After Your Surgery

Once you are ready to leave the SICU, you will be transferred to a floor where the nurses are specialists in caring for patients after cardiac surgery. An important part of your recovery is increasing your level of activity and getting ready for discharge. Nurses and physical therapists will be working closely with you to achieve this goal. 

We are available for any questions you might have once you are home. Please feel free to contact one of our surgeons, nurse practitioners, or physician assistants at 617,638,7350. 

Please call us if: 

• You feel more short of breath than usual or cannot lie flat due to shortness of breath 
• You gain more than five pounds in two days 
• Your temperature is between 99.5° and 101° for three days in a row 
• Your temperature is greater than 101° 

Pain Management 

After your surgery, you will be given medication to keep you as comfortable as possible, so that you can cough and take deep breaths. Your nurses will closely monitor your level of pain and your need for pain medication. You will be asked to rate your pain using a pain scale to help your nurse understand how much pain you have. 

Activity and Exercise 

Getting out of bed and walking will help you recover and prevent complications. Walking and activity will aid in clearing secretions from your lungs, help your circulation, and help you regain muscle strength.  

You will be sitting up in bed and possibly getting out of bed the day of surgery or the day after. You will progress to sitting in a chair and walking to the bathroom with the assistance of your nurse. A physical therapist will also work with you with activities including your first walk and you will then progress to walking several times each day. 

Sternal Precautions 

For six to eight weeks: 

• DO NOT LIFT, PUSH, OR PULL objects heavier than 10 pounds (i.e., a gallon of milk) 
• Avoid trunk twisting 

Breathing Exercises 

• Use the incentive spirometer (IS) four to five times a day 
• At each session, take 10 slow, deep breaths. Be sure to relax your shoulders 
• Take your time between breaths 
• Placing your hands (or cough pillow) over your chest incision, perform two or three strong coughs 
• BMC also offers Breathing Exercise classes 

Mobility and Flexibility Exercises 

• Do these exercises before and after walking 
• Do not hold your breath (count aloud and take slow, deep breaths) 
• Do 10 repetitions of each exercise two times a day 

Walking Program 

• For the next four to six weeks before starting cardiac rehabilitation, you will be doing a walking program twice a day 
• Measure walking in terms of time (minutes) not distance (miles) 
• If you have chest pain, shortness of breath, lightheadedness, or palpitations, STOP YOUR ACTIVITY! 

Helpful hints about walking 

• Wear comfortable clothing and shoes. 
• Wait at least one hour after meals to do your exercise and walking program. 
• Avoid hilly areas and excessive stair climbing. Pace yourself when climbing stairs. 
• Exercising in cold and windy or hot and humid weather puts stress on your heart. If temperatures outside are below 40 degrees or above 75 degrees, then exercise indoors. 
• Riding a stationary bike or walking on a treadmill is an acceptable alternative to walking. 

Cardiac Rehabilitation 

• Three to six weeks after you're discharged from the hospital, your cardiologist will recommend beginning an outpatient cardiac rehabilitation program 
• Prior to beginning cardiac rehabilitation, your cardiologist will schedule an exercise tolerance test (ETT) 

Cardiac rehabilitation consists of: 

• Exercise while being monitored by telemetry 
• Education on pacing, breathing, nutrition, and how to maintain a healthier and rewarding lifestyle 
• The length of the program depends on your needs, but usually lasts three to four weeks, with two to three sessions per week 

Rest 

• You will feel very tired as you gradually increase your exercise program and activity level 
• Your body needs many rest periods in order to recover 
• You may want to nap once or twice a day when you are at home 

Diet 

It is normal to not feel hungry after having surgery. You will begin by taking sips of liquids and slowly advance to solid food. Good nutrition is important for healing. As you begin to eat a regular diet, try to eat foods with fiber to prevent constipation. 

Clearing Secretions 

After heart surgery, it is important to clear the lungs of secretions. This promotes good oxygenation, helps to prevent collapse of the lungs and helps prevent infection. Taking deep breaths and coughing helps to accomplish this. Using an incentive spirometer will help. The incentive spirometer is an instrument that encourages you to take deep breaths. You will be given one after your surgery. It is important that you use it several times an hour (at least 10) for several days after your surgery. Deep breathing and coughing exercises after surgery will help keep your lungs healthy. 

Follow-up Visit after Surgery 

Approximately one to three weeks after your discharge, you will have an appointment to be seen by your cardiac surgeon in the Cardiovascular Center on the 3rd floor of the Preston Building, 732 Harrison Avenue. At that visit, your surgeon and/or nurse practitioner or physician assistant will review your progress. 

Follow-up Visit with Your Primary Care Physician or Cardiologist 

You will have an appointment scheduled with your Cardiology team in approximately four weeks from the time of discharge. 

Please make an appointment to see your primary care physician within two to three weeks. You should schedule this when you go home.  

If you are admitted to another hospital in the month following surgery, please have a family member call our office at 617.638.7350. 

