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More Info
									        After
  heart surgery
- information and advice
   to aid your recovery




Department of Cardiology
Contents                                                 Page

Introduction                                             2
Your information                                         3
The Cardiac Support Service                              5
The Cardiac Support Team                                 5
Going home                                               6
Emotional adjustment after heart surgery                 6
Advice for family and friends                            7
Care of your chest wound and healing of the breastbone   7
Looking after leg and arm wounds                         8
Pain relief                                              8
Heart rate and rhythm, breathing                         9
Physical activity after heart surgery                    10
Some exercises you can do at home                        11
Resuming activities at a glance                          13
Resuming sexual relations                                14
Sleeping, tips to help you sleep and relax               15
Appetite, bowels, alcohol                                16
Driving and travelling after heart surgery               17
Returning to work after heart surgery                    18
If you have had valve surgery                            18
The future – controlling risk factors                    20
Exercise                                                 21
Healthy eating to help your heart                        22
Losing weight, watching alcohol levels                   24
Medication                                               25
Your medication                                          26
Questions                                                27
Useful contact details                                   28




                                        2
Introduction
This guide aims to give practical information and advice to people who have had heart
surgery. It will answer some commonly asked questions about your recovery but the
staff are also happy to talk to you directly if there are things you don’t understand or if
you have any questions that aren’t included in the booklet. There is a blank sheet on
page 27 where you can write down any questions that you would like answered.

Everyone is individual and will have a different recovery experience after surgery. For
this reason it is important not to compare yourself to others, as everyone recovers at a
different rate.

It is a good idea to keep this booklet with you when you visit your GP or attend an
appointment at the hospital. It contains helpful information and has spaces to keep
records of any tests you may have, such as blood pressure readings, cholesterol
checks etc.

We hope you make a speedy and straightforward recovery.




                                             3
Secondary prevention record
Date     Smoking   Blood      Weight   Cholesterol   Alcohol     Daily
                   pressure                          units per   activity
                                                     week




                                  4
The Cardiac Support Service
Our aim is to assist and support you in your recovery from heart surgery. We are here to
answer your questions, deal with concerns and allay any anxieties you may have about
your recovery. We will contact you in the first few days after you have been discharged
from hospital, on receipt of your referral from your Surgical Centre. We will call again
after a couple of weeks, to offer assistance with any recovery issues you may have.

During our contact, you will be invited to attend the Cardiac Exercise Programme
based at the Royal Berkshire Hospital. The exercise programme helps people to build
confidence and stamina and learn correct levels of aerobic exercise for health benefit.
This course tends to be popular and there is a waiting list. If you are interested in
attending, please discuss this with us.


The Cardiac Support Team
The team consists of specialist nurses who have experience of all aspects of the
aftercare of cardiac surgery. At present, the Cardiac Support nurses are Sam Blues
and Juliet Weller.

The team are based at the Royal Berkshire Hospital and can be contacted on
telephone number:

                                   0118 322 6638

If you reach the answer phone, please leave your name, date of birth and telephone
number and we will endeavour to call you back the same day or the next working day.

You can write to the team at:

Cardiac Support Centre, Royal Berkshire Hospital,
London Road, Reading RG1 5AN.

PLEASE NOTE THAT IF THE CARDIAC SUPPORT SERVICE IS NOT AN
EMERGENCY SERVICE. IF YOU HAVE AN URGENT MEDICAL
PROBLEM IT IS IMPORTANT THAT YOU CONTACT YOUR GP DIRECT.

The Cardiac Support Centre is open Monday – Friday
Monday – Thursday        09.00am – 5.30pm
Friday                   09.00am – 2.00pm




                                            5
Going home
Going home after heart surgery is always a big step on the way to getting better. It is
usual to feel apprehensive about leaving the carefully monitored environment of a
hospital ward, but you should be reassured by the knowledge that you will have been
carefully reviewed by doctors to ensure that it is the right time for you to go home.

For the first week or two we recommend that you have someone with you at home to
provide support while you are adjusting to the home environment.

As soon as you return home you should inform your GP and arrange an appointment
with him/her for a repeat prescription of the medication you are on. A letter will have
been sent to your GP from the hospital with details of your hospital stay and medication
requirements.

After heart surgery it will take a while to feel like yourself again or to feel the benefits of
having the surgery. Don’t expect too much out of yourself in the early days just
because you are now at home. Remember to be patient and to take things easy. You
may find it a help to talk to someone who has been through a similar experience. An
organisation called Heartbeats has support volunteers who are good listeners and can
provide additional support – their contact details can be found on page 28 of this
booklet.


