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You were brought to the hospital with severe chest pain, shortness of breath, dizziness and may be you also reported earlier occasions of fainting. Doctors after thorough evaluation found a major problem in your aortic valve in the heart. Blood that flows between different chambers of your heart must flow through a heart valve. The aortic valve controls the flow of blood out of your heart to the body's main artery (the aorta). From the aorta, the blood flows to the rest of your body.
Doctors found that your aortic valve became narrowed which was not only obstructing the blood flowing through it but also allowing the blood flowing back to your heart.
To treat this problem doctors thus advised you to go for an aortic valve replacement surgery.(1)
You have undergone aortic valve replacement surgery when you were in the hospital. Doctors had put you in heart lung machine to maintain the blood flow through-out the body without needing the heart. Doctors then opened up your aorta so that they could see the aortic valve. The damaged valve was removed, and an artificial one put into place and attached with a fine thread (suture).
Doctors then started your heart again, using controlled electric shocks, before taking you off the heart-lung machine. Your breastbone was joined up with wires, and the wound on your chest closed using dissolvable stitches.(1)
Do's and Don'ts after aortic valve replacement surgery:
For the first 6 weeks after your surgery, you must be careful how you use your arms and upper body when you move.
Let anyone pull on your arms for any reason -- for instance, if they are helping you move around or get out of bed
Lift anything heavier than 3-4 Kg for about 3 months
Do other activities that keep your arms above your shoulders for any period of time
Brushing your teeth
Getting out of bed or a chair. Keep your arms close to your sides when you use them to do this.
Bending forward to tie your shoes.
Stop any activity if you feel pulling on your incision or breastbone. Especially stop if you hear or feel any popping, moving, or shifting of your breastbone and call your doctor. Use mild soap and water to clean your incision area. Wash your hands with soap and water first, and then gently rub up and down on the skin with your hands or a very soft cloth. Use a washcloth only when the scabs are gone and the skin has healed.
You may take showers, but limit them to 10 minutes. Make sure the water is warm, not too hot or cold. Do not use any creams, oils, or perfumed body washes. Apply dressings (bandages) the way your doctor or nurse showed you. Do NOT swim, soak in a hot tub, or take baths until your incision is completely healed. Keep the incision dry.
Learn how to check your pulse, and check it every day. Do the breathing exercises you learned in the hospital for 4 to 6 weeks.
Follow a heart-healthy diet.
Continue to take all your medicines for your heart, diabetes, high blood pressure, or any other conditions you have.
Do not stop taking any medicine without talking with your doctor first.
You may need to take an antibiotic before any medical procedure or when you go to the dentist. Consult your doctor regarding same. Tell all of your health care providers (dentist, doctors, nurses, or nurse practitioners) about your heart problem.
Your doctor may ask you to take blood-thinning medicines to help keep your blood from forming clots.(2)
Common things to expect at home:
It will take 4 to 6 weeks to completely heal and start feeling better after surgery. During this time, it is normal to:
Have some pain in your chest around your incision
Have a poor appetite for 2 to 4 weeks
Have mood swings and feel depressed
Feel itchy, numb, or tingly around your incisions for 6 months or more
Be constipated from pain medicines
Have mild trouble with short-term memory or feel confused or fuzzy-headed
Be tired or not have much energy
Have trouble sleeping. You should be sleeping normally within a few months.
Have some shortness of breath.
Have weakness in your arms for the first month.(2)
After an aortic valve replacement, several complications could occur, although most of these are rare. Some possible complications are:
Infection the new valve can become infected and inflamed (endocarditis), which can damage your heart. You will be given antibiotics to reduce the risk.
Clotting this is more likely if you have had mechanical valve replacement. You will be prescribed anticoagulant medication if this is a significant risk.
Stroke the supply of blood to the brain becomes blocked.
The valve may wear out or become damaged this is more likely if you are under 60 years old and have had a biological valve replacement.
You have chest pain or shortness of breath that does not go away when you rest.
You have pain in and around your incision that does not continue to get better at home.
Your pulse feels irregular -- it is very slow (fewer than 60 beats a minute) or very fast (over 100 to 120 beats a minute).
You have dizziness or fainting, or you are very tired.
