Cardiac (Heart) Surgery

Basildon and Thurrock University HospitalsNHS Foundation Trust

Cardiac (Heart) Surgery

Contents Page

Welcome 3

Your heart and how it works 4

Reasons for needing heart surgery 5

Possible complications following heart surgery 6

Preparing for your operation 9

Tubes and lines 13

Recovering after your operation 14

Leaving hospital 15

Arriving home 16

Contact details 24

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3

Welcome

Welcome to The Essex Cardiothoracic Centre.

This booklet aims to give you, and your family and friends,information about what cardiac (heart) surgery will involve. Itprovides a general guide of what will happen, but, as everyone isdifferent, your care will be tailored to your individual needs.

The team of staff who will be looking after you will includedoctors, ward nurses, critical care nurses and physiotherapists,supported by a large number of other staff.

Each member of the team involved in your care will be happy toanswer your questions and deal with any worries you may have. Ifthere is anything that you do not understand please do nothesitate to ask.

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Your heart and how it worksThe heart is a muscular pump. The right side of the heart receivesblood from the body and pumps it to the lungs, where the bloodpicks up oxygen that you have breathed in. The left side of theheart receives this oxygen-rich blood from the lungs and pumps itto all parts of the body. This is a continuous process.

The valves separate the different chambers in the heart, so that the blood flowsin the correct direction.

Major arteries and veinsof the heart

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1. Aorta2. Right Coronary Artery3. Left Anterior Descending

Coronary Artery4. Circumflex Coronary Artery5. Left Main Coronary Artery

1. Aortic valve2. Mitral valve3. Pulmanary valve4. Tricuspid valve

The valves of the heart23

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Reasons for needing heart surgeryCoronary Artery Disease The heart muscle (myocardium)receives its blood supply from thecoronary arteries. Sometimes thesearteries can become narrowed wherefatty deposits are gradually laid downinside them. This is known as coronaryartery disease or atherosclerosis.

As the coronary artery becomesnarrowed, the blood supply to themyocardium is decreased. Whendemand for oxygen-rich blood isgreater than the supply, angina painarises from the muscle.

If the coronary artery becomescompletely blocked, usually by a bloodclot where the artery is narrowed, a heartattack (myocardial infarction) occurs.

The narrowing of your artery will beidentified by a coronary angiograminvestigation, performed by yourCardiologist.

A Coronary Artery Bypass Graft(CABG) operation can be carried out torelieve angina and reduce your risk ofhaving future heart attacks.

During the CABG operation extra bloodvessels are sewn to your narrowedarteries to ‘bypass’ the narrowed areaand bring blood to your heart muscle.There are ‘spare’ arteries inside thechest wall and the forearm, and spareveins in the legs which can safely beremoved. All these can be used toconstruct excellent bypass grafts.

Bypass surgery for coronary arterydisease is very effective. Most patientsfind that their angina goes awaycompletely following surgery, andsome patients experience improvedfunction of the heart muscle.

Heart Valve DiseaseThe heart pumps blood continuouslyaround the body. Within the heart arefour valves that ensure that the bloodflows the right way. Sometimes one ormore valves can become damaged ordiseased. They may not open properlyand obstruct the blood flow (valvestenosis) or they may not closeproperly allowing blood to leak back(regurgitation or incompetence).These problems place an increased strainon the heart. They are often recognisedby tiredness and/or breathlessness whenyou exercise, although sometimes thereare no symptoms, but a heart murmurmay be heard by the doctor. Withouttreatment the heart muscle can becomepermanently damaged.The most common valves to beaffected are the aortic and mitralvalves. The affected valves are eitherreplaced or repaired.If you are having an operation on yourheart valve it is very important that yourteeth and gums are healthy. This isbecause infected teeth and gums cancause the new heart valve to becomeinfected. Please ensure that you see adentist regularly – we will have alreadyasked your dentist for informationabout your dental treatment. Youroperation may be delayed if you needdental treatment as this will need to becarried out before your operation.Some patients need both valve andcoronary artery bypass graft surgery atthe same time. The average stay in hospital followingheart surgery is 5 – 10 days. Howeverthis stay may be a short as 4 – 5 daysdepending on your recovery.