Emotional adjustments after surgery
Having heart surgery is a major life event and your body and mind need time to re-
adjust to what has happened. It is not unusual to have fluctuating moods in the first few
weeks following surgery. Sometimes, people feel euphoric; more often they feel tearful,
irritable, low, anxious or frustrated. These feelings are sometimes described as ‘post op
blues’ and usually pass quickly. Remember they are a natural reaction to what you
have been through and a way of coming to terms with the experience.

Sometimes it may seem that your progress is unbearably slow and that you will never
get back to normal. It is important to be realistic and to keep things in perspective.

• Plan your day and keep occupied. Resume hobbies or take up new ones. Maybe
  plan a holiday and exercise regularly according to the guidelines on page 21 of this
  booklet.
• Set attainable targets to help build your confidence. Reward yourself with a small
  treat when your targets have been achieved.
• Listen to your body. Make sure you rest when you feel tired and allow time for
  relaxation.
• Talk to your family and friends about how you are feeling. You and your family have
  been through a particularly stressful time, and understanding and consideration for
  each other will be essential.




                                               6
Advice for family and friends
It is important that you and your family work together to help your recovery. This does
not mean that your family should overprotect you or ‘wrap you in cotton wool’. Having
your activities restricted can lead to frustration due to a feeling of loss of independence.
Use the guidelines in this booklet as an indicator of when it is okay to progress to the
next stage of recovery. Discuss and plan this with your family. If you are unsure, you
can always contact your Cardiac Support nurse.


Care of your chest wound
Your chest wound will heal and the stitches dissolve between two and three weeks
after the operation. You should allow healing to happen naturally and there is no need
to apply any unprescribed ointments. If the wound does not need a dressing, it is okay
to get it wet whilst bathing or showering, but do not soak it.

You may have a small amount of clear discharge from the wound. This is normal and
nothing to worry about. However, it is important to contact your GP if the discharge
persists and/or the wound appears red, hot, painful, swollen, open or smells offensive.

Some people find that the ends of the stitches appear through the skin. These often fall
out of their own accord. If they do not, they are best removed by a nurse or doctor.

The wound may feel itchy and some people find that their clothes touching the chest
may feel unbearable. Some women find that wearing a bra is too uncomfortable. Try to
persevere with a soft cropped-top as this will offer some support for the healing wound.

Some people experience areas of numbness along the wound. This is usually due to
minor surface nerve damage. The area of numbness often gradually reduces and
disappears over a period of three months. If it persists unchanged after this time, the
numbness may be permanent.

Many people have a lump at the top of their chest wound. This will flatten down fairly
quickly and is nothing to worry about. Scar tissue may seem very noticeable at first but
this will also lessen over time and will eventually fade.


Healing of the breastbone
Your breastbone can take up to three months to heal. It has been wired together with
stainless steel wires (these do not affect airport security systems). The muscles and
soft tissue across the chest wall can take between three and six months to heal.
Therefore, it is important not to place any undue strain on the chest wall by pushing,
pulling, lifting or carrying anything heavier than a full kettle of water for two to three
months after your operation. You should not attempt to lift heavy weights until at least
six months after your operation and we advise that people with heart conditions do not
lift heavy weights at any time.




                                             7
Looking after your leg wound after coronary artery bypass surgery
Your leg wound may take longer to heal than a chest wound – between four and eight
weeks. It can often feel quite sore around the knee and ankle. Swelling of the leg
around where the vein has been stripped is also quite common. This happens because
the veins are responsible for returning fluid to the circulation and one of the veins is
now missing. Eventually, other veins will take over and the swelling will go down.
However, a few people are left with continuing slight leg swelling and your doctor may
prescribe either water tablets or support stockings to ease your symptoms. There are
some simple things you can do to help the healing process:

• When you are sitting down, elevate the affected leg on a stool and do not cross
   your legs.
• Wear loose socks and shoes.
• Do the following calf exercises while you are resting – point your toes to the floor
   and then up to the ceiling. Repeat five times every hour.

If you experience pain, tenderness or redness with the swelling, you should make an
appointment with your GP as soon as possible as these are symptoms of deep vein
thrombosis (DVT).

You may experience numbness along the leg wound. This usually reduces after three
months. However, some people are left with a small area of permanent numbness due
to nerve damage.


Looking after your arm wound
Arm wounds usually take less time than leg wounds to heal. Some people can
experience numbness in the affected hand which can take a while to resolve. Again, for
some people, there may be an area of permanent numbness.




                                            8
Pain relief
During surgery bones, muscles and soft tissues get pulled and stretched. Because of
this, people may experience discomfort for several months after the surgery. Pain is
commonly experienced in the chest wall, shoulders, neck, back and affected arm or
leg.