You have a severe headache that does not go away.
You have a cough that does not go away.
You have redness, swelling, or pain in your calf.
You are coughing up blood or yellow or green mucus.
You have problems taking any of your heart medicines.
Your weight goes up by more than 2 pounds (~ 1 Kg) in a day for 2 days in a row.
Your wound changes. It is red or swelling, it has opened, or there is more drainage coming from it.
You have chills or a fever over 101oF.
If you are taking blood thinners, call your doctor if you have:
A serious fall, or you hit your head
Pain, discomfort, or swelling at an injection or injury site
A lot of bruising on your skin
A lot of bleeding, such as nosebleeds or bleeding gums
Bloody or dark brown urine or stool
Headache, dizziness, or weakness
An infection or fever, or an illness that is causing vomiting or diarrhoea
You become pregnant or are planning to become pregnant.(2)
Counting Your Pulse:
Every time your heart beats, blood is forced through certain blood vessels called arteries, causing them to expand then contract. You can count the rate of your heartbeat by feeling certain places on your body where arteries are close to the skin. One place that your can feel your pulse is on the wrist. Hold your arm with your palm up facing you. Bend your hand slightly away from you. Place your index and middle fingers of your other hand on the thumb side of your wrist, about 2 inches from the center of the wrist. Apply gentle but firm pressure for the pulsation. It may take practice to take your pulse. Sometimes it is easier on the opposite wrist.
The following is a general guideline for increasing your exercise:
Take several walks each day. Spread the walks throughout your day.Gradually increase the distance and duration of your walks. Add one city block to your walk each week.
DO NOT lift more than 3 -5 Kgs for six weeks, such as: lifting children, suitcases, large purses, boxes, groceries, garbage, tools, pets, etc.
DO NOT push or pull anything where you must exert more than 5 Kgs, such as: moving heavy objects, opening a stuck window, pushing open a heavy door, unscrewing a stuck jar lid, etc.
DO NOT hold your breath during strenuous activity, especially when exercising, lifting or when using the restroom.
Getting out of bed - roll onto your side and lower your legs off the bed as you push yourself to a sitting position using your upper arm (elbow to shoulder, held close to your chest).
Standing from a chair - Scoot yourself to the edge of the chair, position your feet under you, and stand up using your leg muscles. DO NOT lift yourself with your arms. DO NOT allow anyone to pull up from under your arms or pull forward on your arms. Sit with your back straight and both feet on the floor or elevated on a stool.
Picking up an object from the floor - bend at the knees (not the waist) keeping your back straight.
DO NOT drive any type of automobile or truck for six weeks.
Don't overdo it: Stop and rest if you get tired.
Avoid long trips. If you have to take a trip lasting over one-hour travel time, dress comfortably, move your legs, and paddle your feet frequently. Do not sit or stand in one position for more than one hour. Stop every hour, get out of the car, walk around and rest for a few minutes before continuing the trip.
Always carry your medications with you instead of having them checked with your luggage.
DO NOT climb on ladders or step stools. It is ok to climb stairs, go slowly (2-4 steps) then rest etc. Rest if you become tired, short of breath, lightheaded, or dizzy. You should limit climbing stairs to two or three times a day for the first two weeks.
DO NOT keep your arms extended above your head for longer than three to five minutes. Keep your arms below shoulder level and do not extend your arms back behind center of your chest. It is OK to do your exercises, wash your hair, etc. Keep you feet and legs uncrossed. By doing these things your heart does not have to work as hard and you decrease swelling and the risk of blood clots in your legs.
DO NOT engage in any sport or activity which will cause stress, unusual movement, twisting or rotating of the chest - such as: tennis, golf, bowling, skiing, etc.
Be sure to protect your incisions from over exposure to the sun during the first year after surgery. The scar will darken with sun exposure.
DO NOT engage in strenuous work - such as: mowing the lawn, gardening, carpenter work, automobile repair, vacuuming, heavy housework as changing linen on beds, etc.
Avoid excessive straining during a bowel movement. Use a laxative and /or stool softener if necessary.
Sexual activity can usually be resumed after two to four weeks. Some guidelines to follow:
Avoid positions which cause pressure on the breastbone or tension on the arms and chest.