Possible complications followingheart surgery

InfectionIn every kind of operation there is a riskof infection in the wound. The risk of aninfection in your wound following heartsurgery is about 1-2%. It is also possibleto get other infections. Chest infections(such as pneumonia) can occur and it isimportant that you breathe deeply,cough (supporting your chest) and havephysiotherapy to ensure that this doesnot happen. Urinary tract (‘water works’)infections can also occur, and these areeasily treated with a course of antibiotics.

Abnormal heart rhythmAround 1 in 4 patients may develop anabnormal heart rhythm after theirsurgery. This is called ‘atrial fibrillation’(or ‘AF’ for short). The heart beatsquite quickly and irregularly.Sometimes patients feel unwell whenthis happens, while others don’t realiseanything is wrong. Do not worry if thishappens to you, as it is not a risk toyour life. It is easily treated in mostcases, with tablets which you will needto take for six weeks. If your heart is ina normal rhythm when you are seen inthe outpatient clinic following yoursurgery, you will be advised to stoptaking the tablets.

A few people remain in AF despitetreatment. If this happens there is a

small chance of blood clots forminginside the heart so we will start you onthe blood thinning medicine calledWarfarin. This takes a couple of daysto work. Once a regular dose ofWarfarin has been established you maygo home. You will be seen by yourcardiologist a few weeks later, whenthey will check to see if you are still inAF, and give you appropriatetreatment. If you have reverted to anormal rhythm, then you will be ableto stop taking the Warfarin tablets.

Some people have a very slow heartrhythm after the operation and mayneed a pacemaker temporarily. If theheart rate does not pick up, we may askyour cardiologist to see you to considerputting in a permanent pacemaker. Thisis very rare after a CABG operation, butmore common after valve replacement.

Renal FailureYour kidneys are very sensitive organs andmay not work properly after your surgery.This is particularly the case if you havehad kidney problems in the past. Oftenthe problem will resolve after a few daysbut occasionally dialysis treatment may beneeded for a short time. The vastmajority of patients do not have thisproblem and you will be told if the risk isgreater in your particular case.

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The risks from having your heart operation will have beendiscussed with you when you met the surgeon in the outpatientclinic. Your surgeon will discuss them with you again when youmeet them the night before your operation. Complications after an operation are always a possibility. These areexplained below.

BleedingThis is a relatively common complicationand affects about 5% (1 in 20) ofpatients. Heart operations involve a lotof stitching around many blood vesselsand it is possible for a ‘leak’ to developafter the operation. Also, to stop yourown blood clotting in the tubing ofthe bypass machine we have to thinyour blood. This, together with someof the effects of the bypass machine,means that some people will haveexcessive bleeding after the operationas their blood will not form clots. Thisis one of the things we will watch forafter the operation.

If there is excessive bleeding from thechest tubes after the operation, wemay try giving medication to help theblood clot, to try and stop thebleeding. This often works but it maytake a few hours to become effective.

If the bleeding continues, we mayneed to take you back to the operatingtheatre for another operation to lookat the heart and see if we can find anexplanation for the bleeding. This isseldom life-threatening and usuallytakes about one or two hours. You willbe asleep under the originalanaesthetic while all this is going on,but it is important that your relativesare aware that it is a possibility. Wewill contact them if this becomes aproblem and let them know if we needto take you back to the theatre.

StrokeThe operation may lead to a stroke. Thismay leave you with a weakness downone side and/or speech problems.Many people recover fully (with time)after a stroke, while unfortunatelyothers are left with some weakness.

Strokes are a result of many things butare usually caused by microscopicfragments of the hardened arteriesbecoming dislodged during theoperation and travelling to the brainwhere they cause the stroke. Wealways do everything we can tominimise the chance of this happening.

Elderly patients, those who have had aprevious stroke and those with carotid(neck) artery disease are at most risk ofa stroke. In otherwise fit patients therisk of stroke is about 1-2%. The riskmay reach 10% for patients in a highrisk group.