Good pain control is essential to aid recovery and it is important not to allow pain to
slow down your recuperation by limiting your mobility or disturbing your sleep.

When you are discharged from hospital, you should have received a supply of tablets
for pain relief. In the first couple of weeks, it is important that you take these on a
regular basis as this is the key to effective pain control. You may reduce the amount of
painkillers you are taking at your own discretion but remember not to be too hasty as
everyone’s pain threshold is different. It is a good idea to take the tablets at night and in
the morning for as long as you feel necessary.

If you find that the painkillers are not adequate and you are still uncomfortable, contact
your GP as effective alternatives are usually available. You should also contact your
GP if you experience any unpleasant side effects from the painkillers, such as
constipation or light-headedness.

In the first few weeks after your operation, you may find it helpful to use a rolled-up
towel to hug if you need to cough or sneeze. The physiotherapy exercise on pages 11
and 12 of this booklet will also help chest wall flexibility and assist in relieving undue
tension and pain.

Some people may experience shoulder damage as a result of their operation. If you
find that your shoulder is very painful and that the movement in your arm is restricted,
contact your GP as you may need to see a physiotherapist.


Heart rate and rhythm
Your body often produces more adrenaline for the first few weeks following heart
surgery. This can cause your heart to feel like its is beating harder and faster than
usual. Some people feel a pounding in their temples or in their chest wall, which can be
worrying. This is entirely normal and slowly gets back to normal with time and
increasing amounts of physical activity. Some people experience a heart rhythm
disturbance called atrial fibrillation following heart surgery. This is normally detected
whilst you are in hospital and is very easily treated with short-term medication. If you
experience palpitations after you have been discharged from hospital, it is important to
discuss this with your GP and the Cardiac Support nurse.


Breathing
It is common to feel slightly breathless in the early stages after heart surgery. This is
because your lungs have been deflated and handled during the operation. This can
cause a small amount of fluid to build up in the lung linings. Your diaphragm can also
be shunted upwards resulting in a decreased lung capacity. You may be a little
anaemic as a result of your surgery, which can also cause breathlessness. All of these
conditions can take up to 12 weeks to settle completely.


                                              9
You should continue with the deep breathing exercises that you have been shown by
the physiotherapist for at least two weeks after the surgery. They will help you to expel
secretions, which may have built up in your lungs. Walking will also help you get rid of
lung secretions and will encourage your lungs to expand.

Some people experience an occasional involuntary extra breath or gasp while the
respiratory muscles are getting back to normal. This will disappear with time.

If you find that your shortness of breath is not improving with time, or has got worse, or
if you start to produce green/yellow or dark coloured sputum, you must inform your GP
straight away.




                                            10
Physical activity after heart surgery
It is important to gradually increase regular walking distances, duration and intensity
now that you are home from hospital. Physical activity will speed up your recovery.
However, you should rest for two or three days when you arrive home, before starting
your walking programme.

Do

• Start off slowly and on the flat. Warm up and cool down (see note on exercise on
   page 21 of this booklet). If you live on a hill, reduce the distances recommended.
• Be realistic. Set achievable targets.
• Listen to your body. It is normal to feel slightly hot, sweaty and short of breath whilst
   exercising. However, if you are so short of breath that you can’t speak, you are
   working too hard and need to slow down.
• Have someone to accompany you and stay within easy reach of contact until you
   have regained your confidence.
• Remember, however far you walk in one direction, you have to walk the same
   distance back so don’t overdo it.

Don’t

• Exercise for at least two hours after a heavy meal.
• Exercise during illness or if you have an infection.
• Exercise if you experience chest pain, undue breathlessness, palpitations or
  dizziness. Contact your GP if you experience any of these symptoms.
• Compare yourself to others. Everyone’s recovery rate is different!

Distances

Week 1:       Start by walking 200-300 metres. Stop after every 100 metres, rest for a
              minute and check how you are feeling. If you feel comfortable, it is fine to
              continue. Increase that distance gradually so that by:

Week 4-6:     you are walking about one mile (it usually takes 20 minutes of walking
              briskly to cover one mile).

Week 8:       You should be aiming to walk two miles a day.


Remember, these are guidelines and not instructions. You may have physical
restrictions which prevent you from following the levels outlined above. If so,
keeping as active as possible within your limitations will also speed your
recovery. If in doubt, ask your Cardiac Support nurse for advice.




                                            11
Some exercises you can do at home
All these exercises are to ease and prevent stiffness in the joints following heart
surgery. You should perform them twice a day and continue to do them until you feel
they are no longer helpful (for approximately 4-6 weeks). Perform all the exercises
slowly. If you feel pain whilst performing an exercise, stop.



