Discharge Advice Following Cardiac Surgery

Every patient is different; therefore a doctor's advice is extremely important for recovery. It can take up to three months for some people to regain full strength and return to their normal activities. Heart surgery can be physically and emotionally draining, so you will need to give yourself time to recover. It is not unusual to feel frightened or anxious about leaving hospital, however, your doctor and nurses will not let you return home until they feel you are absolutely ready. The following information will guide you through your recovery process at home.

Level of activity

• An important part of your recovery involves becoming more active. Activity helps you heal and prevent infection. At first you will sit in a chair, then that will be increased to taking walks around the corridor.
• Your level of activity depends on many factors. Usually patients that walked prior to having their surgery will walk out of the hospital upon discharge.
• Walking and everyday activities in the house can be resumed immediately after discharge.
• Your physical therapist will provide you with information and go through a plan with you to follow both when you are in the hospital and when you return home.

Shortness of breath

• You may find you are not as fit as before for a period after your surgery. This is completely normal.
• It will take time for your exercise tolerance to build up again.
• If you notice your breathing getting worse, particularly at night, please contact your doctor immediately.
• If you have heart failure, please follow the instructions provided by your doctor.

Medication

• It is important to understand all the medications your doctor has prescribed. Make sure to know all your medications by name.
• The pharmacist will explain all your medications and side effects individually. Always ask questions if you do not understand.
• You may be prescribed medications to:
• Lower your blood pressure and heart rate
• Prevent irregular heart rhythms
• Thin your blood
• Lower your cholesterol
• Provide electrolytes to your heart
• Soften your stool
• Other medications you were taking before your surgery
• Prior to discharge, please make sure you know how and when to take all prescribed medications.
• If you have diabetes, make sure you know how and when to take your oral tablets, injectable insulin and how to test your blood glucose. The pharmacist will discuss this with you as your medication regimen may have changed after your surgery.
• If you are prescribed a blood thinner called Warfarin or Coumadin, you will be provided with additional information on this medication. It is important to take the dose prescribed and follow up with the anticoagulation clinic for blood tests as recommended.
• It is important to take all your medications as instructed. Do not take any other medications not prescribed by your doctor.
• Ask your doctor about restarting old medications including vitamins, herbal supplements and other over-the-counter medications.
• Your prescription will be sent to the Cleveland Clinic Abu Dhabi outpatient pharmacy and you will pick it upon discharge prior to leaving the hospital.
• If you have any further questions regarding your medications please ask your doctor or nurse, or ask to speak to a pharmacist.

Pain

• Everyone will have pain after surgery. This may be in your chest, leg, neck and/or back.
• Pain medication will be prescribed to you on a regular basis. It is recommended to take it in the morning in order to carry out your daily activities, as well as at night to get a good night's sleep. The frequency of your dosage depends on the severity of your pain.
• Never exceed the daily recommended dose of your pain medication.
• If you get a sudden onset of chest, neck or back pain and it does not resolve, please seek medical help immediately.
• Pain medication may cause constipation. Please refer to the bowel care section of this document for more information on how to prevent constipation.

Wounds

• It can take your wounds from six to eight weeks to heal. The breastbone needs eight to twelve weeks to heal.
• Upon discharge, you should not have any remaining dressings on your wound sites unless authorized by your nurse. Clear instructions will be given to you on how often these dressings will need to be changed.
• Shower your body using regular soap or shower gel.
• Avoid direct contact with soap on wounds and do not rub them. Instead, allow soapy water to run over the wounds.
• Pat dry wounds and avoid vigorous rubbing.
• Do not apply creams or powders to wounds and avoid applying perfumes until your wounds are healed.
• Sometimes your leg or chest wound may become red and itchy along the suture site. This is not unusual and can be due to dissolvable stitches or glue.
• Women will need to wear a supportive bra (no underwire) to support their chest.
• If your wound becomes increasingly painful, hot to touch, has a discharge, or you develop a fever, please contact your doctor immediately.
• Follow the instructions provided by your physical therapist to protect your breastbone. For example, restrictions regarding heavy lifting.

Leg swelling

• If you had a vein removed from your leg, it may cause some swelling. It is important to elevate your legs when sitting. The swelling will reduce over time.
• Avoid sitting for long periods of time and do not cross your legs.
• Getting up and moving frequently will help. If the swelling persists for a long period of time, please inform your doctor.
• If you have been told you have heart failure, you may notice you have some swelling in both lower legs and ankles. If you notice this getting worse and there is an increase in your weight, please inform your doctor.

Travel & driving

• You are advised not to drive for one month after your surgery.
• Sit in the back seat and bring a pillow or towel to support your chest.
• If you do travel, do not travel alone and avoid sitting for long periods of time on the plane or in the car.
• Always take all your medications with you for the duration of your trip.
• You are advised to check with your travel insurance company regarding medical coverage on your trip.