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MAJOR COMPLICATIONS

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Heart attack

Sometimes a heart attack can occureither just before or during heartsurgery. Usually the heart attack is smalland of no consequence, but sometimesthey can be large and may significantlyweaken the heart muscle. This maycause problems when you are on theCritical Care Unit after your operation.You will be carefully monitored for thispotential complication. About 5% (1 in20) patients have a heart attack aroundthe time of surgery.

Death

With any heart operation there is thepossibility that the operation may leadto your death. This occurs in 1or 2 inevery 100 patients needing a non-urgent, non-complex, operation. If theheart has been weakened by previousheart attacks, or if other proceduressuch as a valve replacement need to bedone, then the risks increase. Theymay be as high as 10-25% in the mostcomplex cases.

We have a risk prediction calculator(called the Euro Score) which gives arough idea of the risk from youroperation. This is the figure yoursurgeon will quote you for theapproximate risk of your operation.

Please try and remember that the riskof major complications following yourheart operation is low, and themajority of patients are fine followingtheir operation.

Possible complications followingheart surgery

Preparing for your operation

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Living a healthier lifestyleThere are certain things that cancontribute to the development ofcoronary heart disease. If you haven’talready taken steps to change yourlifestyle it is important to start now,remember it is never too late to start.By altering some of the things you do,not only will you be preventing furtherheart disease, but you will beincreasing the speed of your recoveryand increasing the chances of yoursurgery remaining effective.

• SmokingIf you continue to smoke your anginawill get worse and you increase therisk of having a heart attack. Smokingbefore the operation will increase therisk of developing complications after,such as a chest infection. It will alsoreduce the longer-term benefits ofyour heart surgery.

• High blood pressure(hypertension)Having high blood pressure increasesthe workload on your heart. Beforeyour operation you must:

- Continue to take the medicationyour doctor has prescribed.

- Continue to go to your GP/Practicenurse for your regular checkups.

• OverweightBeing overweight:

- Increases the workload of the heartand puts it under unnecessary strain.

- Causes undue stress and pressure onwounds leading to delayed healingand increased risk of woundinfection.

Before your operation you should:

- Eat a healthy balanced diet. If youneed help and advice to lose weight,your GP will help and may refer youto a dietician.

- Avoid fatty foods such as fried foodsand full fat dairy products. Theseincrease your cholesterol levels andspeed up the rate at which yourcoronary arteries fur up.

- Eat low fat foods such as fruit,vegetables, chicken and fish.

• High cholesterolIf you have high cholesterol, followthe healthy diet advice and continueto take your cholesterol loweringmedication.

• DiabetesIf you are diabetic, continue to takeyour medication (if you are on any)and continue to go to your regularcheck-ups to control your bloodsugar.

Things you can do in the time leading up to your operation

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Preparing for your operation

• StressExperiencing prolonged periods ofstress can be harmful not only foryour heart but also for your generalhealth. Being stressed increases yourblood pressure and heart rate. Try toidentify what makes you stressedand try to avoid those situations.

• ExerciseThe heart is a muscle and, like allmuscles, it needs to be exercised tohelp it remain healthy. Try to dosome form of exercise each day. Ifyou do suffer from anginaremember to take your GTN spraywith you.

• AlcoholIt is well known that a little alcoholmay help to prevent heart disease,however drinking too much cancontribute to ill health. There is noneed to stop drinking before youroperation, as long as you rememberto stay within the recommendedunits of alcohol per week, which are:

• Men 21 units per week= 101/2 pints

• Women 14 units per week= 7 glasses of wine

• Things to bring with youWe recommend that you bring aminimal amount of belongings withyou. Here is a guide of what youneed while you are in hospital.

• Night wear • Toiletries• Towel • Slippers• Dressing gown • Books, magazines etc• Loose change • Drinks

Please do not bring large sums of moneyor valuables into hospital with you.

The length of time people need to stayin hospital after heart surgery varies.This can be due to many reasons suchas your age, the type of operation thathas been performed, your generalhealth and how well you recover fromthe operation. The average length ofstay is 5-10 days.

