Recovering from your CABG
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This follows on from Having a CABG and provides some information about recovery and rehabilitation after you leave the intensive care unit (ICU). If it doesn’t answer all your questions, or if you have any worries, please do not hesitate to ask your specialist or nurse for more information.
Once your condition is stable, you will be able to return from the intensive care ward to your room, where a nurse will make you comfortable. He or she will monitor your blood pressure, temperature and pulse at regular intervals and check your wounds. Its normal to carry on getting oxygen through a mask to help with your recovery. You will also have drips in your arms providing you with fluids and medication, including antibiotics and pain relief.
There may be tubes in your chest to drain fluid and blood into a bag beside your bed. Another tube (called a catheter) will drain urine from your bladder into a separate bag during and after the operation. These will stay in place for a couple of days.
You will be wearing support stockings to help maintain the blood flow and to help prevent blood clots from forming in the veins of your legs.
When you feel ready, you can begin to drink and eat, starting with clear fluids.
Your anaesthetist will prescribe painkillers for the first few days. Suffering from pain could slow down your recovery, so please discuss any discomfort you have with your doctors or nurses.
A physiotherapist will see you each day during your stay. He or she will run through gentle exercises you can do and offer support and advice about getting back on your feet.
You will be encouraged to take deep breaths and to cough up any fluid in your lungs. Following this advice will help speed up your recovery and help to prevent chest infections.
The physiotherapist may provide further information materials for you to take home, including diagrams to help demonstrate the correct techniques.
As your appetite returns, it’s worthwhile choosing a diet that contains plenty of vegetables, fruit and wholegrain cereals, as this will help your bowel action return to normal – it’s common for it to be a bit slow after an operation and as a result of not moving around very much. Please don’t hesitate to ask for advice from your nurse or the hospital’s dietician.
Before you leave the hospital, your specialist may give you a thorough check up and repeat some of the tests – such as ECG – that you had before your surgery. The nurse will advise you on caring for the operation sites and will provide a supply of medicines to last for several days. You will be given a contact telephone number for the hospital and a follow-up appointment with your specialist for about six weeks later.
Here we outline some general guidelines. Advice that’s specific to you will be given by your specialist and nurse.
You will need to take it easy and should expect to feel tired and perhaps breathless at first. For the first few days, do about the same amount of exercise as you did with your physiotherapist in hospital.
For washing, showers are preferable to baths, as you should not soak your healing scars.
After 3 or 4 days, you will be able to do more activity, although different people will be able to do different amounts. Avoid strenuous exercise and lifting as these may strain the healing breastbone.
Its common for a small amount of fluid to leak from the chest or leg wound, but contact the hospital if any wound:
- Persistently bleeds,
- Becomes more painful, red, inflamed or swollen,
- Smells unpleasant and leaks any liquid.
The wires holding your sternum together are permanent and the stitches sealing the wound will gradually dissolve.
Your breastbone will take about 6 weeks to heal and it is normal for your chest area to feel sore during this time. The site(s) where the grafts were taken from in your leg or arm are likely to feel sore too. If you need them, take painkillers as advised by the hospitals. Controlling any discomfort will help you to stay active, and so help to speed up your recovery.
You shouldn't drive until your specialist (surgeon or cardiologist) agrees that you are ready to do so. After heart surgery, your insurance company may insist you have this approval before your cover is valid.
At your follow-up appointment, your specialist will advise you when you can resume your other normal activities, including returning to work, if applicable. A full recovery can take two to three months.
The hospital will advise you about a programme of rehabilitation, either at the hospital or at another local health centre.
Rehabilitation aims to gently increase your cardiovascular fitness through gentle, progressively increasing activity. Carefully following your rehabilitation programme and maintaining a good level of fitness is likely to ensure you get the maximum benefit from the heart bypass. It may also help to delay any return of the problems associated with heart disease, such as angina or a heart attack.
Walking on most days of the week suits many people, and is a good way to enjoy the “new lease of life” that the operation often brings.
Other lifestyle choices, such as keeping to a healthy weight and eating a balanced diet rich in fruit and vegetables will also help. The hospital may be able to offer you dietary advice.
If you have managed to stop smoking during the treatment, it’s really worth not starting again. Effective treatments to help you quit are available from your GP and pharmacist.
Its natural to feel a bit low or anxious following heart surgery and you will probably have good and bad days. This is why it’s important to measure your progress by weeks rather than days.
Wherever possible, its best to have someone with you for the first week or two following your surgery to provide support. Many people experience mood swings, feel tearful and lack concentration. These are all normal reactions to the surgery and should gradually disappear over two to three months.
This leaflet describes standard treatment but your experience may differ slightly. If in any doubt, you should always follow the advice of your own specialist.
1. What can I do to prevent my arteries narrowing?
To help prevent your arteries narrowing you can take medicines and make lifestyle changes. That way you may not need surgery to treat coronary heart disease.
If you have coronary heart disease, it's not possible to reverse the damage that has already taken place. If you have angina (the feeling of chest pain, chest tightness and breathlessness), you may be able to manage your symptoms with medicines. Medicines for angina include:
- ivabradine (eg procoralan)
- beta-blockers (eg atenolol, bisoprolol)
- long-acting nitrates (eg isosorbide mononitrate)
- calcium-channel blockers (eg nifedipine)
- potassium-channel activators (eg nicorandil)
- statins (eg simvastatin)
These medicines aren't suitable for everyone. Your doctor will advise you which is best for you.
Life-style changes can help to prevent your condition from getting worse. These include:
- giving up smoking
- getting medical treatment to reduce your blood pressure and cholesterol levels, if high
- maintaining a healthy weight and eating a balanced diet
- staying active
Your doctor can advise you on how you can make changes to keep your heart healthy.
2. My doctor says that I may be able to have 'off-pump' CABG. What is this?
'Off-pump' CABG (OPCAB) or 'beating heart surgery' is an alternative technique to conventional CABG that doesn't require you to be connected to a heart-lung (bypass) machine.
In a conventional CABG operation your heart is stopped using medicines containing potassium. Your heart and lungs are then connected to a bypass machine that takes over to add oxygen to your blood and maintain your circulation.
OPCAB is an alternative technique where the heart continues to beat as the surgeon performs the bypass grafts. OPCAB is thought to be just as effective as a traditional CABG operation but may have a slightly lower risk of complications. However, research is ongoing to determine the safety of OPCAB and whether it is as effective as the traditional technique.
3. Since my CABG I have been feeling depressed. Is this normal?
Yes. Feeling depressed, unhappy or anxious is often a natural reaction to having major surgery.
After your surgery you may find that you feel depressed or unhappy. This is quite common and you may even find that you experience a range of emotions, from being happy that the operation is over to being sad that it will take time to recover.
It's a good idea to have someone stay with you for the first week or two to keep you company and to take care of you. If you live alone, it should be possible to arrange extra care visits.
When you get out of the hospital you should notify your GP so that he or she can provide you with any care that you may need.
British Heart Foundation
British Cardiac Patients Association
_020 8289 5591
(Support groups & booklets available in UK)
American Heart Association
This leaflet is for information only. For a detailed opinion or personal advice, please consult with your own doctor
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