Display Patient Information Leaflets

Date issued:  December 2024 

For review: December 2026 

Ref: A-667/AMRM/Cardiology/Cardiac Surgery Post Operative

PDF: Post op cardiac surgery.pdf [pdf] 478KB

Introduction

University Hospitals Plymouth NHS Trust provides adult cardiac surgery for all residents of Devon and Cornwall.

This booklet is designed to help prepare you and those close to you with the information and advice you will need to promote your health when you return home. Although the type of heart surgery will differ between patients, this booklet aims to answer some common questions that you may have about your recovery

All patients will be asked to complete the Friends and Family Test questionnaire prior to discharge. This is your opportunity to share any constructive feedback about your stay in hospital with us.

You will also find online a QR code on our website directing you to a patient satisfaction form. Please spare us a few minutes of your time to complete.

We hope that you find this information helpful over the coming weeks.  All the staff involved in your care wish you a speedy recovery

Returning home

Once you are discharged home

Remember you will need to think about provisions before you have your surgery. Think what you might need help with. Think about shopping, consider online food deliveries or if you can rely on a family member or a friend.

Returning home is an important stage in your recovery. You can take a pillow to go between your sternum and the seatbelt on journey home. Your journey home may be tiring and at the end of your journey it is advisable to rest. In the first week after discharge we advise you to have a family member or a friend with you at home to give general support. The first few days can be both physically and emotionally tiring. You may miss the support of hospital staff and that of other patients. These are normal reactions and will gradually resolve.

You will be given a supply of the tablets you need to continue taking. You will also be given pain relief tablets to take home. The pharmacist will make sure that you know the reason for taking them, the correct dose and time to take them. You should not take any other tablets or medicines unless instructed by your doctor. If you are taking warfarin tablets, you will be given a booklet explaining the special precautions you must take and the need for regular blood analysis tests to ensure the correct dose is prescribed.

 

When you are less active following surgery you are at high risk of clots forming in your legs. Your surgical centre may send you home with support stockings to wear. The stockings are designed to improve the circulation in your legs and prevent clot formation. For this reason, it is important to continue to wear the stockings as directed by your surgical centre until you return to your usual level of mobility. 

 

Remember:  Once your prescription is nearly finished, it is important you get your repeat prescription from your GP in plenty of time, so you do not run out of your tablets and never stop any medications without a conversation first with your GP, cardiologist or surgeon.

If you use herbal remedies or supplements, it is wise to check with your pharmacist that there is no interaction between these and your prescribed medication. 

 

Common problems after heart surgery 

Each patient reacts in a different way to having an operation. Here are a few common problems that you may have following your heart operation and things that can be done for them.

• Nausea and sickness are common following an anaesthetic, you can be prescribed anti-sickness medicine which should relieve it.

• A sore throat and hoarse voice may occur due to irritation by a breathing tube in your mouth during and shortly after the operation. It typically takes around a week to fully recover and drinking fluids will help this.

• Poor appetite, indigestion and constipation are very common after surgery but will gradually improve with the help of antacids, laxatives and mobilising.  Some people find that eating small, but frequent, meals aid the return of normal appetite.

• There may be a small amount of discharge from the chest wound but this should settle after a few days. The nurses will keep a check on your wounds.

• Some pain and stiffness in the chest area, shoulders, neck and back is to be expected but will improve slowly over a few weeks, and painkillers will help to relieve this.

• Ankle and foot swelling are common, particularly if you have had a vein taken from a leg. The nurses will look for this.  In some people this is due to too much circulating fluid, in which case water tablets may be prescribed by the doctor to help. It will improve as you become more active.

• After heart surgery tiredness is very common, it will gradually improve over the 12 weeks following the operation.  It is important to remember that rest is vital after an operation; visitors should be kept to a minimum until you feel ready.

 

Wound Care

Your chest  wound

The stitches in your chest wound will dissolve after 2 to 3 weeks and the wound will heal. There is no need to cover the wound with a dressing, unless small amounts of oozing persist during this time. Just below your chest wound you will have two or three small stitches from where your chest drains were removed. The nurse on the ward may remove these 4 days after the drains were taken out.