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Arrival at the hospital

You will be introduced to your nursewho will show you around the ward,introduce you to other members ofstaff and show you to your bed. Theywill take some details and will behappy to answer any questions thatyou may have. If you have anyallergies, it is important that you letthem know. You will be fitted with awristband with your details on. This isso that staff can identify you correctlyand give you the right care. It isimportant that you do not remove ituntil you go home.

You may need to have some routinetests, such as

• Blood tests• A recording of your heart (ECG)• A chest x-ray• Weight and height

Your nurse will ask you some questionsand explain the operation to you. Youwill be asked to sign a consent formfor your operation.

All patients admitted to the ward will bescreened for MRSA. MRSA is carriedharmlessly by many people on their skinand in their noses without causing anyinfection. If MRSA spreads to a woundor into the bloodstream it may cause aninfection that requires treatment withantibiotics. For this reason, all patientsare screened before their operation. IfMRSA is found, you will be asked to usea special wash gel and also a cream tobe applied inside the nostril.

You may find time to meet otherpatients on the ward. You may find itvery reassuring to talk to others eitherwaiting to have their operation, orthose who have already had surgery.

Before your operationYou must not eat anything for sixhours before your operation. You maydrink water up to two hours beforethe operation.

After you have showered you will beasked to change into a gown whichfastens at the back. Please removeyour underwear, jewellery, make upand nail varnish. Your property mayneed to be locked away, and theproperty policy will be explained to you.If you have a large amount of money,this will be sent to the cashier’s office.

Immediately before your operation youwill be asked to remove any excessbody hair from the places where theoperation will be done. A nurse willhelp you with this.

You will be seen by your consultant whowill ensure that you fully understandwhat will happen during youroperation. A nurse or doctor will behappy to discuss any last minutequestions or worries that you may have.

The anaesthetist will prescribe a pre-medication for you approximately twohours before the operation, which willmake you feel sleepy. After taking thismedication you will need to stay onthe bed until you are taken to theatre.

When you arrive at The Essex Cardiothoracic Centre, you will beadmitted to Chelmer Ward.

You will be taken into the anaestheticroom where you will be met by youranaesthetist along with othermembers of the theatre team. Anarterial line (a small plastic tube whichgoes into an artery in your wrist) willbe inserted so that your blood pressurecan be monitored during theoperation. You will also have a dripthat will be used for the anaesthetic tobe given.

After being attached to an ECGmonitor, you will be given oxygenthrough a facemask for a couple ofminutes before being given the drugsthat will make you go to sleep. Whenyou are deeply asleep, a breathing tube,another drip to allow drugs to be givenand urinary catheter will be inserted.

During the operationYou will be taken to the operating theatre on your bed.

After the operationAfter your operation you will be taken to the Critical Care Unit –Colne Ward. Colne Ward is a specialised critical care unit forpatients who have either had, or are about to have, heart surgery.

Many patients experience someanxiety during their stay in the criticalcare unit, which can be noisy and busy.The nurse responsible for your care willtry and reassure you and explain whatis happening to you.

All patients arrive back from theatrewith unfamiliar equipment, drips,tubes and drains. This is entirelynormal, and allows the nurse lookingafter you to monitor your progress.There are also machines which havealarms. Please do not be upset bythese noises which help the nursingstaff to monitor you.

After your operation you will remainconnected to a breathing machine(ventilator) by a tube that goes intoyour lungs via your mouth. As soon as

you are settled into the unit and yourcondition is stable you will be wokenup from the anaesthetic and you willstart to breath for yourself. When youare ready, the breathing tube will beremoved. Once the breathing tube isremoved you will be given oxygen via aface mask and later via your nose untilyou are able to manage withoutadditional oxygen.

Once the nurses have made youcomfortable, your relatives may wishto see you for a short while. Visitorsshould remember that you will need torest and will be sleeping off theanaesthetic.

You will probably need help from thenursing staff for the first few hoursafter your operation.

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Chest drainsAt the end of your operation yoursurgeon will have placed a number(usually between two and four) ofchest drains around the heart andlungs. These are to allow any bloodfrom inside the chest to be drainedout, preventing the heart from beingcompressed with a build-up of fluid.These chest drains will be removed assoon as bleeding is minimal.

