What to Expect After Heart Surgery
All heart surgery patients are taken to the intensive care unit right after surgery. There, you will be closely observed by a team of heart doctors and nurses who are experts in caring for cardiac patients. Once your vital signs are stable, brief visits will be allowed. You may not recall visits if they occur while you are still asleep or groggy. The nurses will give you a visiting schedule. Only immediate family members are allowed to visit, and only two people at a time.
After you are in the unit, you will slowly wake up and become more aware of wires, tubes and lines that help us take care of you. These items can include:
After waking, you may first become aware of a breathing tube in your throat. It is attached to a machine called a ventilator which will breathe for you until you are strong enough to breathe on your own. While this tube is in place, you will not be able to talk because the tube passes through your vocal cords. Your doctors and nurses will talk to you and ask questions. You can answer by shaking your head yes or no. You can also write on a notepad if you want to tell the nurse something. Usually the breathing tube is removed the day of surgery or early the next morning. You will be asked to speak, and your voice might sound hoarse at first but will improve over time.
You may receive oxygen through a facemask, and later by nasal prongs. Changes will be made when needed by watching your breathing pattern and pulse oximeter. You will be asked to cough, deep-breathe, and use the incentive spirometer hourly. This helps expand your lungs and assures that you are getting enough air into the lower part of your lungs. You will be given a small pillow to support your chest when you cough. Pain medications will be ordered for you. It is highly recommended that you take them because they will help you cough and deep-breathe better.
A small tube is placed from your mouth or nose into your stomach to keep the stomach empty of air and fluid. This helps prevent risk of vomiting. This tube is taken out when the breathing tube is removed. You will then be able to take ice chips and liquids by mouth, and your diet will slowly return to normal. It is quite common to feel very hungry. Eat what you can as long as you are not sick to your stomach.
Your heart rate, heart rhythm, blood pressure and heart pressures are displayed on the bedside screen. These "waveforms" give the heart team vital data about your heart and blood stream. The heart rate and rhythm are obtained through pads placed on the skin. Your blood pressure is obtained through a small tube placed in a blood vessel in your wrist. This tube, or arterial line, is also used to withdraw blood samples so you won't need blood drawn from your veins. The heart pressures are obtained through a small yellow tube placed into a vein of your neck. In most cases, all tubes are removed in 24 to 48 hours.
Chest Tubes/Pacemaker Wires
It is normal to have chest drainage tubes placed in your chest during your surgery. The chest tubes allow blood and fluid that form inside your chest to drain out. The tubes are usually removed the first or second day after surgery.
Temporary pacemakers are placed in all patients. They serve as a backup to assist the heart rhythm if needed. The wires will be covered by a bandage and should not get wet. They will be removed within three to four days.
Intravenous (IV) lines allow us to give you fluids and medications after surgery. The bladder tube drains urine and allows us to watch your fluid balance and kidney function. This tube remains in place for one or two days, after which you should be able to walk to the bathroom. The nurses need to measure your fluid output, so they will give you a container to collect your urine after the tube is removed.
Although you will have a number of tubes and lines after surgery, they are only temporary. Each one is removed as soon as possible, many of them within a day or two. They may seem awkward while in place, but they will cause little or no pain.
If you need to see a physician affiliated with South Texas Health System Heart for a non-urgent medical problem, call the South Texas Health System Reserve and Learn line at 800-879-1033.
Recovering from Heart Surgery
Most patients remain in the Intensive Care Unit for one to two days. Usually you will be allowed to move to a chair with help the day after surgery. When doctors feel you are ready, you will be moved to a telemetry unit. On this unit your heart rhythm will be monitored by a small box-like device that transmits your heart rhythm to a screen.
The nursing team will be watching your progress. You will be urged to begin small tasks with help at first. These include coughing and deep breathing, eating, getting out of bed, walking in the hallway and bathing. By the third or fourth day after surgery, you should be able to carry out these tasks by yourself.
Once you start to become more active, you will probably feel some pain or discomfort around the area of the incision. This pain is due to the spreading of your breastbone, muscles, and ligaments during surgery. As you heal the soreness will gradually go away, but it may take many weeks. Let your nurse know if you are having pain and request pain pills when you need them.
Throughout your stay, you will get stronger and be able to walk in the hall at least three times a day. The nursing staff's cardiac rehabilitation nurse will be able to help you with your activities.
Your nurses will explain in more detail what you can expect after surgery and prepare for your return home. You and your family will be taught things you need to know before discharge. We ask you to save any booklets given to you about your care and share with your family. You can consult with a dietician or social worker if you need to. You will stay on the telemetry unit until you are discharged from the hospital. Plans for discharge are discussed with your surgeon, cardiologist and other health team members. In most cases, discharge occurs four or five days after surgery.
