What Is Open Heart Surgery
Open heart surgery can take the form of a coronary artery bypass graft procedure to reestablish blood flow in blocked arteries , and/or heart valve surgery to repair or replace a faulty valve.
In the case of coronary artery disease, surgery may be indicated when blockages are too widespread for angioplasty and stenting or if a blood vessel is too difficult or risky to access with a coronary catheter.
Mitral and/or aortic valve repair or replacement are also common open heart surgery procedures and may stem from a case of childhood rheumatic fever, or perhaps valve damage associated with viral or bacterial endocarditis.
Other reasons for open heart surgery may stem from a congenital heart condition or a heart transplant in those with advanced heart failure.
No matter what the reason for your surgery, the recovery time and subsequent exercise prescription are quite similar.
Exercising At A Health Club
After you complete your cardiac rehabilitation, you may be cleared to participate in a self-guided exercise program at your local gym.
Do your homework and find out if the staff is qualified and equipped to work with cardiac patients.
Ask if the trainers have experience working with people with heart problems.
Ensure they have all the relevant emergency protocols in place .
Why Is Cardiac Rehab Done
Cardiac rehab helps people whove had a heart attack or other heart problem recover by outlining an individualized plan for safely improving physical health and identifying and managing other risk factors. Having a heart attack or other heart issue can also be scary and make you feel depressed. Cardiac rehabilitation emphasizes the importance of psychological health and quality of life. It provides holistic support for every part of rehab so youre not alone in reaching your goals.
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What To Expect After Open Heart Surgery Pain Management
Pain management is a big concern for most people who undergo heart surgery. There are many things to think about and we want you to know that you are not alone! Nikhil Kumar MD and Angelia Nadiak, CNP, talk about how your care team works together to make sure your pain is managed. Each person is different and each pain plan is unique to each patient.
Kevin Hodges MD, joins the discussion to add a surgeons perspective on pain management and goals for helping our patients have a smooth recovery.
What to Expect After Open Heart Surgery Pain Management
What Is The Cabg Procedure
- Minimally Invasive Direct CABG
Traditional CABG involves splitting the sternum, stopping the heart, and utilizing a heart-lung bypass machine to keep the blood oxygenated and flowing. Once the vessels are bypassed the sternum is wired back together.
With Off-pump CABG, the heart is allowed to continue beating throughout the surgery and no bypass machine is needed.
More recently, Minimally Invasive Direct CABG has been developed but is less common. Thats because its not appropriate for those needing more than one or two bypasses and can only be used to bypass anterior coronary arteries. This procedure is performed through small incisions between the ribs, and as with Off-pump CABG does not require the heart to be stopped.
Regardless of which type of procedure is performed a new vessel will need to be harvested to perform the bypass. The majority of the time it is the saphenous vein, however, on occasion, the left internal mammary artery can be rerouted and utilized to bypass the affected coronary artery. Arterial grafts also have the benefit of being less likely to become blocked over time. With the use of the saphenous vein, the risk of thrombosis and atherosclerosis is increased.
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Types Of Strength Training
Resistance bands or tubing
Resistance bands or tubing can be a great way to perform resistance exercise because its simple, easy to use, and does not require expensive equipment.
Resistance machines
Resistance machines found in gyms work your muscles but keep your body within a safe guided range of motion.
Free weights
Free weights include dumbbells and barbells and require you to balance and stabilize the weights through the range of motion. If youre a new exerciser, it may be advisable to hire a trainer to help you with correct technique.
How Long Is A Cardiac Rehab Session
Heart rehabilitation following bypass surgery, it should go without saying, lowers the chance of having another heart attack or dying.. Patients suffering from cardiovascular disease might benefit greatly from the physical exercise, health education, and mental health counseling offered by these programs.
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Articles On Living With Coronary Artery Disease
Cardiac rehabilitation can help people with a wide range of heart issues.
Your doctor may suggest that you take part in your hospital’s cardiac rehab program if you have a heart condition or if you had heart surgery or a heart attack. You’ll get an exercise plan that’s designed just for you and learn how to improve your habits, like switching to a healthier diet and quitting tobacco if you’re a smoker.
A cardiac rehab program also offers you emotional support. You can meet others who are going through the same things you are and who can help you stay on track to maintain a healthier heart.
Pathophysiology Of Acute Pain
Postoperative pain mechanisms are complex, but generally speaking, in addition to the nociceptive stimulus from direct tissue trauma, an inflammatory response leads to peripheral and central sensitization in pain experience. Most of the pain after sternotomy occurs because of tissular damage in the skin, subcutaneous tissue, bone, and cartilage.11 Mazzeffi M, Khelemsky Y. Poststernotomy pain: a clinical review. J Cardiothorac Vasc Anesth. 2011 25:1163-78.
The intercostal nerves that arise from the thoracic nerve roots innervate the sternum, ribs, and the adjacent subcutaneous tissue. The main thoracic nerves that supply the sternum range from T2 to T6. The parietal pleura is also densely innervated by pain fibers that can be activated by both mechanical and chemical stimulation. In contrast, visceral pleura has no significant sensory innervation. Pericardium is innervated by sensory fibers from the vagus and phrenic nerves and sympathetic trunk.11 Mazzeffi M, Khelemsky Y. Poststernotomy pain: a clinical review. J Cardiothorac Vasc Anesth. 2011 25:1163-78.
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Sternal Precautions With Physical Therapy
Your physical therapist can work with you in cardiac rehabilitation to help you understand and maintain your sternal precautions. You may find that basic functional mobility is difficult while maintaining sternal precautions.