 

For the surgeon to operate on your heart it was necessary to divide the breastbone. Small wires are inserted to hold the bone together to allow it to heal. These wires stay there permanently and rarely cause any problem. They do not rust, and they will not affect any airport security scanners in the future. 

 

It is common for the wound to feel numb and sometimes itchy in the weeks after the operation. Some people are aware, at first, of a lump at the top of their chest wound.  This is due to the wound healing and as time passes this will gradually disappear. The wound can also be very sensitive, wearing light cotton next to the skin can help.

 

If you notice any discharge from the wound, contact your GP or community nurse (through the GP surgery) to assess the wound. 

 

Female patients

We advise female patients to wear a sports bra (preferably a front fastening bra) after the operation as this may help to support your wound.  It is advisable to wear it for a few hours each day to begin with, so by the time you go home you will be able to tolerate it all day.

 

Your leg wound(s)

During surgery it may be necessary to remove veins from one or both legs.

 

It will take a while for the circulation in your legs to adjust and, as already stated, during this period your affected leg(s) may swell, especially around the ankle and foot. This is to be expected and will gradually improve. You may need to use some mild painkillers. In the meantime, you can help the circulation in your legs by:

• Sitting with your feet on a stool.

• Avoid crossing your legs, as this restricts the normal flow of blood in the veins.

• Going for walks.

• Wearing support stockings (follow the advice from your surgical centre).

Some numbness and discomfort associated with the leg wound may be expected until it is completely healed. There will also be some bruising, but this will gradually improve over the first month.

 

Your forearm wound(s)  

An artery from your forearm may have been used for grafting. Stitches in this wound are usually dissolvable. Otherwise, clips are usually removed 10 days after your operation. You may experience some numbness or loss of sensation around the wound, which may extend to the thumb. This is usually a temporary occurrence. 

 

 

What to do if you experience pain or discomfort  

You will be given painkillers when you are discharged home. Usually, this is paracetamol and sometimes a stronger painkiller such as Tramadol or a codeine-based painkiller. Do not be in a hurry to reduce your painkillers. It is important that you can breathe deeply, cough, and move freely.  If you are taking a stronger painkiller in combination with paracetamol, try to wean yourself off the stronger ones first. Do this slowly over a few days. 

 

Be aware that the stronger painkillers may make you feel more nauseous. If this becomes a problem, try to reduce, and then replace these painkillers with paracetamol. They can also sometimes cause constipation. Your GP can prescribe laxatives. It is important you do not allow yourself to go more than 3 days without a bowel movement. 

 

Paracetamol works best when it is taken regularly. When you start to reduce the frequency, start off with cutting the painkillers midday or teatime. Paracetamol at night will help to keep you more comfortable and therefore enable you to sleep. First thing in the morning it will help you mobilise more easily.

 

It is normal for some people to still need painkillers 8 weeks after the operation.

Breathlessness

It is normal to be more aware of your breathing following heart surgery. Particularly if you are experiencing discomfort in the chest and/or are feeling anxious. Over time you will become less aware; continue your painkillers as you need them and practice the relaxation exercises on page 21, to help relieve any anxiety you may have. 

 

When you exert yourself, it is normal to feel slightly breathless. If you feel so breathless that you cannot talk, slow down or stop until your breathing settles.

 

Occasionally following heart surgery, you may develop a chest infection or small amount of fluid around the lungs. In which case you may be given medication to help fight the infection or reduce the fluid. It is important to speak to your GP if you notice your breathlessness isn’t improving or is getting worse. 

 

Eating and drinking

While things are returning to normal, you may prefer frequent light meals. As your appetite returns, try to avoid large, heavy meals and remember to drink plenty of fluid. It is common to experience constipation after your operation. You will be offered laxatives and encouraged to eat a high fibre diet.