Arterial lineThis is a small plastic tube which goesinto an artery in your wrist, to measureyour blood pressure. Care is neededas these needles, if knocked, cancause bleeding.

Central venous lineThis is a plastic needle that goes into alarge vein in your neck or below yourcollarbone. It is used to monitor thefluid levels in your body, or to give youmedication or fluids.

Urinary catheterThis is a tube that goes into yourbladder. This allows the nurses tomonitor your fluid output, and you willnot need to get out of bed to passwater. It is usually removed within aday or two.

Intravenous dripThis is a small plastic tube into one ofyour smaller veins, which is used togive you fluid drips and medication. Itis usually in the back of your hand, andcare should be taken not to dislodge orknock the tube.

Oxygen saturation probeThis is a small peg-like device clippedto your finger, which reads the level ofoxygen in your blood.

Other equipment includes: Infusion pump This is a machine that gives small orlarge volumes of medication and fluidswhen needed.

Monitor This provides a constant reading ofyour heart rate, blood pressure, oxygensaturation and temperature. It has anumber of different alarms that assistthe nursing staff who continuallyassess the information it provides.

ECG dots These are sticky pads that are placedon your chest which are connected vialeads to the monitor. These pick up theheart rate and pattern and display thereading on the monitor.

Ventilator This helps you breathe when you areunable to do so for yourself. Thismachine also has a number of differentalarms.

Temporary pacemaker This is a box that is connected to a wirewhich goes through the skin and ispositioned within the chest. This wiremay be used instead of drug therapyto increase your heart rate.

All these drips and drains will beremoved over the days following youroperation. Your level of care will thenbe reduced as your condition improvesand you become more independent.

Tubes and Lines

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PainIt is important that after your operationyou remain as pain-free as possible. Ifyou are experiencing any pain you shouldtell the nurse looking after you, who willdo their best to relieve it with suitablepain relief. Remaining pain-free will helpyou to do the breathing exercises thatthe physiotherapist will teach you.

PhysiotherapyYour physiotherapist and the nursingstaff will advise you and assist you withyour recovery. You may be surprisedhow quickly you will be able to get upand walk after the operation. It is thisactivity that is the key to regaining yourstrength and independence. In mostcases you will be helped to get out ofbed, take a few steps around the bedand sit in the chair on the first day afteryour operation.

By the second day you should be able totake short walks around the ward withsomeone to assist you.

By the third day you can usually walkaround the ward independently. Yourphysiotherapist and nurse will beguiding you to make sure that you arewalking enough to increase yourstrength without over-doing it.

On the fourth or fifth day, you should beable to climb stairs. This may sounddaunting but it does get easier everyday, and early activity reduces the risk ofcomplications following an operation.

You will also be shown some exercises topractice to get your shoulders, chest andback moving freely after the operation.

Cardiac RehabilitationYou will also see a nurse from theCardiac Rehabilitation Team. They willdiscuss lifestyle changes and your futurerecovery with you, and answer anyquestions or worries that you may have.This is called Phase I rehabilitation.

They will also ensure that you arereferred to your local cardiacrehabilitation centre, who will contactyou when you leave hospital (this is callesPhase II rehabilitation). Most hospitalsoffer a structured education and exerciseprogramme that you can attend atapproximately eight weeks after yoursurgery. (this is phase III Rehabiliotation).

Eating and drinkingYou may lose your appetite for a whileafter the operation. This is quitenormal and should improve graduallyover time.

Wound careAll patients will have a chest wound,and for those patient having CABG, aleg and/or arm wound where thesurgeon has taken a vein or artery tomake the grafts. These wounds will beregularly inspected and new dressingsapplied as required. You will also haveto wear elastic stockings on your legsto prevent blood clots.

Transfer to Chelmer WardYou will be seen daily by nurses, doctors, anaesthetists andphysiotherapists and your progressclosely monitored. As soon as you arewell enough you will be transferred toChelmer Ward.

After the operationRecovering after your operation

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Before you are able to go home youmust be able to:

• Walk around the ward withminimal assistance.

• Wash and dress yourself withminimal assistance.