For your shoulders
‘Windmills’. Stand up and take both arms up
straight over your head. Swing them forwards ten
times then backwards ten times. Then swing once
forwards followed by once backwards and do this
ten times. Swap directions and repeat ten times.




                    2. ‘Morecambe & Wise’. Stand up and
                       place the palm of one hand behind
                       your head and the other up your
                       lower back. Swap arms quickly. Do
                       this ten times.




                             Stand up and stretch both arms
                             out to the side. Swing them up
                             above your head. Repeat this
                             ten times.




                                            12
For your neck

  1. Sitting. Look up to the ceiling and then down to
     the ground. Repeat this five times




                    Sitting. Turn your head to look over
                    your right shoulder, then turn your
                    head to look over your left
                    shoulder. Do this five times to each
                    side.

                                     3. Sitting. Keeping your
                                        shoulders still, take your
                                        right ear towards your
                                        right shoulder. Then take
                                        your left ear towards your
                                        left shoulder. Repeat each
For your upper                          movement five times on
                                        each side.
body



                         1. Sitting. Bending at the waist only,
                            stretch one hand down the side of the
                            chair whilst stretching the other arm
                            over your head. Repeat on the other
                            side. Do this ten times on each side.




                                 2. Sitting. Twist to look over
                                    your right shoulder whilst
                                    swinging your right arm
                                    around as you turn.
                                    Repeat on the other side.
                                    Do this ten times on each
                                    side.




                                              13
Resuming activities at a glance

General activities
Getting dressed           Straight away
Climbing stairs           Straight away – take it steady
Receiving visitors        Straight away – don’t be afraid to tell them that you need
                          to rest if you feel tired
Having a bath or shower   Straight away if the wounds are healed. Don’t strain to
                          get out of the bath – you may need help to start with
Driving                   See the note on page 17 of this booklet
Household tasks
Cooking                   Straight away – don’t lift more than half a saucepan full of
                          water for the first 12 weeks
Dusting                   At 2 weeks
Hoovering                 Not for 8 weeks – leave it 12 weeks if you are still sore
                          across your chest wall
Mowing the lawn           Not for 8 weeks – leave it 12 weeks if you are still sore
                          across your chest wall
Digging                   Not for 8 weeks – leave it 12 weeks if you are still sore
                          across your chest wall
Decorating                Not for 8 weeks – leave it 12 weeks if you are still sore
                          across your chest wall
Shopping                  Don’t lift heavy shopping baskets for at least 12 weeks
Sport
Golf                      12 weeks
Racket sports             12 weeks
Bowls                     12 weeks
Fishing                   12 weeks
Swimming                  12 weeks – do not swim in cold water or jump off high
                          diving boards and make sure your wounds are healed
Bike riding               12 weeks
Contact sports            6 months
Squash                    6 months (ask your Cardiologist first)
Heavy weight lifting      Not advised




                                         14
Resuming sexual relations after heart surgery
Sex is a natural and normal part of a loving relationship and can be expressed in many
ways such as cuddling and caressing. Initially, you may have no desire for intercourse.
Don’t worry as this is normal after heart surgery. It is important not to resume sexual
relations until both you and your partner feel ready. Good communication between you
and your partner is essential as you may both have anxieties around the issue of sex.
Remember not to feel too upset if things are strange or difficult at first. Take your time,
talk to each other, start with cuddles first and develop things when you both feel ready.

It is safe to resume sexual activity whenever you feel ready. In energy terms, sex is the
equivalent of walking up two flights of stairs at a moderate pace, and does not put
undue strain on your heart!

Do

•   Find a time when you won’t be interrupted.
•   Ensure that the room is warm.
•   Choose a position which feels comfortable.
•   Choose a time when you and your partner are feeling rested and relaxed.

Don’t

•   Rush.
•   Expect too much at first.
•   Attempt it if either of you is feeling anxious or tense.
•   Attempt it straight after a heavy meal.


Sleeping
Some people find that their sleep pattern has been disturbed following heart surgery.
This can be due to being unable to settle in your usual position caused by discomfort,
altered activity levels or anxiety.

Some tips to help you sleep
• Ensure that the bedroom is the right temperature.
• Make sure the room is adequately dark.
• Reduce background noise as much as possible.
• Position yourself comfortably, propping yourself up with pillows if necessary.
• Try to limit your caffeine intake throughout the day and have your last drink at a
  sensible time (not after 7pm). Try camomile tea.
• Do not exercise for at least two hours before going to bed.
• Have a warm bath a few hours before settling – try a couple of drops of lavender oil
  in the bath water.
• It may be a good idea for you to take some pain relief tablets before settling – this


                                              15
should make you more comfortable and relaxed.