 

Mood swings and poor concentration

During your stay in hospital and for the first few months after your operation you may experience changes in your mood. This may affect you in different ways. Some people feel depressed, some cry for no apparent reason and some people become easily irritable. It is important to remember that these mood changes are only temporary and will gradually resolve. Discuss your feelings with your family. Try to be honest with each other about how you are feeling. If you feel unduly depressed or have continuing problems let your GP know. 

Memory loss is common after surgery. This can be related to an inability to concentrate and will gradually improve.

 

Visual disturbances

‘Floaters’ (small black spots seen in peripheral vision line) are commonly experienced during the first 3 months. This is due to the by-pass machine. Any routine eye-tests should be done only after 3 months. If the ‘floaters’ continue, consult your GP.

Sleeping patterns and rest

There may be a change to your sleeping pattern, in that you may only be able to sleep for short periods of 2-3 hours. This is quite common after cardiac surgery. You may find that your normal sleeping position is not comfortable in the early days after the operation due to soreness around the chest. It is important to continue to regularly take your painkillers. Some people have found it more comfortable to sleep lying on their back, sitting up slightly with an extra couple of pillows. In time you will find the position most comfortable for you. If you cannot sleep at night, it can help to get up and try again a little later.

 

Adequate rest is as important in your recovery as exercise. This is important for you in the early days following surgery.  While you are in hospital there is a rest period in the early afternoon, where visiting is discouraged, or in some places prohibited.  At home, plan to continue having a rest in the afternoon.  Try to limit visitors to 1 or 2 per day in the first couple of weeks, as this also can be very tiring.  

Increased awareness of heartbeat

It is very common in the early stages after surgery to find you are more aware of your heartbeat, especially when you are relaxing or in bed.  This is nothing to worry about. 

 

Following heart surgery, you may experience palpitations related to atrial fibrillation (an irregular heartbeat). This is a common complication, and you may be discharged on medication such as amiodarone to help regulate the heartbeat. Often atrial fibrillation will resolve; this will be reassessed at your follow up appointment.

 

Bathing/Showering

You will be able to shower from the 3rd or 4th day after your operation. A nurse may supervise you for your first shower and will also be available to assist you as necessary during the shower. Do not use excessively hot water as this may make you feel dizzy. Your wounds can be gently cleaned, but you should not scrub them. Avoid soap, talc and perfumed products. If you wish to, you will be able to dress in your day clothes. It can help you feel you are returning to ‘normal’ to get dressed each day.

 

Getting back to normal

You will have good and perhaps not so good days. Sometimes 2 steps forward may be followed by 1 step backwards, but you should see a gradual improvement over the first 6 to 8 weeks. It is important to pace yourself, do not try to do too much on the good days as it often affects the following day. You can gradually introduce light tasks into your routine, e.g. washing up and pottering around the garden. Increase your activities, as you feel able. Eventually you should be able to do all the daily activities you used to do before your illness. Remember to listen to your body.

Driving

You must not drive for at least 4 to 6 weeks after your surgery. You do not need to inform the Driver and Vehicle Licensing Authority (DVLA). 

 

Following your operation your reactions and concentration will be affected. Also, it may place more stress on your shoulders and chest wound than you expect. We advise you to be sure you feel safe and confident before you drive. 

 

There is no exemption from wearing seat belts. Placing a small cushion between the belt and your chest may ease any discomfort. 

 

You should inform your car insurance company to ensure the terms of your policy are not affected due to you having heart surgery. The price of your premium should not be affected.

 

If you have an occupational licence, for example to drive a large goods vehicle (LGV) or a passenger-carrying vehicle (PCV), you MUST inform the DVLA about your heart surgery. You will not be able to drive for at least 3 months and then the DVLA will ask your cardiologist to carry out various tests including a specific type of exercise tolerance test, walking on a treadmill. The results of these tests will help the DVLA decide whether you can keep your licence.

DVLA            

Swansea

SA99 1TU 

 

Telephone: 0300 790 680

 

Find more information about the DVLA’s medical guidelines 

 

Returning to work

Most people can return within 8 to 12 weeks. This will depend on factors such as the type of work you do. A person doing a light office job could expect to return sooner than one doing a heavy manual job. The progress of your recovery is also important. If you prefer to return to work gradually, it is a good idea to take advantage of this. Remember, your colleagues or manager may quickly forget you have had heart surgery and may make demands upon you, that you are unable to meet at that time, so do not rush. Try to avoid stressful situations and do not get over-tired by thinking you are capable of more than you are.

