Before you leave the hospital after heart surgery, you will be given instructions on how to care for yourself during the first phase of recovery, which lasts about six to eight weeks. Those who have had minimally invasive surgery may have a shorter recovery time.

Typical instructions include:

Care of your incision

You will be told how to care for your incision(s) before you leave the hospital. It is important to:

• Keep your incision(s) clean and dry.
• Use only soap and water to cleanse the area.
• Do not apply ointments, oils, salves or dressings to your incision unless specifically told to do so.
• Eat a healthy diet to help healing.

Call your doctor if signs of infection appear:

• Increased drainage or oozing from incision
• Increased opening of the incision line
• Redness or warmth around the incision
• Increased opening of the incision line
• Increased body temperature (greater than 101 degrees Fahrenheit or 38 degrees Celsius)
• If you have diabetes and your blood sugar levels begin to vary more than usual

Relief of pain

At first, you may have some muscle or incision discomfort in your chest during activity. Itching, tightness and/or numbness along your incision are normal after surgery. You should not have pain in your chest similar to what you had before surgery. You will be given a prescription for a pain medication before you leave the hospital.

If you had bypass surgery, you may have more pain in your legs than around your chest incision if saphenous vein grafts were used. Walking, daily activities, and time will help to lessen leg discomfort and stiffness.

Call your doctor if your sternum (breastbone) feels like it moves, or it pops or cracks with movement.

Swelling - for those with vein grafts taken from their legs

You may return home with some swelling in your legs and feet, especially if you had vein graphs taken from your legs. If you notice swelling:

• Place your feet up higher than your heart level when resting. One way to do this is to lie on your bed or couch and put several pillows under your legs. Or, you may lie on the floor and place your feet on the couch. Try this three times a day for one hour to relieve swelling. (Note- recliners do not adequately elevate your feet).
• Do not cross your legs
• Walk daily even if your legs are swollen
• Hospital support hose may be suggested

Call your doctor if swelling in your leg(s) become worse or painful and/or associated with increased fatigue and/or shortness of breath.

Medications

You may need medications after surgery. Your doctor will tell you if you need these medications until you recover from heart surgery or lifelong. Make sure you understand the names of your medications, what they are for, how often and what times to take them. Only take the medications that are prescribed when you are discharged from the hospital. Talk to your doctor before continuing any medications you were taking before surgery.  Talk with your doctor before taking any over-the-counter medications or nutrition supplements, including pain relievers and cough or cold medicines. Some over-the-counter medications may have an effect on your prescription medications and cause side effects.

Driving

Your doctor will tell you when you may resume driving, after your sternum has healed and your reflexes have improved. This usually occurs about six to eight weeks after surgery, however, you may resume driving quicker if you had minimally invasive surgery. During this time, you may be a passenger as often as you like. If you take long drives during the first eight weeks after surgery, stop every hour and walk for 5 to 10 minutes.

Return to Work

You will need to take time to recover, usually about six to eight weeks (may be earlier with minimally invasive surgery). Your doctor will tell you when you can return to work. If you have the flexibility at your job, ease back to your work schedule. If possible, start back at half-time and gradually increase back to your normal routine.

Activity

For the first six to eight weeks:

• Gradually increase your activity. You may do light household chores, but do not stand in one place longer than 15 minutes.
• Do not lift objects greater than 20 pounds (your doctor may give you a different number if appropriate). Also, do not push or pull heavy objects.
• It is OK to perform activities above shoulder level, such as reaching for an object or brushing your hair. But, do not hold your arms above shoulder level for a longer period of time.
• You may climb steps unless they have been restricted by your doctor. You may need to rest part of the way if you become tired. Do not climb up and down stairs several times during the day, especially when you first arrive home. It is better to plan activities to go downstairs in the morning and back upstairs when it is time for bed.
• Pace yourself - spread your activities throughout the day. If you become tired, rest and schedule unfinished activities for another time.
• Walk daily. Your doctor or cardiac rehabilitation specialist will give you guidelines for walking when you return home.
• Get a good night’s sleep. If you feel tired, go to bed early. Be careful not to nap too much during the day or you may have difficulty sleeping at night.
• Check with your doctor to confirm activity guidelines.

Sex

Many patients and their partners feel nervous about resuming sexual activity after heart surgery. The amount of energy it requires to perform intercourse with a spouse or regular partner is similar to climbing about one or two flights of stairs or walking about one half mile (0.8 km) at a brisk pace. If you cannot perform these activities without becoming tired or short of breath, please allow additional recovery time before resuming sexual activity. For the first six to eight weeks, use positions which limit pressure or weight on the breastbone or tension on the arms and chest.