                                    16
Relaxation technique

• Make sure there will be no interruptions.
• Lie on your back on the bed, with a rolled-up towel beneath your knees.
• Take a deep breath in through your nose and sigh out – repeat this twice.
    Concentrate on your breathing for the rest of the relaxation – you should feel your
    tummy gently rising and falling in a steady, slow rhythm.
•   Point your toes to the ceiling and release – repeat this twice.
•   Tighten your thigh muscles and release – repeat this twice.
•   Tighten your buttocks and release – repeat this twice.
•   Push the small of your back gently into the bed and release – repeat this twice.
•   Stretch your finger tips to your knees and release – repeat this twice.
•   Raise your arms above your head and slowly glide them back down to your side –
    repeat this twice. Try and rest your arms with your elbows slightly away from your
    body. Your fingers should be in a soft curl and not tensed or gripped.
• Gently lift your head off the pillow to look at your toes and then gently let your head
    move back – repeat this twice.
• Open your mouth wide and release – repeat this twice.
• Lift your eyebrows up to the ceiling and release – repeat this twice.
• Gently close your eyes and listen to some soothing music for five minutes. You may
    find that it helps to concentrate on something that gives you pleasure, such as a
    holiday, a poem or a prayer.

If you find that your sleep problems persist and you are feeling exhausted during the
day, you may want to talk to your GP about a short course of night sedation to break
the pattern.


Your appetite
You may find that you don’t have much of an appetite in the early period after your
operation. This is usually due to the effect of the anaesthetic. If this is the case, you
may find it helpful to have five or six light snacks during the course of the day instead of
three large meals. Try to eat food that is easy to digest and supplement your diet with
soups and build-ups if needed. After an operation, food plays an important part in
tissue healing and warding off infection. For this reason it is not a good idea to
contemplate a diet in the first six weeks of recovery. After this time, a low fat diet is
advisable.




                                             17
Your bowels
You may experience some constipation after the operation. This can be due to a
combination of change in diet, limited mobility and painkillers (co-dydromol often
causes constipation). Try to make sure that you are drinking plenty of fluid, eating
plenty of fruit and vegetables and walking around on a regular basis. You may be
prescribed some laxatives to help with constipation. If you have not had your bowels
open for three days, we advise you to contact your GP. If you feel that the painkillers
are causing your constipation, speak to your GP about finding an alternative painkiller.


Alcohol
It is advisable to limit the amount of alcohol you drink to one or two units a day for the
first six weeks of recovery. This is because alcohol can interact with some of the
medication you may have been prescribed, such as painkillers, night sedation,
warfarin*).

*People taking warfarin can drink a small amount of alcohol on a regular basis. Binge
drinking should be avoided as it will affect your blood clotting time.


Driving after heart surgery
After heart surgery, bones, muscles and soft tissues need time to repair. Muscular
strength and flexibility will be diminished. Some people experience blurred vision and
lapses in concentration. For these reasons, your cardiac surgeon will want to review
you in the clinic at your six-week post-operative appointment, before giving you the all
clear to drive. It is fine for you to travel as a passenger until this time. If you find that
wearing a seatbelt presses on your wound and is uncomfortable, try using some light
padding between your chest or shoulder and the seatbelt.

If you hold an ordinary driving licence, you do not need to inform the DVLA that you
have had heart surgery. However, you may need to inform your motor insurance
company, as failure to disclose this information may render your insurance invalid.
Read the small print that comes with your policy for specific details.

If you hold a LGV (for vehicles exceeding 3.5 metric tonnes) or a PCV (for vehicles with
more than eight seats) licence, you will need to inform the DVLA that you have had
heart surgery. Their address is:

DVLA
Swansea
SA99 1TU

You will only be allowed to re-licence if you are angina free, complete a successful
exercise test and if your Cardiologist sends a satisfactory report to the Department of
Transport.

Taxi drivers
If you are a taxi driver you will be governed by guidelines from your local council. You
will need to contact them for details. The office covering the Reading area is at:


                                              18
West Berkshire Occupational Health Department
21 Craven Road
Reading RG1 5LE

Pilots
If you are a licensed pilot you will be expected to fulfil the requirements set out by the
Aviation Authority.

Flying as a passenger
If absolutely necessary, it is physically safe to fly as a passenger approximately 10
days after your surgery. However, it can be difficult to get holiday insurance for the first
six months following your surgery. Your Cardiac Support nurse will have a list of travel
insurance companies who are sympathetic to heart patients. These companies have
been recommended by previous patients and the Heartbeats Support Group.

When you are flying, remember to take regular walks around the cabin. Do calf muscle
exercises (pointing toes to ceiling and then down to the floor), avoid alcohol and drink
plenty of fluid.