After you are discharged from the hospital, it is important to make an appointment with your family doctor, the cardiologist and your heart surgeon for follow-up care. But remember, the heart team at South Texas Health System Heart is always available to answer any questions you may have in the meantime. Before you leave for home, your nurse practitioner will give you a phone number to call with any questions or concerns.
After your surgery is completed, and you begin to heal, plans will be made for you to return home. There are certain things that you should know before you go home that will ease the healing process. This section will answer many of your questions, but don’t be afraid to ask us about anything that concerns you about recovery.
Getting back to a normal routine takes time because your body systems have slowed as result of surgery, medications and less activity. Healing time will take at least two to three months after you go home. You can expect to have good and bad days during this time and you may feel tired, irritable, anxious, depressed or simply not quite yourself for a few weeks.
Don't be worried if you express your moods and feelings more than before. A lot of psychological energy is used in coping with the fears and demands after surgery. Talking with your family and friends can help with the normal emotional ups and downs after surgery.
Resuming Physical Activities
A balance between rest and exercise is the key to a successful home recovery. A slow increase in your activity will help promote healing and rebuild your body tone and strength. You should expect to be able to resume many or all of your normal routines within a short time period.
While you are staying at South Texas Health System Heart you will be receiving activity instructions from the nurse practitioner, staff nurses and/or cardiac rehabilitation nurses. Because individual needs vary, we will work with your doctor to develop a plan just for you. This plan will help you increase your activity level while you are home. Following are guidelines to follow. You should not vary from these guidelines unless your doctor, nurse or therapist has said to do so in your rehabilitation plan.
- Try to get at least eight hours of sleep each night.
- Get out of bed, get dressed daily and plan your daily schedule.
- You may shower. Have someone nearby the first few times to help you in case you feel weak of dizzy. You may want to place a stool in the shower stall until you feel stronger. Avoid very hot water. Use mild soap for washing. The incisions may be gently washed, but not rubbed.
- Plan one or two rest periods each day, especially during the first week or two at home.
- When at home, lay down and raise your legs above heart level to help reduce swelling. Do not cross your legs since this reduces blood flow. Avoid standing for long periods of time.
- You can climb stairs when you go home, although you should proceed slowly. Avoid excess trips up and down the stairs. Try to limit yourself to two or three trips per day for about one week after surgery.
- You may engage in light household chores such as cooking, washing dishes, dusting and desk hobbies. If you are unsure about a certain activity that you would like to continue at home, ask your doctor or nurse.
Take a Walk
A short walk is a great way to speed your recovery. Early on, avoid steep inclines and temperature extremes (below 35 degrees and above 90 degrees), as they put added strain on your heart. Walk during the cooler part of the day in the summer and the warmer part of the day in the winter. Enclosed shopping malls are a good place for walking when the weather is bad. Walking daily is encouraged. Distance covered should be slowly increased over time.
If you cannot follow the walking schedule below, proceed at a pace that is best for you with a slow increase in distance. To be helpful, exercise must be brisk, sustained, and performed on a routine basis.
Brisk — raises your heart rate and breathing rate.
Sustained —15-30 minutes or exercise without a break.
Routine — daily if able to, but at least three times per week. Your cardiologist will discuss the need for a cardiac rehabilitation program with you after you are home.
- You may have visitors when you go home but don't tire yourself. You should limit visits to one or two per day for 30-45 minutes until you feel well enough for longer visits.
- You may go for short trips (i.e. to a friend's house, to dinner, to a house of worship, or to a store) so you are not confined to your house.
- You may have questions about having sex after surgery. If you feel good and you are rested, then your sexual activity does not need to be restricted. You may feel that certain positions are more comfortable than others. As a rule, you can resume sex when you are able to climb two flights of stairs or walk three blocks briskly without problems.
- Use the incentive spirometer while you are home during waking hours. Use it once an hour for the first week, once every two hours for the second week, and three times a day for the third week.
Activities to Avoid after Heart Surgery
- Do not drive a car. Your reaction time will be slowed, and you must avoid danger of re-injuring the breastbone while it is healing. You will be able to resume driving when cleared by your surgeon. You may ride in a car with your seatbelt on.
- Do not lift, carry, push or pull items weighing more than five to ten pounds, such as a heavy shopping bag, suitcase or small child. You should avoid strenuous exercise, such as swimming, jogging, biking, bowling, tennis and golf for three months after surgery. No arm exercises, rowing machines or arm cycling is allowed during this time.
