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Coronary artery bypass or commonly called Heart Bypass surgery is used to treat people who have severe coronary heart disease that could lead to a heart attack. It also might be used during or after a heart attack to treat blocked arteries.(1),(2)
Treatments:
Coronary artery bypass surgery is a type of surgery that improves blood flow to the heart. Surgeons use this method to treat people who have severe coronary heart disease.During bypass surgery, the doctor takes a vein or artery from another part of your body and uses it to make a graft (bypass) around the blocked area in your artery.After the graft has been created, your breastbone will be closed with wires. These wires stay inside you. The surgical cut will be closed with stitches.(1),(2)
(A) (B)
Fig. 1. (A) and (B): Schematic representation of Coronary Artery Bypass Surgery.
Self-care instructions: Full recovery from traditional coronary artery bypass surgery may take 6-12 weeks or more.You have several responsibilities while you are recovering from this surgery.
Do's after Coronary Artery Bypass Surgery
Take a warm (not hot) shower every day.
Inspect your incisions every day.
Keep your swollen arm or leg elevated.
Wear special supportive hose (available from your doctor).
Take each medicine regularly and on time.
Get regular blood tests.
Prevent falls and injuries.
Weigh yourself at the same time every morning and keep a record.
Call your doctor if you gain 3 lb. (1.4 kg) or more in 2 to 3 days.
Don'ts after Coronary Artery Bypass Surgery
Do not remove the tape from your incisions (it will come off by itself).
Do not scrub or rub your incisions.
Do not use lotion or powder on your incisions.
Do not overexpose your incisions to sunlight.
Do not lift objects heavier than 5 lb. (2.3 kg), including small children, trash baskets, and bikes.
Do not drive (even a minor car accident may cause your chest to hit the steering wheel).
Do not increase, decrease, or stop a medicine without asking your doctor.
Side effects/Risk Factors:
Blood clots in the legs that may travel to the lungs
Breathing problems
Infection, including in the lungs, urinary tract, and chest
You have chest pain or shortness of breath that does not go away when you rest.
Your pulse feels irregular -- it is very slow (fewer than 60 beats a minute) or very fast (over 120 beats a minute).
You have dizziness, 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 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 3 pounds (1.4 Kg) in a day for 2 days in a row.
Your wound changes. It is red or swelling or it has opened, or there is more drainage coming from it.
You have chills or a fever over 101 F.
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.
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.
Typical follow-up schedule: Care after surgery may include periodic check-ups with doctors. During these visits, you may have tests to see how your heart is working. Tests may include an ECG (electrocardiogram), stress testing, echocardiography, and a cardiac CT scan.
Medical Instructions: It is EXTREMELY IMPORTANT that you take your blood thinners as prescribed to prevent any blood clot formation. During your therapy you MUST take them every day.
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 programes 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.
Exercise Guidelines:
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.
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.
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.
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.
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.
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.
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.
Quit! Research suggests that tobacco use and second-hand smoke are the primary risk factors of cardiovascular diseases. Globally around 10% of cardiovascular deaths are attributed to tobacco use. Need help quitting, call - the National Tobacco Cessation Quit Line, 1800-22-77-87rn To know more about the health benefits of quitting, go to
Alcohol
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 Management
Lowering stress levels are important when recuperating from a cardiac surgery. Stress can increase blood pressure. Incorporate a daily routine to relax and rejuvenate try to listen to soothing music, chant, read a book or meditate.
Weight Management
It is crucial to maintain ideal weight as being overweight or obese is recognized as an important risk factor for cardiovascular diseases. To find out your ideal weight and Body Mass Index (BMI) go to this link. A healthy, low fat diet combined with a regular exercise regime is the key to lose and maintain weight.
Social Support
Post-surgery can be a challenging period to manage emotions. Patient may experience anxiety, anger, and depression to name a few. It is important to find an emotional anchor either a family member or a friend who can help you cope with the feelings.
Caffeine
Reduce the intake of tea, coffee, colas and chocolate especially later in the day. Lowered caffeine intake is known to induce a better sleep during the night.
Blood Pressure management
Maintaining a normal blood pressure of lower than 120/80 is important to lower the risk of further cardiovascular complications. Exercise can help to maintaining normal blood pressure.