 

Sexual Activity

Sexual activities may resume within a couple of weeks after your discharge from hospital. Many people who have undergone heart surgery experience some anxiety about resuming sexual activities. This is perfectly normal. Take time for discussion about how you are both feeling. Some people think sex places enormous strain on the heart, when in fact it has been shown to result in less strain than briskly climbing 2 flights of stairs. Choose a time when you are relaxed, choose a position that is comfortable, does not restrict breathing and does not stress your chest (perhaps a passive role). If you have any on-going problems, then discuss them with your GP.

Holiday

It is advisable to remain in familiar surroundings for the first 4 to 6 weeks after your operation, and therefore you should plan any holidays for after your follow-up appointment. It is advisable not to fly for at least 6 weeks. Airlines may require a medical form to be completed by your doctor.  Guidelines on flying will vary between airlines.

 

Plan your trip carefully:

• Allow plenty of time for whichever form of transport you are taking.

• Don’t carry heavy bags or rush around.

• If you are going abroad, check your travel insurance to make sure you have enough cover.

• Take enough of your medications with you. 

 

Always take a list of all your medication and their doses with you

If you have a problem obtaining travel insurance, the British Heart Foundation can send you a list of insurance companies that are ‘sympathetic’ to heart patients. This list gives details of companies which offer travel, life, health and car insurance. 

 

For details either write to:

British Heart Foundation

14 Fitzhardinge Street

London 

W1H 6DH  

 

Tel: 020 7935 0185 or visit: www.bhf.org.uk

Dental care

Visiting the dentist every 6 to 12 months is important for everyone.  If you have had a valve operation it is even more vital that you update your dentist regularly. 

 

Anyone with a replacement valve or Valvular Heart Disease runs a slight risk of infection of the valve. Whenever bacteria or other organisms get into the blood stream the body defences rise up and kill these organisms. If, however, the bacteria can hide away in an artificial/diseased valve or other abnormal lining structure of the circulation, then they can remain undisturbed and immune to one’s natural defences. The organisms can then multiply and infect the heart leading to serious structural damage.  

 

A small dose of bacteria invading the blood is of no consequence but during certain procedures such as dental work near the gums, some surgical procedures or an investigation of one of the passages, the number of bacteria entering the blood can be considerable. In this situation there is a small risk of infection of the heart lining (called endocarditis). Such a risk can, in the case of dentistry, be reduced by good oral hygiene. It is important that you visit your dentist 6 to 12 monthly and take good care of your teeth and gums. In some circumstances your cardiologist may advise antibiotics before a given procedure.

 

Follow-up appointment 

You will be given a cardiac outpatient appointment for approximately 6-12 weeks following your operation.  At this appointment, the emphasis is on ensuring you are making a good recovery and any concerns regarding your recovery can be addressed. This will be either a face-to-face or telephone appointment depending on your needs.

 

Cardiac Rehabilitation

Unfortunately, not all patients will be referred for cardiac rehabilitation. Due to funding, only patients that have undergone coronary artery bypass surgery will be referred. In the future we hope this programme will be available to patients undergoing all types of cardiac surgery.

 

Regionally, Cardiac Rehabilitation is offered in Plymouth, Kingsbridge, Cornwall and Exeter. Cardiac Rehabilitation courses may differ slightly. Prior to participating in a course, you may be invited to attend for an exercise assessment and risk factor talk. Those patients who have stated that they are unable to exercise but would like to take part the Cardiac Rehab Health Education and Relaxation components of the course, should let the Cardiac Rehabilitation Team know.

 

After a heart operation, time is needed for physical and mental recovery. A rehabilitation programme can help by:

• Improving physical fitness.

• Ensuring a more rapid recovery.

• Helping prevents anxiety or depression.