- Do not do heavy house and yard work such as running a vacuum, mopping or scrubbing floors, mowing the lawn, raking, digging or chopping wood. These chores will strain your chest and upper arms and will affect proper healing of the breastbone.
- Do not return to work. After your follow-up visit, your doctor will discuss your return to work. Many factors will be discussed - the type of work you do, your physical state, and the results of your follow-up examinations. If your job does not involve heavy lifting, you may be able to return to work in about three months, as long as you are healing well.
Taking Care of Your Incisions
As you heal, your incision will look better and the soreness will go away. Changes in the weather, too much or too little activity and sleeping in one position too long can cause this soreness. You may also feel numbness or itching or see redness or swelling, which will also stop with time. Take special care of your incisions with by doing the following things.
- Wash gently with mild soap during your daily shower. Dry carefully with a towel. Pat it dry; Do not rub the incision.
- If you have seri strips (small pieces of white tape) over your incision, you must remove them after you have been home for seven days. If the strips come off on their own, you may leave them off.
- If your incisions are puffy, have areas of redness, are oozing, or begin to open slightly, call your surgeon.
- Women should wear a bra. A good support bra will reduce the tension placed on the incision. If the bra bothers you, you may put a small piece of gauze under the bra for added comfort.
- For discomfort or soreness, you may use a heating pad. Apply it four or five times per day on the low setting for about 20 minutes each time. If needed, take Tylenol or another pain medication prescribed by your doctor.
Common Symptoms After Heart Surgery
After heart surgery, many people often have symptoms that will improve with time, such as:
- Clicking or rubbing of the breastbone with movement or breathing. After you have completely healed (about three months) this often stops.
- Swelling or knot-like lump at the top of your chest incision. This often goes away in six to eight weeks.
- Aches between your shoulder blades, over the ribs, in the back of the neck, chest or leg incision. This may last for many weeks and lessen with time.
- Tingling or numbness in your elbow or fingers. This may be due to the way your arm was placed during surgery.
- Slight swelling in your legs, which lasts four months or more. Keeping your legs up above heart level when sitting and sleeping will help this problem.
- Weakness and hoarseness in your voice may be present because of the breathing tube that was in place during and after surgery. This improves in a couple of weeks, although it may last longer.
- Constipation is a common problem and can be controlled with a mild laxative or diet changes. Increasing your daily routine, eating more fresh fruits, vegetables and other high fiber foods often helps.
- Difficult time sleeping while you are in the hospital and also at home. Some common reasons are lack of exercise, a decrease in your daily routines, anxiety about surgery or being at home, family matters, depression and incision pain. Try to decide what may be causing your sleeping problem and talk to your doctor about ways to resolve this.
- Numbness and soreness on the side of your chest where the internal mammary artery is located.
Most patients need medications while they are healing. Before you are discharged from the hospital, your doctor will prescribe medications for you to take home. Do not take any of the medications you were using before surgery unless you are told to do so by your doctor. Do not increase, decrease or stop the amount of your medications without your doctor's advice. Once your prescriptions are written, one of your nurses will discuss each medication with you and give you a schedule. Keep your schedule on the refrigerator or another visible place and bring it with you when you visit your doctor.
Reasons to Call Your Doctor
If you feel any of these symptoms, report them to your doctor or nurse:
- Palpitations or a heart rate greater than 120 beats per minute when you are at rest, or a change from a regular to an irregular pulse.
- Increased fatigue or shortness of breath at rest.
- Temperature greater than 101 degrees more than one time, or chills for 24 hours.
- Excessive redness, swelling, soreness or drainage from any wound site.
- Swelling in your ankles and hands with a weight gain of two or more pounds in one day or five pounds in one week.
- Abnormal pain or other symptoms that do not go away with your medication.
- Pain in the calf of your leg.
We will want to see you for a follow-up visit in about three to four weeks after discharge. If your appointment is not made for you before you go home, be sure to call the doctor to schedule one. A report of your operation and your progress will be sent to your family doctor. You should also schedule a visit with your cardiologist and family doctor after you are home.
Having heart surgery demands special care during your hospital stay and at home. To ease your return home, we have reviewed many topics and concerns that you may be faced with. Before you leave, you will be given the right phone numbers to call with questions or concerns. Remember to keep these numbers handy in case you need them. And finally, remember these last few pointers and things should run smoothly when you return home.
- Use common sense in planning activities.
- Listen to your body, if you are tired, rest!
- Set goals you can reach.
- Pace yourself according to your own abilities.
- You are not alone out there, call us if you think we can help.