Pick a time when you are rested and relaxed.
Wait two hours after a meal or drinking alcohol.
The temperature of the room is comfortable.
It is normal for your heart to beat faster and your breathing to speed up during sex. These should return to normal within three to five minutes after sex. If you feel short of breath, have pain or discomfort in your chest or arms, you may need to change position, if the symptoms continue, stop what you are doing.
You may experience a change in desire and/or sexual function after a major illness or surgery for several reasons, one may be your medication, if you are have difficulty talk to your doctor.
Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems. These programmes are sometimes recommended by the doctors for improving the cardiac health condition.Your doctor can tell you where to find a cardiac rehab program near your home.(2)
CAUTION: Women who have recently had heart surgery should avoid pregnancy.
1. Dress appropriately. Wear clothes that fit loosely and are made of cotton or nylon. In the summer wear light colors which reflect the heat. In cold weather wear layers of clothes, as you warm up a layer can be removed before you sweat too much. As you cool down a layer can be put back on. Wear shoes that go with the sport. They should not feel uncomfortable in any way. If you buy new shoes, buy then in the afternoon when your feet may be the biggest.
2. Avoid extremes of heat or cold. The heat the body produces balances body temperature and the heat it loses. In hot weather the body temperatures goes up, blood vessels become larger, and blood moves to the skin's surface. As you sweat, heat leaves the body and the skin and blood is cooled. Just as hot weather expands blood vessels, cold weather narrows them. As the blood vessels get smaller, the heart must pump harder to move the same amount of blood through the smaller vessel. This can cause your blood pressure to go higher. Cold weather also decreases how much air the lungs can exchange, which reduces the amount of oxygen going into the working muscles. Do not exercise outside in very hot or very cold weather, i.e.; if it is over 80 degrees F., or less than 30 degrees F. (including the wind chill factor), or greater than 70% humidity. In the summer when it is hot and humid walk in the early morning or late in the day, when it is cooler. In cold or bad weather, walk in an enclosed area such as a shopping mall or long hallway.
3. When you exercise against wind, slow down or exercise for a shorter period of time than is normal for your. Wind makes you work harder and makes the body feel cooler than it may be.
4. Each exercise session should begin with a warm-up-stretching and 5 minutes of slow walking. End with a cool-down of 2 minutes slow walking then stretching. If you stop after a workout without cooling down, the muscles get stiff and blood tends to pool in the veins, which can cause light-headedness or even fainting.
5. Do not eat large meals or drink alcohol before exercising. Eating too much puts added strain on the heart. Alcohol, marijuana, and/or cocaine increase the heart rate. They may also hide symptoms that are telling you to stop. Over-the-counter decongestants can also cause your heart rate and blood pressure to increase during exercise and should not be taken while exercising.
6. Check with your doctor before using health club facilities and equipment. Do not use saunas, steam baths, hot tubs or Jacuzzi's for 6-8 weeks following surgery, also before or immediately after exercise or eating.
7. Persons with claudication (leg pain or cramping with walking) need to walk as far past the start of the pain as possible and may need to alternate short bouts of walking or cycling of 1 - 10 minutes with equal rest periods.
Check this link to know more about exercises:
When To Resume Usual Activities:
After 6 Weeks
Setting the table
Small mechanical jobs
Attend sports event
Passenger in car
Stationary bike (without movement of arms)
Playing cards and board games
Continue activities of weeks 1-6
(you should be able to tolerate more)
Return to work part-time
Business or recreational travel
Light aerobics (no weight > 25 pounds)
Walking dog on leash
Maintaining an Ideal Weight is crucial as obesity is a big risk factor for cardiovascular diseases (CVD). Any weight gain could mean water retention, contact your doctor immediately. Calculate your Body Mass Index (BMI) here and aim to keep it below 23.
A moderate intensity workout lasting 30 -60 minutes daily can boost heart health, lower BP and also help maintain a healthy weight. Don't lift weights till the breast bone heals completely.
