HEART SURGERY PATIENT'S HANDBOOK

Before your operation, much of your body hair will be shaved off, especially from your chest and legs. You will probably be asked to shower and wash with antiseptic soap to remove bacteria from the skin. This reduces the chance of infection. You should remove personal items such as glasses, contact lenses, dentures, watches and jewellery and give them to family members for safekeeping.

You will be served a light meal, given the pre anaesthetic medications prescribed and will be asked to rest. A good night’s sleep is important, your body needs to be fresh and strong. Ask the doctor or the nurse any last-minute questions, tell them if you are feeling any discomfort or symptoms, you may suddenly develop at this stage.

Medications that will make you relaxed will be given about an hour before the operation. The medication will make you feel drowsy, so remain in bed and try not to move around too much.

You will be taken to the operation room at the pre appointed time, the anaesthesiologist will give you an anaesthetic that brings sleep and freedom from pain during the operation and then the operation will be performed.

Coronary artery bypass graft operations/ Open Heart Surgeries usually last from three to six hours. Their length depends upon what has to be done. Each operation varies in complexity, so its duration can only be estimated.

Hospital has places where a patient's family and friends can wait during surgery. Be sure the reception knows where your family will be waiting during the surgery. The patient’s relatives can wait in the reception lobby or in relatives’ dormitory or in the respective rooms (in the case of Deluxe and Suite room patients). As soon as the operation is over relatives will be informed about it and about the progress of the patient, but no patient's relatives will be allowed to visit the patient till the patient is in the Surgical ICU.

When your surgery is over you will be taken to the recovery area for your post-operative care. You will remain in this area until your condition is stable and you are ready to be transferred back to the ward. This usually takes two or three days. In this area, your heart function, lungs and urine output and other vital parameters are carefully monitored.

As soon as the operation is over, relatives will be informed about it and about the progress of the patient. One relative will be invited by the sister in charge in the intensive care unit to visit the patient and for direct first-hand viewing. Most patients at this stage would be unconscious, paralysed and on ventilator and therefore only viewing the patient and first-hand conversation with the intensive care doctor about the patient’s clinical condition is possible. Whenever the patient regains consciousness (usually within 4-6 hours), and when he is taken off ventilator (6-24 hours), the sister in charge will invite one relative to interact with the patient. Every day at 7'O Clock in the morning, patient's relatives can meet the intensive care doctor on duty, who will brief them about the progress of the patient. Any time if the relatives are uncomfortable, they can contact the reception desk, who would organize their meeting with the doctor on duty.

When you awake in the recovery room you will hear the sounds of equipments and be aware of activity within the unit. There will be a number of tubes and pieces of equipment attached to your body which are essential for your proper treatment.

An endotracheal (or breathing tube) will be in your mouth and passes through the vocal cords into the windpipe. While this tube is in place you will not be able to talk but the nurses are specially trained and will anticipate your needs. This tube is connected to a respiratory machine (Ventilator) which assists you with your breathing. When you are fully awake after the operation and no longer require assistance with your breathing, the tube will be removed.

The nurse will help you sit up in bed and cough vigorously to clear your lungs of secretions. For the next day or two, you will receive oxygen through a mask. In addition, you will have several tubes in your veins to administer fluid, blood and medications. These tubes will be removed one by one in the next one or two days.

A urinary catheter will drain your bladder continuously and enable the nurse to keep an accurate record of your urine output. Sometimes it may give you a feeling of pressure in your bladder and make you feel as if you need to urinate. This will usually be removed two days after surgery.

Drainage tubes are placed around your heart at the time of surgery and passed through the skin near the lower end of your chest incision. The drains prevent blood from accumulating around the heart during the postoperative phase. Sometimes small wires are taped on your lower chest. They have been placed at the time of surgery to regulate your heart rate if required. These wires will be removed before you go home.

Free access to relatives is not permitted in the recovery room. However, relatives will be kept informed about the progress of the patient. Every day at 7:30 AM duty doctor will brief your progress to your relatives. Relatives can sit in the reception lobby.

HOW LONG YOU WILL STAY IN RECOVERY AREA ?

Usually, on the 2nd or 3rd post-operative day, patients are shifted to the ward where under close observation, your mobility and activities will gradually increase. Doctors and Nurses will assist you in:

It is not at all unusual to feel apprehensive about returning home. Sometimes these feelings are prompted by concerns about leaving the security of the hospital, with its expert medical team and equipments. Remember that no patients are allowed to go home until the doctor thinks their condition is satisfactory for them to continue their safe recovery at home.

Depending on your recovery, the senior consultant attending you will organise your discharge. Since you have been through a major operation, the preparation of the discharge summary may take some time as it must be checked and rechecked to ensure that an accurate account of your treatment has been stated. If you feel it needs correction inform the doctor right away.

FATTY FOODS ARE BEST AVOIDED

Cholesterol - Nutrition experts generally agree that keeping blood cholesterol at normal levels reduces the risk of heart complications in persons who have coronary artery disease. It is a good idea to check your blood cholesterol periodically. If it is high you will have to reduce it by proper diet and exercise. If diet and exercise don’t do the job, medications may be needed.

Smoking has a bad effect on the heart, as well as on other parts of the body. It is a major risk factor for additional heart disease after your surgery. If you smoke, quit and if you don’t, don’t start. You may drink alcoholic beverages in moderation only, NEVER exceeding one and a half drink. (60-90 ml of 42% proof whisky or 200 ml. of wine or 375 ml. of Beer)

MEDICATIONS

You should only take medicines which have been prescribed in the discharge summary. Don’t keep taking medicines that you took before the operation unless they are specifically prescribed. Before you leave the hospital make sure you know which medications you must take and what each tablet is for. This is most important. If you are to take anticoagulants you must understand how often follow-up blood tests are to be done.

WHEN SHOULD THE DOCTOR BE CONTACTED ?

Usually, patients are called for follow-up in the OPD by prior appointment. But you can always contact us if there is any problem. Your referring cardiologist will wish to follow your progress, after your visit to the surgeon and in the long term make sure you have appropriate appointments. Call the Doctor on duty if there is any problem (phone numbers have been provided in the booklet and in discharge summary). Call the doctor if there is any sign of infection (redness or drainage at the incision), fever, chills, increased fatigue, shortness of breath, swelling on ankles, weight gain over five pounds (2 kgs) in 5 days, change in heart rate or rhythm or any other sign or symptom that seems disturbing.

For sedentary workers, the average is four to six weeks. For persons who must perform heavy work, the time is six weeks or longer.p>

Routine at Home

Patient Should Follow These Principles

Week 1

Week 2

Week 3

Week 4 & 5

Week 6 & 7