Sleep

• You may have experienced a poor sleeping pattern during your stay in hospital and this may persist for a few weeks when you return home.
• This will improve in time as you recover at home in your own bed and surroundings.
• Disrupted sleep is normal and will also improve. You may also experience nightmares.
• If you are tired during the day, take a nap. However, if you nap too much, it may affect your sleeping patterns at night.

Sexual activity & alcohol

• You can resume activity after two to four weeks depending on your progress (if you can walk up two flights of stairs comfortably).
• Do not do anything that does not feel comfortable or puts any pressure on your chest or leg.
• Avoid any activity after a large meal.
• If you drink alcohol, it is important not to have any alcohol six weeks after your surgery.
• It can cause abnormal heart rhythms, delay healing and increase leg swelling.
• After six weeks you may resume adhering to the American Heart Foundation Guidelines:

On average, one drink per day for women and two drinks per day for men. (A drink is 355ml (12 oz.) of beer, 118 ml (4 oz.) of wine, 44 ml (1.5 oz.) of 80-proof spirits, or 29 ml (1 oz.) of 100-proof spirits.)

Diet

• Your appetite may be poor after your surgery, but it is important to eat well.
• Try to eat small portions often rather than big meals if that helps.
• Ensure good protein intake for wound healing, such as beans, eggs, meat, fish and chicken.
• Include plenty of fresh foods, fruits and vegetables.
• Eat grilled and roasted foods. Try to avoid fried foods.
• Drink six to eight glasses of water per day, unless otherwise advised. This will keep you hydrated and keep your bowels moving regularly.
• Ensure good iron intake, such as red meat without the fat, green vegetables (green beans, cabbage and spinach). If you are taking Warfarin, please ask your nurse about specific dietary precautions when taking this medication.
• You are advised not to commence a weight-reducing diet until six weeks after your surgery or on advice from your doctor during your follow-up appointment.
• If you have diabetes, follow your diet and ensure close monitoring of your blood sugar levels. Maintain normal values to promote good wound healing and recovery.
• If you have not seen a dietician as an inpatient and you would like to discuss your heart-healthy diet, please do not hesitate to ask your doctor to refer you to the nutrition clinic.

Bowel care

• Constipation can become an issue for some people after surgery due to the intake of many medications and reduced mobility. Please take note of your bowel patterns, eat fruits and vegetables, drink plenty of water and continue to mobilize.
• Foods high in fiber are important. Eat whole grain and brown breads rather than white. Prune juice, dates and senna are natural laxatives and can be taken if necessary.
• If you need further assistance, please contact your doctor.

Dental hygiene 

• If you have had heart valve surgery it is important to look after your teeth and oral hygiene.
• Brush your teeth twice daily and look out for signs of infection. Infection in your mouth can travel to your heart and valves.
• Inform your dentist of your surgery and make sure to have regular check-ups.

Things to be aware of

• Limit visits from family and friends according to how you feel during the first two weeks following your discharge.
• You may feel up and down, have mood swings and even be tearful at times. This is normal and will improve as you get back to normal life as you know it.
• Wear comfortable, loose-fitting clothes that do not put pressure on your wounds.

If you encounter problems at home

• If you experience sudden shortness of breath, chest pain, wound problems, chest palpitations, or extreme or worsening fatigue, please call emergency services at 999, call your doctor or return to the Cleveland Clinic Abu Dhabi Emergency Department.
• If you have heart failure and have been told by your doctor or nurse to weigh yourself, please do so every morning before breakfast and after going to the bathroom. If you notice an increase of more than two kilograms for more than two days in a row, please contact your doctor.
• Upon discharge, you will have a follow-up appointment with your surgeon in the Cleveland Clinic Abu Dhabi Heart and Vascular clinic usually within one to two weeks.
• A cardiac rehabilitation exercise program at is also available following your cardiac surgery. Further information will follow after your follow-up appointment.
• Remember, always do what feels comfortable for you. Listen to your body.

Information sought

• NHS Cardiac surgery for Patients
• Dietary Guidelines for Americans website
• June Petrie - Cardiac Nurse
• Mahmoud Al Tamimi - Cardiac Rehab Physical Therapist
• Mary Boyle - Cardiac Rehab Nurse
• Marie Daly - HVI Nurse Educator
• Bassam Atallah - HVI Pharmacist
• Jessica Szymura - HVI Dietician
• Dr Johannes Bonatti - Cardiothoracic Surgeon
• Medline Plus: US National Library of Medicine.
• Cleveland Clinic Ohio Health & Recovery Booklet