During your recovery from heart surgery, you may experience a wide range of emotions, from happy and energetic to tired and angry. Progress after heart surgery can be slow, so please do not get discouraged. Some suggestions to help you cope with your recovery: 

• Stay involved with your family and friends 
• Share your worries 
• Get up and get dressed every day 
• Go outdoors every day (weather permitting) 
• As you feel better, get back to activities that you enjoy 
• If after six to eight weeks you are still feeling depressed and are having trouble going back to the activities you enjoy, contact your doctor 

Home Care Instructions 

Pain 

It is normal to have aches and pains after surgery. You will receive a prescription for pain medication, but you may also use acetaminophen (Tylenol) instead. Be sure not to take more than four grams (4,000 mg) of acetaminophen in a 24-hour period. 

Continue using the cough pillow, which supports your chest when you cough. 

Elastic Stockings 

Elastic stockings will prevent or lessen leg swelling. They should be worn during the day and removed at night. Have someone help you with them to avoid straining. The stockings can be machine washed and dried. Once you are active and have no swelling, you may not need to wear them. 

Showering 

Have someone nearby when you shower. Use mild soap, rinse your incision with water, and pat dry. Do not scrub your incision. You should have a small chair or stool in the shower with you in case you need to sit and rest. Do not take a bath until your incisions are completely healed. 

Wound Care 

Look at your incisions daily, checking for any increased redness, drainage, open areas, swelling, or tenderness. Call your doctor if any of these symptoms occur. Most patients have internal sutures, which will dissolve in time. If you have steri-strips on the incision, they can gently be removed in the shower after one week. 

Diet 

You may not have much of an appetite at first, but this should improve with time. Eating a balanced diet will help you recover quicker. For coronary heart disease, your diet should be low cholesterol, low fat, and high fiber. Limit your intake of red meat, eggs, and fried foods. Increase your intake of fish, chicken, fresh fruits, and vegetables. Try to limit your caffeine to one or two cups per day. 

Constipation 

Constipation is common after cardiac surgery due to inactivity and some pain medications. You should have a bowel movement on a regular basis. If you become constipated, take a laxative of your choice, such as milk of magnesia, or ask your pharmacist for suggestions of an over-the-counter laxative. If you are taking iron pills, remember that your stool will be black. 

You will also receive a prescription for a stool softener called Colace, or docusate sodium. Stop taking this medication if you have diarrhea. To avoid constipation, drink enough water, eat a high-fiber diet, and follow your exercise program. 

Medications 

It is important to take all your medications as prescribed. Common medications after heart surgery include aspirin, a cholesterol-lowering medication, and blood pressure medication. Some medications are temporary. If you have an artificial heart valve, you may be on a blood thinner. Some medications require occasional blood work for monitoring kidney and liver function. 

• Check with your cardiologist to see what medications are right for you. 
• Always bring a copy of your medications and doses to your doctor's appointments to confirm proper medication and dosing. 

Temperature 

Check and record your temperature. If your temperature is greater than 101° or if your temperature is between 99.5° and 101° for three days in a row, call your doctor. 

Weight 

Weigh yourself every morning after you urinate and write it down. Call your doctor if you gain more than five pounds in two days, feel shorter of breath than usual, or you are unable to lie flat due to shortness of breath. 

Dressing 

Try to split up your routine, to avoid becoming tired. For example, gather all your clothes at one time to avoid extra work. 

Driving 

For the first four to six weeks after surgery (or until your doctor says you are able to) you should avoid driving a car. Driving can be stressful and your reaction time may be slowed due to some of the medications you are taking. As a passenger, place the cough pillow under the seatbelt for protection. 

Housework 

Housework should be limited to light work around the house, such as washing dishes and dusting. DO NOT move furniture. Avoid activities that involve reaching above shoulder level for long periods (such as washing windows or hanging out clothes), as this will increase your heart rate. Keep cleaning supplies in an easy-to-reach area to conserve energy. Use a short stool to sit when cleaning low-level surfaces or try to use long-handled mops and sponges to reduce bending and stretching. 

Returning to Work 

You and your cardiologist will decide together when you should return to work after surgery. You may be able to do some paperwork, take phone calls at home, or return to work part-time at first. Work that requires lifting should be restricted for at least two months and only after you have spoken with your cardiologist. 

Sexual Activity 

You may resume sexual activity once you are able to walk ¼ mile briskly or climb two flights of stairs without discomfort. It is important to remember that you should communicate with your partner about what position is most comfortable, and least stressful. Please remember your sternal precautions. 

Recreation 

• You may enjoy going out to dinner with family and friends. 
• Sports generally should be avoided for the first two months. 
• If you golf, you may chip and putt during the first two to three months. 
• When your incision heals completely, you may wade in a pool, but do not swim laps for two months. 
• Avoid saunas and hot tubs. 
• Discuss any other sports with your cardiologist before you participate.