Returning to work after heart surgery
If you have a job which is not too physically demanding, it is often possible to return to
work 6-8 weeks after your operation.

If your job is very physically demanding, we recommend you wait at least 12 weeks
before returning to work, and only then if it is possible for you to negotiate light duties
for the first three months following your return.

You should talk to your Cardiologist and GP to decide when it is most appropriate for
you to return to work. The ward sister/charge nurse will issue you a sick certificate for
the time you spend in hospital and you can obtain subsequent sick certificates from
your GP.


If you have had valve surgery
If you have had valve surgery, you will be at increased risk of developing endocarditis
(infection of the heart, which if left undetected or untreated can be very serious) unless
you take simple precautions. These include making sure your teeth and gums are as
healthy as possible and visiting your dentist on a regular basis.

You should have been given a card titled ‘Infections and your heart’. You must take this
card with you to show your dentist or doctor if you require any dental or surgical
procedures. The card outlines which antibiotics are necessary, before the procedure, in
order to prevent increased risk of endocarditis.




                                             19
Symptoms of endocarditis
If you experience a high temperature, extreme tiredness or general lethargy, it is
important that you report this information to your GP straight away. The Cardiac
Department will want to see you promptly if you have an unexplained illness or
breathlessness.

Warfarin
If you have had a mechanical/metal valve, it will be necessary for you to take warfarin
for life, in order to prevent blood clots forming on the valve. Before your discharge from
hospital, an appointment will be made for you at the Anticoagulant Clinic in the Royal
Berkshire Hospital. The Clinic will be able to help you to monitor and maintain your
warfarin levels.


Do

• Keep your Anticoagulant Clinic appointments.
• Inform your GP of unusual bruising/bleeding.
• Remind your doctor or dentist that you are taking warfarin, especially if you need
    additional medication, surgery or dental treatment.
• Take your warfarin tablets at the same time each day.
• Ensure that you have an extra blood test for warfarin five days after you have been
    started on a course of antibiotics.

Don’t

•   Miss a dose.
•   Take an extra dose.
•   Run out of tablets.
•   Take any other drugs without consulting your GP first. Many drugs interact with
    warfarin. If you wish to take ‘over the counter’ preparations, discuss this with the
    Pharmacist.
• Go on crash diets or start binge eating.
• Drink more than moderate amounts of alcohol on a regular basis. Binge drinking
    can be dangerous.


The future – controlling risk factors
For people who have had coronary artery bypass surgery in order to alleviate the
symptoms of coronary heart disease, controlling risk factors for heart disease will help
to preserve the grafts and slow the disease process.

There are risk factors for heart disease that cannot be changed, such as age,
hereditary factors and gender. There is, however, a lot of evidence that shows that
addressing modifiable risk factors can improve your future progress.



                                             20
21
Stop smoking!
•   Smoking doubles your chance of having a heart attack.
•   Smoking increases your heart rate and blood pressure.
•   Smoking makes your blood more likely to clot.
•   Smoking speeds up furring of the arteries.

There is help available to help you give up smoking. Your GP may run help groups or
ask your Cardiac Support nurse for advice. Or contact one of the following:

NHS Smoking Helpline 0800 169 0169
Ray Foan (a local free service from your NHS) 0118 322 8163.


High blood pressure
High blood pressure can prematurely age blood vessels making them thickened and
fragile. The heart becomes thickened and muscular, which can cause the heart to tire.
You should have your blood pressure checked every year or more frequently if you
have had high blood pressure.


Blood fats
Your cholesterol and triglyceride levels should be well controlled. For someone who
has had coronary artery surgery, it is recommended that cholesterol be below 5mmols
and triglyceride be below 1.5mmols. Your Cardiac Support nurse will arrange for you to
have a ‘fasting lipid profile’ (blood test) to look at your blood fats 12 weeks after your
coronary artery surgery. The result would be inaccurate if the blood test was done any
sooner than this.

It is recommended that you stick to a low fat diet in the long term. See the advice on
page 22 of this booklet. If your blood fats are elevated, it will often be necessary for you
to take medication to control them.


Exercise
Exercise is important as it can help you to:
•   Reduce high cholesterol levels.
•   Control your blood pressure.
•   Maintain a healthy weight or help you lose excess weight.
•   Alleviate stress.
•   Improve your physical fitness and stamina. Exercise can also increase your energy levels.
•   Improve your suppleness, posture, co-ordination and reflexes.
•   Increase your lung expansion and lung function.
•   Improve your muscle tone and bone density.
•   Increase the efficiency of your heart muscle.



                                               22
It has been demonstrated that 30 minutes of aerobic exercise five times a week can
dramatically improve quality of life and increase your life expectancy.