• Reducing future cardiac problems by addressing risk factors.

• Meet other people who have been through a similar experience to you.  

It is normal to feel anxious about exercising after surgery. Participating in a Cardiac Rehabilitation Course can help give you the confidence to become active again. The course gives you the opportunity to ask questions and talk about any worries you may still have.

The Aims of the Course

To enable you to return to a state of wellbeing which is acceptable to you, help you understand things you can do to help your heart and optimise the medication your heart needs.

How is this done? 

The course usually lasts for several weeks (slightly longer for the gentle course) and each “session” lasts for up to 2 hours.

 

The course is made up of 3 components to help address you as a whole person.

1. Exercise

This is under the supervision/guidance of an exercise specialist. The exercises are designed to suit people of varying abilities. Everyone can exercise at their own level.  

 

2. Health education   

This is an informal discussion, listening and teaching time; aiming to address your heart health and the risk factors leading to heart disease; including: 

• Coronary heart disease risk factors.

• Medications.

• Exercise.

• Healthy eating and cholesterol.

• Blood pressure.

• Stress/anxiety.

3. Relaxation   

A simple form of relaxation is taught.  This can be used to help people to cope with stress.

 

How can I reduce my risk of further coronary artery disease?

Coronary Artery Disease occurs as we age. However, risk factors relating to your lifestyle and health can increase people’s risk of worsening the disease.

There are several known addressable risk factors for coronary artery disease. The main ones are:

• High blood cholesterol.

• Poor diet.

• Overweight or obesity.

• Drinking too much alcohol.

• High blood pressure.

• Smoking.

• Lack of physical activity.

• Diabetes.

• Stress. 

 

Healthy Eating

Everyone benefits from eating a healthy, balanced diet. Concentrating on certain aspects of the diet can help prevent further narrowing in the heart’s arteries from developing. A Mediterranean style diet is a healthy diet that is generally low in saturated fats and high in fibre (roughage). This can be achieved by eating more whole foods such as vegetables, fruits, wholegrains, unprocessed meats and fish. Research has shown, that following a Mediterranean style diet can reduce the chance of developing conditions such as heart disease, type 2 diabetes, high blood pressure, obesity and even Alzheimer's disease.

Fruit and Vegetables

Eating plenty of fresh vegetables and some fruit not only helps to prevent constipation, by increasing fibre intake; but also provides the majority of the polyphenols, vitamins and minerals required by the body. Aim to eat vegetables and fruits of different colours, such as dark leafy greens, berries, carrots etc… This will enable you to obtain a variety of vitamins and minerals from your food. 

 

Cholesterol and fats

Cholesterol is a fatty substance made mainly in the liver, which circulates in the blood and contributes to the gradual narrowing of the coronary arteries (atherosclerosis). To help reduce your cholesterol level you could try to do the following: 

• Swap to a lower saturated fat such as extra virgin olive oil.

• Reduce the total amount of fat you eat, especially if you are overweight. For example, you should eat less highly processed foods such as pastries, crisps or biscuits, and replace them with healthier alternatives such as nuts, seeds and fruit. 

• Eat lots of foods high in fibre.

 

Examples of changes to diet:

• Eat fewer highly processed foods such as cakes and biscuits.

• Choose leaner cuts of meat instead of processed meat options.

• Grill rather than fry foods. 

 

Losing weight 

If you are overweight, reducing your weight will reduce the workload of your heart, help keep your blood pressure down and lower your cholesterol. Weight gain is directly related to the calories you consume. Remember that losing weight involves both eating healthily, reducing your calorie intake and increasing your daily physical activity.

 

Alcohol

Too much alcohol can damage the heart muscle, increase blood pressure and lead to weight gain. During the weeks after your heart surgery, it is best to limit the amount of alcohol you drink. Small amounts, for example a half pint of beer or a glass of wine, will do you no harm. If you are taking sleeping tablets, remember that alcohol will have a more powerful effect.

 

Everyone should avoid binge drinking, but this is particularly important if you are taking anticoagulant tablets (i.e. warfarin). Too much alcohol can interfere with the anticoagulation process so, if you do drink alcohol, you should only have a small amount.