• Safely undertake two flights ofstairs (depending on your mobilitybefore surgery).

Planning for your going home startedas soon as you were admitted, so thatarrangements could be put in place forwhen you are well enough to leave.You will also want to discuss your planswith your family or the people whohelp and support you.

You will usually be told at least 24hours before you are able to go home.However, the final decision will dependon up-to-date results such as blood,x-ray and ECGs.

You will need to arrange to be collectedfrom The Essex Cardiothoracic Centre.We recommend that a friend or relativedrive you home if possible. You will needto wear a seat belt on the way home,and may find it more comfortable tohave a soft blanket or pillow betweenyour chest and the seat belt.

Before you leave hospital, you shouldmake sure you have:

• A supply of tablets.

• The letter for your family doctorinforming them of your recentoperation and recovery. Whenyour medication has run out, youwill need to go to your GP whowill prescribe further supplies.

• Attended a discharge talk ordiscussed any questions that youmay have with a member of staff.

• The time and date of your nextblood test if you are takingWarfarin

• The time and date of youroutpatient appointment.

• Seen a member of the CardiacRehabilitation Team.

Leaving HospitalFollowing heart surgery it will take some time before you are wellenough to do everything for yourself.

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You may feel tired when you gethome. This is quite normal and youshould rest when you feel you need to.

A nurse will contact you approximatelytwo weeks after you have returnedhome to answer any questions youmight have. If you have any non-urgent queries or need some advice orreassurance in the first few weeksfollowing your return home please callChelmer Ward on 0845 155 3111ext 4370, or the Cardiac RehabilitationTeam on 0845 155 3111 ext 4076.

How you will feel when youreturn homeThe first few days at home can feel abit strange as you adjust to being backin your home environment, and a newdaily routine. You may worry abouthow you are feeling, both physicallyand emotionally, and about whatactivity you should be doing. This isnormal. The information belowexplains what you should expect.

• PainWhen you leave The EssexCardiothoracic Centre, you will begiven a supply of pain relief tablets.You should take these until you feelthat the pain is easing, and then slowlyreduce them. You may still be takingthe odd dose after about six weeksand this is perfectly fine.

If you have had vein grafts taken fromyour leg(s) you may find that youexperience some discomfort andswelling in your legs and ankles for a

few weeks. Taking pain relief, puttingyour legs up on a stool while sitting, andnot crossing your legs, may relieve this.

Pain relief can cause constipation. Ifthis is a problem, make sure that youdrink plenty of fluids and eat foodswhich contain fibre. Do not stop takingyour pain relief. If you remainconstipated, please contact your GP.

• Looking after your woundIt can take 2 – 3 weeks for your woundto heal. It is very important that you lookafter your wound carefully. Use a mirroror get a member or your family to checkyour wound daily. Some swelling aroundthe wound is perfectly normal andshould settle down after a few weeks.

It is very important that if you noticeany oozing or inflammation from on oraround any of your wounds that youcontact Chelmer Ward as soon aspossible and they will advise you aboutwhat to do. This is to detect and treatany infection at an early stage.

Although showers are preferred it isperfectly safe to have a bath. Avoidusing bath salts, oils or lotions. Do notrub soap directly onto your woundarea until it is well healed. You shouldavoid using talc. There is no need foryou to cover the wound unless yourdoctor or nurse tells you to.

There are wires in your chest to helpyour breastbone to heal. You will betotally unaware of these wires. They donot rust and will not set off airportsecurity systems.

Arriving homeYou will need to arrange for somebody to be with you for the first24 hours after returning home.

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The stitches in your main surgicalwound will dissolve on their own. Anyother stitches will be removed beforeyou go home, or arrangements madeto have these removed following yourreturn home.

Numbness around the scar is verycommon and will start to settle after afew weeks.

• MedicationYour medication may have changedsince your operation. You may need tostop taking some of your previousmedication, and you may need to starttaking some new medication.

This will be discussed with you. Youwill be given a letter to give to your GPthat lists all of the medication you areon, and the doses.

If you have any questions about yourmedicines, please contact your GP.

