Undergoing open heart surgery is akin to running a marathon without training and after months of physical de-conditioning from heart disease. Cardiac surgery has an enormous impact on body, mind and emotions, and the journey to full recovery is different for everyone. Knowing what to expect along the way can help ease any concerns and build the confidence needed to move beyond heart surgery and resume a healthy and vibrant life.
In-Hospital
The specifics of an admission for cardiac surgery vary with hospitals, the type of surgery, and the general health of the patient before surgery. In general, all patients return to the Intensive Care Unit (ICU) immediately from the operating room, and remain there for one to two days.
On leaving the ICU, most of the IV lines and drain tubes are removed and the patient moves to the general ward where the real work of recovery begins.
Heart patients are encouraged to mobilize early. In the past people were put to bed post-operatively, but no more; immobility may lead to complications and can delay recovery. In particular after cardiac surgery, immobility can cause pneumonia, blood clots in the veins of the legs which can travel to the lungs, as well as muscle wasting and weakness.
Physical therapists work with patients to clear lung secretions and teach people how to move safely and without pain. A general guide to mobilizing in the first few weeks post surgery is short walks often and rest as required.
An uncomplicated hospital course will mean returning home around the 7th post-operative day. Patients are showering, eating and walking independently before discharge. But what happens next?
Pain
Access to the heart is by sternotomy, or division of the breastbone. The bone is reunited using fine, stainless steel wires and bony healing is complete at 6 to 8 weeks. In coronary artery bypass surgery, veins and arteries are taken from the limbs meaning further incisions.
Surprisingly, chest pain after heart surgery is well-tolerated and on leaving hospital most people are taking only paracetamol or acetaminophen as pain relief, with something stronger before bed to counter unconscious rolling. Patients are taught to brace before sneezing and coughing to minimize sternal pain.
Fatigue
Feeling tired is normal after heart surgery and the midday ‘nana nap’ is an important part of recovery. Listening to the body’s needs is critical and rest allows for restoration and healing; ignoring this will delay recovery. Ironically, sleep disturbances can also occur after surgery with vivid dreams and frequent waking.
Cognitive Changes
Any major surgery can disrupt the mind’s equilibrium, most likely due to a combination of fatigue, general anesthetic, pain medications and in the case of heart surgery the use of the cardio-pulmonary bypass machine. In the first few weeks patients can temporarily experience poor memory, appetite and concentration as well as blurred vision. Emotional fragility and mood swings are common as the enormity of what has occurred sinks in; rest and reassurance will help these feelings to pass.
Other
Some patients report an awareness of their heartbeat after cardiac surgery, especially whilst lying in bed. This may be due to post operative anxiety or the surgery itself but unless the heartbeat is especially rapid or irregular, it is not dangerous and will resolve.
Mild shortness of breath on exertion can occur in the weeks following surgery. This is likely a combination of retained fluid, general fatigue and poor stamina. Supervised cardiac rehabilitation will help build exercise tolerance in a safe and reassuring environment.
When to Worry
The body undergoes many changes in recovering from cardiac surgery and full recovery can take 3-6 months or longer.
Some symptoms and signs which should be reviewed by your doctor are;
- Dizziness
- Rapid heart palpitations
- Redness or increasing wound pain, especially in the chest incision
- Fever or chills
- Cough producing yellow/green sputum
- Severe shortness of breath
- Calf swelling, redness or pain
