This checklist will help you to prepare for cardiothoracic surgery. Use the checklist and write down your questions so we can answer them when you return to the hospital for your surgery. If questions need an answer before surgery, please call us during office hours.
We operate in several different hospitals. If you are being admitted the morning of surgery we will give you instructions as to where and when to report, usually the hospital admissions office. During your surgery, we would like your family members to wait in the surgical waiting room so that we may send word out regarding the progress of your operation and so that we may visit with them when the procedure is concluded.
When your operation is over, persons having heart surgery or lung/thoracic surgery will go to the Surgical Intensive Care Unit. It may take an hour or more before your family is able to see you following your surgery. Your family will have an opportunity to speak with a member of the surgical team following your surgery. If you live outside the San Antonio area, you will need to make arrangements for lodging the night before surgery.
- Do not eat or drink anything (including water) after midnight the night before your surgery except that you may drink a small amount of water with medications you were instructed to take on the morning of your surgery. You may brush your teeth and/or gums. Rinse your mouth with mouthwash or water, just do not swallow any liquids.
- Please, No alcohol consumption 24 hours before surgery.
- If you have not stopped smoking, you should do so at this time. Smoking makes it more difficult for you to cough and clear your lungs of secretions after the operation.
- If you are taking Coumadin, Plavix, Persantine, Ticlid, and/or Aspirin product, your doctor will advise you to stop taking the medication several days prior to your surgery.
Heart, coronary artery bypass surgery patients should continue taking their Aspirin as ordered.
- If you are diabetic and take Metformin, you should stop taking the medication 2 days prior to your surgery date. Your primary care physician may wish to prescribe some other diabetic medication for you to take during this period.
- Continue to take all your other regular medications as ordered. Bring your medications or a list of your medications including the dosage and when you take them with you to the hospital on the morning of surgery. This will allow the nursing staff to correctly record all medications that you normally take at home.
- Practice getting in/out of a chair, bed, toilet with arms hugged around a pillow across chest.
- Women (having heart surgery) should bring a bra a size or two larger around the chest than normal (cup size as normal), soft elastic, no under wire. We recommend Playtex Eighteen-Hour Posture Bra. It should be given to your nurse in the Surgical Intensive Care Unit to be worn immediately after surgery.
- Pack loose fitting clothes/pants with elastic waist and button or zippered top/shirt such as a sweat suit. These clothes are to be brought to the hospital after you have been transferred to the cardiovascular step-down unit or progressive care unit (usually day following surgery).
- You will be given Hibiclens surgical soap in which to take a shower at home the evening before and the morning of your surgery. Take a 10-minute shower, wash well from head to toe (including your hair, beard, etc.), do not apply any creams, lotions, powders, hairspray, etc. after the shower. Do Not shave any surgical areas. Male patients should shave their face/neck. You do not have to shave off your beard or mustache.
- For patients having surgery involving a specific side, (such as lung surgery on the left side), after your shower, mark the surgical site (right or left) with a permanent marker, with your initials.
- Remove all jewelry before surgery and leave at home. If you are unable to remove rings, we have special equipment to cut the ring. Rings are a hazard after heart surgery because of the normal swelling that occurs, especially in fingers.
- We encourage you to limit visitors to close family members during your hospital stay. We suggest you request that friends and extended family wait to visit until after you return home.
- If you get a fever, cold/flu, rash, or feel as if you have any type of infection call your doctor. Surgery may need to be postponed.
- Heart surgery patients will take the following medications one time a day for two days prior to surgery:
Vitamin C 2 Grams (1,000 mg = 1 Gram)
Vitamin E 400 Units
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.
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.
DO NOT lift more than 10 pounds for six weeks, such as: lifting children, suitcases, large purses, boxes, groceries, garbage, tools, pets, etc.
DO NOT push or pull anything
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.
DO NOT hold your breath
DO NOT hold your breath during strenuous activity, especially when exercising, lifting or when using the restroom.
Getting out of bed
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.
DO NOT drive any type of automobile
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.
DO NOT climb on ladders or step stools
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.
DO NOT keep your arms extended above your head
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.
DO NOT engage in any sport or activity
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.
DO NOT engage in strenuous work
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.
Avoid excessive straining during a bowel movement
Avoid excessive straining during a bowel movement. Use a laxative and /or stool softener if necessary.
Sexual activity can usually be resumed after two to four weeks
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.
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
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.
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.
Avoid extremes of heat or cold
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.
When you exercise
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.
Each exercise session should begin with a warm-up-stretching
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.
Do not eat large meals
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.
Check with your doctor
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.
Persons with claudication
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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Limit visitors or visits to how you feel. Never hesitate to excuse yourself and rest when you become tired.
- 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.
- 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.
- Your doctor can advise you on the best plan in returning to work. Usually 4-6 weeks following surgery.
- 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.
- 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.