Tobacco and Smoking
Quit! Tobacco and smoking can lead to narrowing of blood vessels lessening oxygen to the heart which may lead to other CVD. Call - the Quit Line, 1800-22-77-87. For more-
Abstinence is the best policy Alcohol is high in calories and known to increase blood pressure. Talk to your doctor to know more about how much alcohol can be consumed.
Stress can increase BP leading to pressure on the heart and other complications. Incorporate a daily routine to relax and rejuvenate try to listen to soothing music, chant, read a book or meditate.
Limit intake of tea, coffee, colas to only 1 Cup a day. Lowered caffeine intake is known to induce a better sleep and rest during the night.
For speedy and long lasting recovery after the heart valve replacement surgery, it is necessary to combine positive dietary and lifestyle changes with the recommended medications.
Typically, food items can be classified into six major groups as shown in the Healthy Heart pyramid.(3)
Immediate Diet Plan
1. Include lots of fresh, seasonal, local and if possible organic Fruits and Vegetables.
2. Add plenty of Whole Grains (whole wheat flour, brown rice, whole beans).
3. Choose foods high in Good Fat such as olive oil, peanut oil, fatty fish, walnuts, flaxseeds. If you do not eat fish, talk to your doctor about taking fish supplements.
1. Say NO to all Sugary beverages and foods. Do not add any extra sugar to beverages like tea coffee etc.
2. Refined ingredients like white rice, white flour, maida should be completely omitted from diets.
3. Avoid combination of sugary and refined foods like cakes, pies, ice creams as they do the most harm.
4. Avoid Unhealthy Fats such as Cholesterol, Saturated and Trans Fat as they clog the arteries. Stay away from egg yolks, cream, butter, ghee, coconut, deep fried items, whole milk, dalda, vanspati.
5. No Carbonated, Caffeinated and Alcoholic beverages.
6. Curb Salt intake, as salt increases blood pressure and retention of water in the body. Don't add salt while cooking and reduce packaged food consumption.
7. Consume foods or vitamins which are high in Vitamin K. You do not have to avoid these foods, just eat normal amounts.
Foods High in Vitamin K:
Sample Diet Plan (for patient recovering from Heart Valve Replacement surgery)
Check portion sizes for each food by going to these links.(5), (6)Do not add SALT or SUGAR while cooking or as seasoning. For cooking, use only Olive oil or Peanut oil.
- 1 Cup (250ml) lukewarm water with 1 Tbsp. freshly squeezed lemon juice and 1/2 tsp. honey
- 1 Ragi Dosa (Recipe) OR 1 Moong Dal Dosa (Recipe) - 1 medium Apple OR 1 medium Orange
Early Morning Snack
- 1/2 Cup boiled Sweet potatoes, sprinkled with lemon juice OR Brown rice Poha - 1 Cup Coconut water (discard the malai")
- 2 dried Figs and 1 whole Walnut OR 1/2 Cup Murmura
- 1 large bowl of tossed Salad (carrots, cucumbers, beets, tomatoes and onions) (Dressing - mix Olive oil, lemon juice and pepper) - 1 Multigrain phulka OR Jowari Roti - 1 Cup Palak/Plain Dal OR 1 Cup Rajma - 1 Cup Buttermilk
Mid Afternoon Snack
- 1/2 Cup Mixed sprouts OR Chole salad (Recipe) - 1 Cup Green Tea (no milk)
Early Dinner Snack
- 2 Ragi Biscuits - 1/2 Cup pomegranate seeds OR cubed Musk melon
- 1/2 Cup Brown rice with 1 Cup Mixed vegetable sambar OR 1 Cup Brown rice Khichadi with 1 small bowl of Raita made with low fat yoghurt
- 1 Cup Cabbage curry OR Bottle gourd (Lauki) curry - 1 Cup Buttermilk
Late Night Snack
- 1/2 Cup Skim milk infused with Saffron
Life Long Instructions
It is never too late to adapt a healthy lifestyle.
Maintain a balanced diet and perform regular physical activity.
Eat foods that are low in saturated fats and cholesterol.
Avoid foods high salt content.
If overweight or obese, loose the extra kilos and maintain a healthy weight.
Quit smoking and cut down on alcohol.
Check your blood pressure and blood glucose regularly.
Eat Right and Exercise your way to a Healthy Heart.