Blood Glucose management
Diabetic patients are at a risk of developing complications, post cardiac surgery. Keep your blood sugar in constant check by maintaining a balanced diet and a prudent lifestyle. Normal fasting glucose range is 70-100mg/dL and for diabetics it is 70-130mg/dL. After meals for non-diabetics it should be less than 125mg/dL and for diabetics, it should be less than 180mg/dL.
Nutrition Plan: It is important to eat the right kind of food for a healthy heart, mind and body. Cardiac surgery can be intense and demanding both physically and emotionally. For a speedy and long lasting recovery we advise you to combine positive dietary and lifestyle changes with the medical care. Post-surgery, many patients experience poor appetite. To boost the appetite, consume small portions of food about 7-9 snacks/meals throughout the day. Nausea is another common complaint that could be caused due to medications. Take the prescribed medicines on full stomach. Consult your doctor if nausea persists.
Generally, all food items can be classified into six major groups as shown in the Healthy Heart pyramid.(4)
Immediate Diet Plan:
Do's:
Include lots of fresh, seasonal, local and if possible organic Fruits and Vegetables in your daily diet.
Add plenty of Whole Grains such as whole wheat flour, brown rice, whole beans etc. to the diet
Choose foods high in Good Fat such as olive oil, peanut oil, fatty fish , walnuts, flaxseeds.
Try to include a weekly serving of Fatty Fish, such as Tuna, Rohu, Surmai, Katla, and Mirgi. If you don't eat fish, talk to your doctor about taking fish oil supplements.
Include food sources rich in Magnesium and Potassium to increase heart health.
Dont's:
Say NO to all Sugary and Refined foods such as cakes, biscuits, chocolates etc. and do not add any sugar to tea or coffee.
Avoid Unhealthy Fats such as Cholesterol, Saturated and Trans Fat. Stay away from egg yolks, cream, butter, ghee, coconut, deep fried items, whole milk, dalda, vanspati.
Slash down any intake of Carbonated, Caffeinated and Alcoholic beverages.
Curb your Salt intake, as sodium in the salt has to tendency to retain water in the body which can increase blood pressure and add other complications.
Do not add salt while cooking and restrict consumption of packaged food.
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:
Broccoli
Cooked onions
Turnip Greens
Green Tea
Cabbage,
Liver
Lettuce
Spinach
Mustard Greens.
Sample Diet Plan: Below is a sample Diet Plan for a patient who has undergone coronary bypass surgery. Make sure to check the correct portion sizes for each food item by going to these links.(6), (7) Talk to you doctor or dietician about any restrictions on fluid or water intake. Do not add SALT or SUGAR while cooking or as seasoning. For cooking, use only Olive oil or Peanut oil.
Early Morning
- 1 Cup (250ml) lukewarm water with 1 Tbsp. freshly squeezed lemon juice and 1/2 tsp. honey
Breakfast
- 1 CupDahliaporridge made with Skim Milk OR 1 Moong Dal Dosa (Recipe)OR 1 Ragi Dosa (Recipe) - 1 medium Apple OR Orange OR 1/2 Cup of pomegranate seedsrn
Early Morning Snack
- 1/2 Cup boiled Sweet potatoes, sprinkled with lemon juice OR Brown rice Poha soaked in low fat yoghurt - 1 Cup Coconut water (discard the malai")
Mid-Morning Snack
- 2 dried Apricots and 1 whole Walnut OR 2 dried Figs and 2 Almonds (unsalted)
Lunch
- 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 Dal OR Rajma - 1 Cup Buttermilkrn
Mid Afternoon Snack
- 1/2 Cup Mixed sprouts OR Chole salad (Recipe) - 1 Cup Green Tea (no milk)
Early Dinner Snack
- 2 Ragi Biscuits OR Unsweetened Oatmeal Biscuits
Dinner
- 1/2 Cup Brown rice with 1 serving of Mixed vegetable sambar OR 1 Cup Brown rice Khichadi with 1 small bowl of Raita made with low fat yoghurt - 1 Cup blanched or steamed beans OR Cabbage curry OR steamed Cauliflower curry - 1 Cup Buttermilk