Remember to drink responsibly, find out more at drinks aware uk 

High blood pressure

Otherwise known as Hypertension; this refers to a higher-than-normal pressure flowing through the arteries of the body. As well as affecting the coronary arteries, it may lead to damage to kidneys, brain, eyes and other organs in the body. If you are known to have high blood pressure, you are likely to require antihypertensive medication to control it. It is not uncommon to require more than 1 medication, sometimes up to 4. It is important this medication is taken regularly as prescribed and must not be stopped suddenly unless under medical supervision. Your GP may ask you to occasionally monitor your own blood pressure at home.

 

Smoking /Vaping

If you were/are a smoker, you will have been strongly advised, whilst in hospital, that you MUST stop smoking. Although easy to enforce in hospital, once home, it may be tempting to slip back into old habits. Although it is not something that is going to be easy, this is one of the most important lifestyle changes you can make. Speak to your practice nurse, GP or local smoking service team for more advice and help regarding quitting and which aids are available to you.

 

Devon Smoking Service is part of the NHS and provides FREE support and advice to assist people wishing to give up smoking. Specially trained staff can help you to understand why you smoke and give you ways to cope when you decide to stop.

Tel: 0800 2982654

 

NHS Smoking Helpline Tel: 0800 1690169

Or visit: www.nhs.uk/smokefree

 

Physical activity

Many of us do not take enough exercise. It is important to review just how active you used to be. Some forms of exercise are harmful, particularly those that are associated with sudden extremes of effort or require a lot of straining. e.g. heavy weightlifting. The best exercises involve a lot of free movement, with little resistance i.e. cardiovascular exercise. These include walking, jogging, cycling and swimming. 

 

Physical activity helps:

• Lower high blood pressure and prevent high blood pressure from developing.

• Improve your blood cholesterol levels.

• Maintain, or reach, a healthy weight.

• Control your diabetes, if you are diabetic.

• Improve general well-being and speed up recovery following heart surgery.

Once you have completed a cardiac rehabilitation course, aim to exercise 5 times a week for at least 30 minutes, at moderate intensity (i.e. an exercise that makes you feel warm and slightly out of breath). Alongside this, keep as physically active as possible e.g. housework, gardening, hobbies, golf, bowling. In general, be more active more often. For advice on how to gain the most benefit from exercise, speak to the Cardiac Rehabilitation Team

Diabetes  

Diabetes is a condition in which the blood sugar is raised to an extent that it leads to damage of the blood vessels throughout the body. Patients with diabetes are at a higher risk of heart attacks. If the blood sugar is only slightly elevated, you may not be aware that you are affected.

 

If you are diabetic, it is important to gain good control of your blood sugar. This reduces the chance of a narrowing developing in the heart’s arteries. All patients diagnosed with, or a suspected diagnosis of, diabetes should have regular reviews of their diabetes with their practice nurse, GP or with the diabetes team at the hospital. 

 

As part of the pre assessment process, all patients will have blood tests. All patients will be screened for prediabetes. This test is called a HbA1C which provides a 3-month window. This test will identify if you are reaching a pre diabetic state which will be manged by your GP or a diabetes nurse.

 

Find more information at diabetes uk

 

Stress

Stressors are a part of everyday life. There is some evidence that those who find it difficult to manage their stressors are more likely to suffer from heart disease. Stress puts an immediate strain on the heart by increasing blood pressure and the pulse rate. Relaxation and meditation may help you to avoid this.

 

Find more information and advice about stress and your health 

 

Useful telephone numbers

 

Local cardiac rehabilitation centres

 

Devon

• Plymouth (01752) 431 812

• Kingsbridge (01548) 855 985

• Torquay (01803) 527 062

• Exeter (01392) 403 973

• Barnstaple (01271) 341 531  

Cornwall

• Liskeard (01579) 373 535

• St Austell & Newquay (01726) 873 086

• Truro (01872) 246 904

• Redruth and Penzance (01209) 318 063