Warfarin patientsPeople who have had an operation onthe valves of their heart usually needeither short or long term anti-coagulation treatment with drugs suchas Warfarin. You may take Warfarin forreasons other than heart valve surgery.This will have been discussed with youwhen you started on the medication.

If you are on Warfarin you should nevermiss a dose. If you accidentally forgetto take your medication you shouldnever double the dose, but do tell thedoctor at your next appointment. Ifmore than one dose is missed pleasecontact your GP as soon as possible.

You may be asked to return to ChelmerWard after your discharge for bloodtests, so that the dose of yourmedication can be adjusted until yourclotting levels are stable.

Aspirin and other medications such asantibiotics can affect the clotting ofyour blood. DO NOT take these unlessprescribed by your GP, who should thenadjust your anti-coagulant dose.

In the event of severe bleeding,bruising or illness contact your GP, NHSDirect or local Accident & EmergencyDepartment.

• Support stockingsThese stockings are worn to promotegood circulation in the legs, preventingblood clots from developing within thefirst few weeks following surgery. It isimportant that these stockings are puton correctly i.e. they are wrinkle free andclean. Due to the physical effort neededto put them on, you should havesomeone to help you.

• Dental careIf you have had valve surgery, regulardental check ups are very important.This is because bacteria from the teethand gums can cause the new heartvalve to become infected. It isimportant that before any dentaltreatment, your dentist knows whattype of surgery you have had andwhether or not you are on Warfarin.

The dentist should ensure that youhave antibiotics before the treatmentand may wish to check with your GP orhospital before starting any treatment.

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• Eating and drinkingIf your appetite has not returned tonormal by the time you return home,try and eat small amounts ofnourishing foods often. This willpromote both your recovery and aidwound healing. You should expectyour appetite to return to normalwithin one month of your operation.Once your appetite has returned, youshould aim to eat a healthy, wellbalanced diet.

• AlcoholKeep within the maximumrecommended limits. Do not save allyour units to drink on one occasion.

If you are taking Warfarin, you candrink but keep within the maximumrecommended limits. Drinking inexcess can seriously affect the action ofWarfarin which can cause veryunpleasant side effects.

• Avoid ConstipationFollowing surgery you may havedifficulty opening your bowels, a fewtips to help prevent this are:

• Eat a high fibre diet to includeplenty of fruit and vegetables

• Drink lots of fluids• Keep active by taking regular walks

When on the toilet, try not to strain asthis may put extra pressure on yourheart and your chest wound.

Sometimes pain relief medication cancause constipation. Do not stop takingthe pain relief. If you are still in pain,constipation can easily be remedied

with mild laxatives from your pharmacy.

• Moods and emotionsDuring the first six weeks followingyour operation you can feel emotionaland unusually irritable. It may alsoaffect other members of your family,especially those closest to you. Thesefeelings will usually pass after a fewdays, so please do not be worried. Youand your family have been through aparticularly stressful experience sopatience, understanding andconsideration for each other will beessential. Please discuss your feelingswith your partner and be honest witheach other.

If you continue to feel emotional andare concerned, please speak to your GP.

• Other symptoms you maynotice

Previous cardiac patients have alsonoticed other symptoms followingtheir operation, which include:

• Strange taste in mouth• Blurred vision• Sense of smell becoming stronger

or lost• Loss of concentration• Sweating• Muffled hearing• Alternating between feeling hot

and cold• Hoarse voice• Disturbance of your sleep pattern• Hair loss

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Arriving home (continued)

These are usually temporary and goaway after a few days or weeks,however if you continue to haveproblems or are feeling undulydepressed let your GP know.Alternatively you could speak withyour Cardiac Rehabilitation Nurse.

• ActivityYour aim over the next couple ofmonths should be to increase youractivity week by week. This will improveyour well-being and your recovery.

Everybody recovers at a differencepace. Take the activity at a gentler pacefor a while. If you feel comfortable,keep going.

You should rest when you are tired.

Normal sexual activity may be resumedafter about four weeks. If you find thatcertain positions cause discomfort toyour chest area, try different ones. If youfeel uneasy about sex, allow more timefor hugging and getting to know eachother again. Take it at your own pace.

