Cardiac Surgery

• You will be brought directly to the ICU from the operation theater. You will feel drowsy and be sedated for 4-6 hrs after the operation due to effects of anesthesia. The breathing will be mechanically assisted by a ventilator with oxygen going in through the tube. Normally, one person of the family can visit the patient in the ICU one to two hours after the operation. Many tubes will be attached to the patients body soon after the operation such as: 1. Nasogastric tube (Stomach tube): It will be put in the nose, going down into the stomach to prevent gastric distention and nausea. This tube causes no pain but may cause some post-nasal drip. The tube may be removed the next morning. 2. Breathing (endotracheal or E.T) tube: Connected to a ventilator or (breathing machine) the purpose is to ensure deep breaths and make it easier to breathe.
• When you awaken you will not be able to talk because the breathing tube goes down between the vocal cords.
• You will be able to communicate by writing notes or nodding your head. u Hands may be gently restrained to remind you not to pull tube out.
• Suctioning of the breathing tube will be done, as needed, to remove secretions and prevent pulmonary problems.
• A coughing sensation may be experienced when the breathing tube is suctioned. u The tube will be removed as soon as you are awake and breathing adequately on your own.
• Once tube is removed, your throat may be sore and you may be hoarse.
• When you cough out sputum, it may be blood tinged due to irritation from the tube. All of these conditions are temporary and normal. 3. Foley catheter: It will be inserted into your bladder while you are asleep to accurately measure and record urine output. You may still feel the urge to urinate even with the catheter. It will be removed on the 2nd postoperative day. There may be a burning sensation the first time you urinate after the Foley catheter is removed. 4. One or two tubes will be inserted in your chest at the end of the operation. The purpose of the chest tube(s) is to prevent accumulation of fluid in the chest cavity. Chest tube(s) will be gently squeezed or milked to ensure adequate drainage. When the family comes in to visit they will see drainage container at the foot of the bed with some bloody drainage in it. This is entirely normal. The chest tube(s) will be removed when the drainage stops, usually on the second day. 5. An arterial line is a soft plastic needle that is inserted into the radial artery in the wrist to monitor the blood pressure. For the first day any blood sample that are necessary for tests can be drawn from the arterial line. It is usually removed on the first postoperative day. 6. IV lines will give you fluid, medications, and blood when needed. The IVs are removed the morning after surgery. u Once fully awake, you will be taken off the ventilator and allowed to breathe on your own. The breathing mask, which supplies humidified oxygen, will still be in place on your face.
• The nasogastric tube will be removed.
• You will be taught how to perform coughing and deep breathing exercise. This exercise may seem uncomfortable but is beneficial and will not cause any damage to the heart, grafts or incisions.
• You will be turned from side to side at least every four hours to relieve pressure areas. 

• Once fully awake, you will be taken off the ventilator and allowed to breathe on your own. The breathing mask, which supplies humidified oxygen, will still be in place on your face.
• The nasogastric tube will be removed.
• You will be taught how to perform coughing and deep breathing exercise. This exercise may seem uncomfortable but is beneficial and will not cause any damage to the heart, grafts or incisions.
• You will be turned from side to side at least every four hours to relieve pressure areas.
• Clear liquids will be given several hours after the breathing tubes have been removed and then there will be a gradual progress to a regular diet.
• If the condition is stable, some of the monitoring lines will be removed. The only line left will be an IV or heparin lock.
• The chest tube(s) remains in place for 4-5 days.

• Depending on the medical condition, the following protocol will be observed on the second day.
• Once the patient acquires an appetite, he can begin to eat regular food, but the fluid intake will be limited to 6 cups (48oz.) to 8 cups (64oz.) in 24 hours.
• One of the chest tube(s) will be removed. Pain medication will be given prior to this procedure.
• You may have one or two tubes attached to a bag which can be carried.
• Foley catheter will be removed on the 2nd day after surgery.
• Chest physical therapy will begin as indicated. u After the chest tube(s) have been removed, you will be assisted out of bed and into the chair.
• One may experience tiredness and fatigue as a result of stay in the ICU. Depression and discomfort is common. But it is important to let the nurse know so that she/he can administer pain medication. If the comfort level is satisfactory it will be easier to do breathing and coughing exercise and to get out of bed and walk.
• You will be shifted to room/ward after 2-3 days depending upon surgery & recovery.

Pain

It is natural to have aches and pains after surgery. Your physician will prescribe pain medication, which should be taken when needed. The nurses will ask you if you have pain in either chest or leg incision, but it is your responsibility to ask the nurse for pain medication. A good time to request the pain medication is 15-20 minutes before beginning your breathing exercises.

Pericarditis

The pericardium is a thin lining (sac) around the heart that is opened during the surgery. Normally, there is a small amount of fluid in the pericardial sac, and the heart moves easily within it. The sac may become inflamed and irritated as a result of the surgery, and this will cause discomfort in the chest, shoulder and neck. The soreness can be mild to severe. Sweating may occur especially at night. The discomfort can increase with deep breathing, coughing, or lying down. It can be treated with one of several anti-inflammatory drugs or steroids. The discomfort subsides within a few days and the medication can be discontinued within a few weeks.

Dysrhythmias

Dysrhythmias, or irregular heartbeats, can occur after surgery in 30 % of patients & in particular old age patients. The patient may feel that his heart is racing, palpitating, or doing flip-flops. There is no need to panic. Notify the nurse. An electrocardiogram may be done and, if necessary, medication will be started.