You should always warm up with some light activity for 10-15 minutes before doing
aerobic exercise as it takes this long for blood to be diverted to the heart muscle and
the exercising muscle groups. At least 20 minutes should be spent exercising at a brisk
pace (you should feel slightly hot, slightly sweaty, slightly short of breath, but able to
hold a conversation – if you are speechless whilst exercising, you are working too
hard). You should spend at least 5 minutes cooling down (ending slowly) after the
aerobic exercise and should never stop exercising suddenly.

Good examples of aerobic exercise are: brisk walking, swimming, riding a bicycle,
supervised gym sessions.


Remember not to:
• Exercise for 2 hours after a heavy meal.
• Exercise during illness or if you have an infection.
• Exercise if you have chest pain or undue breathlessness, palpitations or dizziness.
     Contact your GP if you have these symptoms.
• Compare yourself to others. Everyone is different and has different levels of fitness.


Healthy eating to help your heart
Improving your diet can help to prevent the progression of heart disease. It does this in
several ways:

1.   It reduces the tendency for blood to clot.
2.   It provides protective nutrients for your heart.
3.   It reduces bad cholesterol levels.
4.   It helps reduce weight if you are overweight.

It is important to eat a healthy balanced diet, choosing a variety of different foods at
each meal.

Fruit and vegetables
You should eat at least five portions of fruit and vegetables a day.

A portion is:
•    A whole fruit
•    3 tablespoons of vegetables (raw or cooked)
•    1 glass of fruit juice
•    1 large slice of melon

Fruit and vegetables protect you in two ways: they provide vitamins and minerals which
can protect your heart by working as antioxidants – antioxidants mop up damaging



                                               23
cells in our bodies; and they are a source of fibre, which has been shown to help
reduce cholesterol levels.

Fish
Fish is a good source of protein and is low in saturated fat. Both white and oily fish are
a good healthy alternative to red meats. Try to eat at least three portions of fish every
week. Oily fish, such as sardines, mackerel, salmon and pilchards, contains Omega-3
fat – this has been shown to reduce the tendency for blood to clot. Try to eat around
100g (4oz) oily fish at least twice a week.

Meat
Red meat is high in saturated fat so try and reduce your intake of this. Chicken and fish
are good alternatives and with all meat, choose lean cuts and remove any visible fat
and skin. Try to avoid processed meat and meat products which will be high in fat.

Beans, pulses, lentils and soya
These are a good source of protein and fibre and are low in fat. Try to include these in
your diet.

Fats
Fat can affect your cholesterol levels and can contribute to weight gain. There are three
types of fat:
• Saturated fat
• Polyunsaturated fat
• Monounsaturated fat.

Saturated fat is found mostly in animal products and includes:
• Meat (fat and skin), lard, butter, cheese, pastry, cakes, biscuits, full fat dairy
   products, coconut and palm oil (and products containing them).

Saturated fat can increase your cholesterol level so avoid it whenever possible. Choose
low fat alternatives and try to keep cakes, biscuits and pastries to a minimum.

Polyunsaturated fat is found in pure vegetable oils, sunflower oil, margarine and oily fish.

Monounsaturated fat is found in oils such as olive oil and rapeseed oil.

There is some evidence that polyunsaturated and monounsaturated fats can help to
reduce cholesterol levels but remember all fat is high in calories and can lead to weight
gain. Cut down your total fat intake and replace saturated fat with polyunsaturated or
monounsaturated fat where possible.




                                             24
Cholesterol lowering margarines
These can be effective at lowering cholesterol levels. However, they do need to be
taken in quite large quantities to have any effect, and they are high in calories.
Therefore, they may not be suitable for weight reducing diets.

Don’t get depressed if your cholesterol doesn’t fall much with dietary control –
most of the cholesterol in the body is made in the liver and is not absorbed
through diet.

Salt
On average, most of us eat more salt than we actually need to. Too much salt in the
diet may lead to high blood pressure. Avoid using salt at the table and avoid salty food
such as bacon, ham, tinned meats, Marmite, Oxo and hard cheeses.

Aim to make dietary changes gradually, introducing the two or three most important
ones first. Don’t worry if you slip up. Just assess why and make changes to prevent it
happening in future.


Losing weight
If you are overweight, this puts an extra strain on your heart and can contribute to high
blood pressure and raised cholesterol levels. If you are overweight, cut down on sugary
and fatty foods and take regular light to moderate exercise – for example, 30 minutes of
brisk walking or swimming every day. It is important to reduce weight slowly, 1-2lbs a
week.

Remember not to try and lose weight for the first six weeks after surgery.