Week 1• Shower and get dressed.

• Continue to take your pain relief.

• Spend your first 2 or 3 daysadjusting to being at home, andthen start taking regular walks.

• Always allow yourself time to warmup before walking and cool downafterwards. You can do this bywalking at a slower pace forapproximately five minutes beforeand after a brisk walk. Walk 15minutes in total.

Week 2• Introduce light housework such as

dusting or drying up dishes whenyou feel fit and able.

• Daily Walk – 20 minutes walk twicea day.

Weeks 3-8• If you feel ready you may introduce

some light gardening, such asweeding.

• Daily walk – gradually build up from 25 – 40 minutes once or twice eachday.

Weeks 8-12• You may start to introduce more

strenuous housework such asvacuuming or carrying theshopping.

• You may now start to lift heavieritems as you feel able.

• You may introduce more strenuousgardening activity, such as mowingthe lawn and digging, as you feelable.

• Do not walk your pet if they arelikely to ‘pull’ as this will strain yourchest wound.

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FlyingIt is safe to fly to any destination 10days following your operationprovided that you have had nocomplications. Each airline has its ownprocedures so you will need to discussthe situation with them. However, itmay be better to leave going onholiday until at least six weeks afteryour operation as you will then getmore out of your time away.

Driving You should not drive for at least sixweeks after your surgery. You do notneed to inform the DVLA about youroperation unless you hold a LGV orPSV Licence.

You are strongly advised to inform yourinsurance company about the surgery.This will avoid problems with anyclaims that you may make in thefuture. The British Heart Foundationcan be contacted for an up to date listof insurance companies that aresympathetic to those with heartproblems.

Returning to workMany factors influence when youreturn to work. You should discuss thisin detail with your GP and with yoursurgeon when you have youroutpatient appointment at The EssexCardiothoracic Centre. It may be thatyou can return to work within 10 – 12weeks depending on your job.

Other activity

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21

Information Page

This page can be used to note down any information that you may find helpful.For example you may want to make a note of the name and dosage of any newmedication, any special instructions for your first few weeks at home, or thedetails of your treatment.

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Information Page

Chelmer Ward0845 155 3111 ext 4370,or ask for Chelmer Ward

Colne Ward0845 155 3111 ext 4272,or ask for CTC Critical Care Unit

Cardiac Rehabilitation Team0845 155 3111, ext 4076, or ask forCardiac Rehab Team

Additional Information is available from:

British Cardiac Patient Association2 Station RoadSwaveseyCambridgeCB4 5QJEmail: enquiries@bcpa.co.ukTelephone: 0800 4792800 (free of charge)or 01954 202022 (Telephone and fax number).Website: www.bcpa.co.uk

British Heart Foundation14 Fitzhardinge StreetLondonW1H 6SHTel. 020 793 50185Heart Information Line: 0845 070 8070Website: www.bhf.org.uk

Essex Cardiac Network(details of local support groups in your area)01206 288 231www.essexcardiacservices.nhs.uk.

NHS DirectProvides health advice and information0845 46 47www.nhsdirect.nhs.uk

Who to contact

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Basildon University HospitalNethermayneBasildonEssex SS16 5NL0845 155 3111

Minicom01268 593190

Patient Advice and Liaison Service(PALS)0845 155 3111 ext 8536pals@btuh.nhs.uk

This booklet can be provided in a different format (e.g. large print or audiocassette) on request.

www.basildonandthurrock.nhs.uk

The Trust will not tolerate aggression, intimidation orviolence directed towards its staff.

Our hospitals are a Zero Tolerance zone. Zero Tolerance means ridding the NHS of intimidationand violence directed towards its staff.

This is a smokefree Trust. Smoking is not allowedin any of our hospital buildings or grounds.

Main Car Park

Main Hospital

CTC Car Park

MainEntrance

Basildon

A13

Drop-off Point

A130

A127

A13

Basildon University Hospital

and The Essex

Cardiothoracic Centre

A176

A176

A176

London

London

Southend

Chelmsford

FiveBells

Billericay

A12

London

A12Colchester