of heart problems?
There is a combination of factors that may make certain
individuals more likely to develop coronary artery disease. You
can reduce your risk of further heart problems by:
•
•
•
•
•
•
•
•
Giving up smoking
Controlling high blood pressure
Learning how to cope better with stress
Making sure your weight is suitable for your height and
build
Eating a healthy, well-balanced diet
Making sure your cholesterol stays within normal limits
Taking regular exercise
Drinking sensible amounts of alcohol.
Cardiac rehabilitation
Rehabilitation programmes have been set up to help you and
your family cope during the first few months after your
surgery.
Once a week at Harefield, we give you the opportunity to
meet other people who have the same heart problems and are
also recovering from heart surgery. It will give you a chance to
share experiences. Each week there will be a talk on a variety
of topics relating to your recovery and future well-being.
All sessions will be repeated at eight weekly intervals and each
one is very informal. Time is also spent talking over particular
worries you may have once you have been discharged from
hospital.
The rehabilitation team will be available to answer any queries
you may have about your recovery in general.
37
Following on from the educational/support classes, you will be
referred to the second stage of the programme. This consists
of an individual exercise regime, which will help you to
become fitter safely and effectively. Regular exercise will
improve the flow of blood and oxygen to the muscles and
reduce the risk of further heart disease. We feel that the
programme will be of great benefit to you by helping you get
back to a ‘normal’ lifestyle as soon as possible.
Please ask the rehabilitation team for further information. If
for any reason you were not seen by the rehabilitation team
before your discharge and you would like to join the
programme or you have any worries or concerns, please
contact them through the secretary on 01895 823 737
extension 5944. You can find more contact details on the next
page.
38
Who can I contact for more information?
If you would like further information about heart surgery or
have any questions or queries, please contact us on one of the
following telephone numbers:
Harefield switchboard
01895 823 737
Cardiac rehabilitation nurses
Call switchboard on 01895 823 737 and ask for bleep 6170,
6151 or 6131
Answer phone 01895 828 944
Rehabilitation physiotherapist
Call switchboard and ask for bleep 6268
Intensive Therapy Unit (ITU)
01895 828 685
Parkwood House visitor accommodation
01895 828 823
Outpatient department
01895 823 737 ext. 5696
If you have concerns about any aspect of the service you have
received in hospital and feel unable to talk to those people
responsible for your care, call PALS on 020 7349 7715 or email
[email protected]. This is a confidential service.
39
© Royal Brompton & Harefield NHS FoundationTrust
Royal Brompton Hospital
Sydney Street
London
SW3 6NP
tel: 020 7352 8121
textphone: (18001) 020 7352 8121
Harefield Hospital
Hill End Road
Harefield
Middlesex
UB9 6JH
tel: 01895 823737
textphone: (18001) 01895 823 737
website: www.rbht.nhs.uk
October 2010
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