Depression

This is a most common post-operative syndrome and can last for several days, or even months, after the operation. Sleep can be difficult in the ICU. There are noises, people and activity in the ICU 24 hours a day. You, may therefore feel tired, irritable, grumpy and even depressed. As one catches up on sleep after being shifted into the room, and the time of discharge approaches, the depression usually lessens or disappear.

Coughing

After surgery, coughing and taking deep breaths might be painful, but coughing is extremely important. Deep breathing is essential so that secretions do not build up in the lungs which could lead to a partial collapse of lungs, or even pneumonia. By coughing and deep breathing, secretions are discharged, thus keeping the lungs clear.

Bleeding

Bleeding can occur after surgery. The drainage from the chest tube(s) is observed closely for any signs of excessive bleeding. Occasionally a patient is returned to the operating room for control of the bleeding. The procedure takes about an hour. The patient is returned to the ICU. This can occur in 20 % of cases after the procedure & is normal.

The day you are transferred to the regular unit, you should walk in your room and sit in a chair two or three times. The next day, you should walk in the hallway; at first, walk with assistance until you are more steady on your feet. Do lot of exercise & physiotherapy. For the remainder of your hospital stay you should start walking more and more in the hallway. By the time you leave the hospital you may be able to walk up to one mile a day (not all at one time) and climb 7-8 steps. You may not feel like eating for a few days which is normal because of antibiotics & medicines. You will probably be ready to leave the hospital 6 to 10 days after your surgery. The remainder of your recovery will take about four to eight weeks at home.

It is extremely normal to feel anxious or depressed about leaving the hospital which has provided you with a sense of security. Do not forget, that you will not be discharged until the doctors are confident of your fitness to go home. Once home, try to resume a normal routine. It is important to arise at a reasonable time, have a bath and dress in clean clothes. This simple act will help you greatly in feeling normal and aid your recovery process.

It is advisable to discuss with your doctors the apprehensions you and your family feel. The following points need to kept in mind while going home:

• Appointments for check ups. On the day of discharge, you should fix up an appointment with your heart surgeon/cardiologist for check-ups. u The surgeon might want to see you 4 weeks post-discharge.
• Your cardiologist/family physician will be responsible after the surgeon has discharged you and the post-operative visits are over.
• You should contact the surgeon’s office, if any problems arise before the next appointment.
• Take appointments with your local doctor & family physicians after returning home.

1. Patient should maintain slightly lower than the standard weight. Accordingly, total calories should be restricted.

2. The diet should be rich in fiber including foods like raw salads, fruits, green leafy vegetables and whole grains.

3. Five servings of fruits and vegetables should be included in the diet not only to meet the nutritional requirement but also to meet antioxidants and fibre.

4. Consumption of two or more oils help in obtaining the optimal ratio of different fatty acids.

5. Inclusion of fish in the diet is beneficial as they contain omega-3 fatty acids.

6. Concentrated foods like sweets, chocolates, cakes, pastries, ice creams and fried foods should be restricted.

7. Foods giving only empty calories like carbohydrated beverages, alcohol, sugar and sago are to be totally avoided.

8. Small quantities of almond can be consumed to bring down the cholesterol levels. High amounts of nuts and oil seeds increase the calories and fat content in the diet.

9. Coconut should be avoided in the diet as it contains high amount of saturated fatty acids and it is a concentrated source of energy.

10. Coffee and tea can be taken in moderation. Excess amount of caffeine can increase the heart rate.

11. Animal foods like meat and pork which contain high amount of saturated fat should be avoided. All sea foods are rich in sodium, hence hypertensive patients should avoid these foods.

12. Foods that have hypercholesterolamic effects like soyabean, fenugreek, garlic, onion and turmeric should be included in the diet.

13. Heavy meals should be avoided. Small and frequent meals are preferred.

14. Taking outside meals are to be avoided as they are mostly high in fat.

15. Constipation should be prevented by including plenty of water and fiber in the diet. Best cooking oils : (1) For deep frying foods : The best oils are those with a high smoke point such as canola oil, corn oil, safflower oil and sunflower oil (2) For stir frying and salad dressing : Any oil low in saturated fat like canola oil,

It is only after the checkup with the surgeon, one should assume household responsibilities such as cooking meals, or taking care of children. As one feel stronger, one can help with light household duties such as dusting, setting and clearing the table or lending a hand in cooking. One should avoid strenuous activites such as moving furniture, vacumming, scrubbing floors, gardening, lifting objects greater than 10lbs. until cleared by the doctor. Avoid any activity that causes incision discomfort or causes tiredness easily.

This perhaps, is one of the most important questions that patient’s have post surgery. After the surgeon gives his consent after the 4-week check up, most patients can return to work in 6-10 weeks, depending on the occupation. After a one month follow-up with surgeon and the cardiologists opinion, one can resume work slowly with light duty initially.

It is advisable to discuss with your doctors the apprehensions you and your family feel. The following points need to kept in mind while going home:

• Appointments for check ups. On the day of discharge, you should fix up an appointment with your heart surgeon/cardiologist for check-ups. u The surgeon might want to see you 4 weeks post-discharge.
• Your cardiologist/family physician will be responsible after the surgeon has discharged you and the post-operative visits are over.
• You should contact the surgeon’s office, if any problems arise before the next appointment.
• Take appointments with your local doctor & family physicians after returning home.