• Keep in mind that a sexual relationship has both physical and emotional aspects
• Talk openly with your partner
• Allow a gradual return of sexual activity
• Have sex when you are rested and physically comfortable
• Create realistic performance expectations - it may take time to return to an active sex life
• Be caring honest and loving with each other

Soon you and your partner will return to a satisfying emotional and physical relationship. Anxiety on the part of either partner, as well as some medications, may interfere with sexual arousal or performance. Discuss any difficulties with your doctor.

Cardiac Rehabilitation

For many people with coronary artery disease, a cardiac rehabilitation program provides an excellent opportunity to begin an exercise program, learn about your heart disease, and learn strategies to change your lifestyle to prevent further progression of your disease.

Your family doctor can give you information about programs in your local area (cardiac rehabilitation is covered by most insurance companies) or you may go to the American Association of Cardiovascular and Pulmonary Rehabilitation website (http://www.aacvpr.org) to search for a program, or call the Cardiac Prevention and Rehabilitation program at the Cleveland Clinic Foundation 216/444-9353. Click here to learn more about choosing a cardiac rehabilitation program.

Diet

You should eat a healthy diet to help you heal. Your doctor will tell you if you should follow any special diet instructions. It is common after surgery to have a poor appetite at first. If this is the case, try to eat smaller, more frequent meals. Your appetite should return within the first few weeks. If it does not, contact your doctor.

Sleep

It is important to get enough rest or you may feel overtired and irritable. Unfortunately, many people complain of having trouble sleeping for some time after surgery. Normal sleep patterns should return within a few months. Call your doctor if lack of sleep begins causing changes in behavior or if normal sleep patterns do not return. For more tips on what to do if you cannot sleep, click here.

Emotions

It is common for you to feel sad or depressed after you
leave the hospital. These emotions may be the result of
not knowing what to expect or not being able to do
simple tasks without becoming overly tired. Temporary
feelings of sadness are normal, and should gradually go away within a few weeks, as you get back to your normal routine and activities.

Sometimes, however, a depressed mood can prevent you from leading a normal life. When a depressed mood is severe and accompanied by other symptoms that persist every day for two or more weeks, treatment
is necessary to help you cope and recover. More specific reasons to seek help include:

• You have suicidal thoughts or feelings. Suicide is an irreversible solution to problems and causes permanent harm to family members and friends. If you are having thoughts of suicide, call your physician or local 24-hour suicide hotline right away, or go to the nearest emergency room for help.
• Your negative feelings persist for any length of time.
• You don’t have anyone in whom you can confide. If you don’t have anyone to share your thoughts with, it’s hard to know if what you’re thinking makes sense.

Without treatment, depression can become worse. For heart patients, depression can contribute to an increased risk of heart attack and coronary disease. Your health care provider can refer you to a mental health specialist who can provide the appropriate treatment when necessary.

Mental Functioning and Heart Surgery

Some people become frustrated during recovery from heart surgery because they feel they are not as sharp mentally as they were before surgery. These cognitive changes are normal after heart surgery. The entire body, including the brain, was seriously stressed during surgery, especially if the surgery involved stopping the heart and circulating the blood through a heart-lung machine. With time, in most cases, normal cognitive functioning returns. Patience is needed to avoid the frustration that can accompany this side effect of surgery. You should not force yourself to work or perform mentally stressful tasks, such as balancing a checkbook in the first couple of weeks after surgery.

Follow-Up Care

A report of the surgery and your progress during your hospital stay will be sent to your referring cardiologist. Call him or her as soon as you return home to make a follow-up appointment. You will need to see your cardiologist six to eight weeks after the surgery to determine how well you
are healing. At this appointment, your doctor will give you instructions on driving, returning to work, and medications. Then, your doctor will tell you how often you should return. A plan of regular follow-up visits (at least once a year) is advised.

Be sure to follow your doctor’s guidelines on managing certain risk factors, including high cholesterol, high blood pressure, obesity and smoking. Your doctor can provide a full risk factor evaluation and a schedule for regular follow-up visits to reduce the development or progression of coronary artery disease and reduce the risk of future complications.

If you had valve surgery, you will need to take precautions to reduce the risk of infective endocarditis. This includes taking antibiotics before you undergo any procedure that may cause bleeding such as dental work, invasive tests and surgery. Your doctor will give you more specific guidelines about reducing your risk.

What is Mended Hearts?

Mended Hearts is a national volunteer support group for heart patients and their loved ones. If you would like to speak to someone who as been through heart surgery, contact Mended Hearts:

• Nationally: http://www.mendedhearts.org/* or call the American Heart Association Information Line 1-800-AHAUSA1, and ask for Mended Hearts
• Locally: http://www.mendedhearts138.org*, call 216/791-7500 or write Mended Hearts, Inc, Greater Cleveland Chapter 138, PO Box 606133, Cleveland, OH 44106

More information:

• American Heart Association
• National Library of Medicine
• Society of Thoracic Surgeons additional information

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