For more advice on loosing weight, you may benefit from seeing a dietician. Discuss
this with your GP or Cardiac Support nurse who may be able to arrange this.


Alcohol
It is important to stay within the British Heart Foundation guidelines for alcohol
consumption - 14 units a week for women, 21 units a week for men. Large
amounts of alcohol can enlarge the heart, making it weaker. It can also cause skipped
heartbeats and a fast heart rate. Too much alcohol can also make you put on weight
and increase your blood pressure.

One unit of alcohol is equivalent to:

•   ½ a pint of beer
•   1 small glass of wine
•   1 pub measure of spirits
•   1 small glass of sherry




                                           25
Medication
Listed below are a few of the medications you may be taking.

Aspirin
Aspirin makes the blood less sticky which helps prevent clots from forming.

Cholesterol lowering drugs
These drugs help lower cholesterol in the blood used alongside a healthy diet. Often
you will be advised to take these at night, ie simvastatin. After coronary artery surgery,
it is advisable for cholesterol to be below 5mmols and triglyceride (a different sort of fat
in the blood) to be below 1.5mmols. The Cardiac Support nurse will issue you with a
pathology request form for 12 weeks after your coronary artery surgery to check your
fasting lipid levels.

Diuretics
Most people following heart surgery are given a course of diuretics to help alleviate
excess body fluid. This may be a short course, for example to help alleviate leg
swelling following coronary artery surgery or a more long term therapy to help to control
blood pressure or reduce the workload from the heart.

Laxatives
People often experience constipation following heart surgery. This can be due to the
type of painkiller you have been given and/or a change of diet and limited mobility
immediately after the operation. Senna and/or lactulose may be prescribed for you to
help alleviate the constipation. This is only usually necessary for a short period of time.
Once you have started to cut back on the amount of painkillers you are taking you
should no longer need a laxative. If you experience loose bowel movements, it is wise
to stop taking the laxative. Alternatively, If you have not had your bowels opened for
longer than three days, you should contact your GP.

Painkillers
It can take three months for your breastbone to heal and six months or longer for the
muscles and soft tissue across your chest wall and shoulders to heal. Co-dydromol is
often prescribed to help alleviate discomfort. Co-dydromol contains dihydrocodeine and
paracetamol. It is important not to take other preparations that contain paracetamol
(such as cold relief powders) when you are taking co-dydromol as you may exceed the
recommended daily dose. Some people are discharged home just on paracetamol. The
benefit of this is that it does not cause constipation.

It is important to take your painkillers regularly as instructed in the early days following
surgery, as they are more effective if taken in this way. You will be the best judge of
when it is the right time to start cutting back on them. If you find that the pain control is
not effective, contact your GP.




                                              26
Warfarin
Warfarin prevents blood clots by stopping the body’s production of chemicals needed to
make clots (ie it is an anti-coagulant). More information about warfarin can be found on
page 18 of this booklet.




                                           27
Your medication

     Name                       Strength            Frequency          Classification

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20


You will receive one week’s supply from the hospital. You will need to get further a
prescription for further supplies from your GP before you run out of medication.




                                           28
Questions page




                 29
Useful contacts

Royal Berkshire NHS Foundation Trust

Royal Berkshire Hospital                          0118 322 5111
Cardiac Support team                              0118 322 6638
Cardiac reception enquires                        0118 322 6573
Dr Bell’s Secretary                               0118 322 6695
Dr Spyrous Secretary                              0118 322 5363
Dr Luxtons Secretary                              0118 322 5363
Dr Chow’s Secretary                               0118 322 6695
Dr Orr’s Secretary                                0118 322 5363
Dr McKenna’s Secretary                            0118 322 6676
Dr Swinburns Secretary                            0118 322 6695
Cardiology Outpatients                            0118 322 5274

Trust website                                     www.royalberkshire.nhs.uk

NHS Direct                                        0845 4647
NHS Direct website                                www.nhsdirect.nhs.uk

British Heart Foundation                          www.bhf.org.uk

West Berkshire Heart Support group – Heart Beats

The local heart support group hold regular monthly meetings in Reading, Earley and
Newbury. For details see Heartbeats magazine, posters or ask nursing staff for details.

Reading Branch Secretary          Isabel Jackson              0118 945 5428

Newbury Branch Secretary          Jeanne Turville             01635 861 546

Wokingham, Woodley and Earley Branch Secretary                0118 926 4260

Support Volunteer Co-ordinator                                0118 984 4758



                         Royal Berkshire NHS Foundation Trust
                                     London Road
                                   Reading RG1 5AN
                               Telephone 0118 322 5111
                              www.royalberkshire.nhs.uk

Written by: Cardiac Support Team, Feb 2003
Revised Aug 2007


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