Your physical therapist can teach you how to move around while maintaining your surgeon’s suggested precautions.Modifications you may learn include:
- Scooting in and rising from a chair
- Walking on stairs without pulling on the railing
- Sitting up in bed
- Using an assistive device, such as a walker or quad cane
Physical therapy is designed to help you return to performing basic activities of daily living, such as brushing your hair and dressing, cooking, maintaining hygiene, and managing stairs.
What Happens After Cardiac Rehab
After you complete your last cardiac rehab session and as part of finishing out your program, the staff may ask you to perform another exercise stress test in order to:
- Reassess the safety of exercise.
- Quantify how much improvement you made in your cardiorespiratory fitness compared with your initial exercise stress test.
- Update your individualized exercise training recommendations to reflect your improved physical functioning.
Even though you graduated from center-based cardiac rehab, you should feel confident in continuing to participate in your cardiac rehab style of exercise, but self-supervised over the long term. Youll also improve the heart-healthy benefits of regular exercise if you continue to use everything you learned about controlling your cardiovascular risk factors, managing stress, cooking heart-healthy meals and avoiding tobacco products. These can help you for the rest of your life.
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It Enhances Quality Of Life And Provides Emotional Support
Cardiac rehab also involves educating you about your hearts health. Plenty of studies show that early cardiac rehabilitation after CABG improves quality of life and self-efficacy.
In addition, cardiac rehabilitation will help improve your mood, your health and lessen depression. Incidentally, meeting people who have the same condition as yours will give you a sense that you are not alone.
Things To Expect After Open Heart Surgery
In a previous blog, we offered advice on how to prepare for open heart surgery. Today, we are going to share with you some tips on what to expect during the recovery phase of this procedure.
Although each patients experience is different, below are four common elements of the recovery process that youll want to consider:
Pain After surgery, pain is to be expected given the fact that the chest bone is the slowest to heal. So be aware that you will experience pain when you breathe, cough, sneeze and laugh. Usually after six weeks, this pain subsides. If youve undergone bypass surgery, there might even be pain in your legs because of the grafts that were used during the procedure. Light walking and general mobility can help alleviate the pain and discomfort in your legs.
Medication Once youve been discharged from the hospital, your doctor will likely prescribe pain medication to manage discomfort. Take these medications according to your doctors instructions. If the medication isnt helping to reduce the pain or youre experiencing negative side effects, contact your doctor to discuss other options.
Though everyones recovery is different, take note of these key factors of the recovery process. When a person is cleared to go home, the caregiver as well as the patient will be provided with a set of post-surgery care instructions from the hospital, which may overview these as well as other topics.
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Comparing The Prevalence Of Chronic Pain After Sternotomy In Patients Undergoing Coronary Artery Bypass Grafting Using The Internal Mammary Artery And Other Open Heart Surgeries
how to cite: Kamalipour H, Vafaei A, Parviz Kazemi A, Khademi S. Comparing the Prevalence of Chronic Pain After Sternotomy in Patients Undergoing Coronary Artery Bypass Grafting Using The Internal Mammary Artery and Other Open Heart Surgeries. Anesth Pain Med. 2014 4:e17969. doi: 10.5812/aapm.17969.
Determine Appropriate Recovery Intervals
Depending on the patients functional capacity either active or passive recovery intervals can be used. In recent years, IAT and High-Intensity Interval Training have been trialed in patients in rehab after CABG. One such protocol that was shown to be effective involved an 8-minute warm-up, 4×4 minute intervals at 90% max HR, with 3-minute pauses of walking at 70% max HR, and a 5-minute cooldown.
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Who Works With You
Different experts help with different parts of your rehab. Some people who might be on your team:
Physiatrist. They are doctors who specialize in rehab. They tailor a plan to your needs and oversee the program to make sure it’s going well.
Physical therapist. They teach you exercises to improve your strength and the range you have when you move your arm, leg, or whatever part of your body had the operation.
Occupational therapist. They help you regain the skills you need for some basic activities in your everyday life. They might teach you how to cook meals, get dressed, shower or take a bath, and use the toilet. They’ll also show you how to use gadgets that can help you care for yourself more easily, such as a dressing stick or elastic shoelaces. Some occupational therapists will visit your home to make sure it’s safe and easy for you to get around.
Dietitian. They’ll help you plan healthy meals. If your doctor has told you to avoid salt, sugar, or certain foods after your surgery, the dietitian can help you find other choices.
Speech therapist. They help with skills like talking, swallowing, and memory. Speech therapy can be helpful after surgery that affects your brain.
Nurses. They care for you if you’re staying for a few weeks or months in a rehab center. They may also come to your home to help track your recovery and help you with the transition to life back at home.
Show Sources
Johns Hopkins Medicine: “Care and Recovery After Brain Surgery.”
How Rehab Helps You Recover
It takes time and effort, but it’s worth it. Keep in mind some key goals of your rehab program:
- Improve movement and range of motion in the part of your body where you had surgery
- Strengthen your muscles
- Help you walk again — first with crutches or a walker, and then on your own
- Teach you to do daily activities, such as climb stairs, get up from a chair or bed, get in and out of a car, get dressed, and bathe
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Your Personality And Mood May Change After Open
After open-heart surgery, many people experience personality and mood changes. The most commonly experienced emotions are depression, fatigue and anxiety. These can be caused by being on bypass, anesthesia, or medication such as oxycontin. You may experience mood swings like crying or getting angry or easily frustrated.
I mostly experienced this after my second open heart surgery when I was a teenager and my third open-heart surgery. After both of them, I experienced depression, anxiety and PTSD. Before my second open heart surgery, I was more outgoing but afterward, my personality changed and I was quieter and self-reflective. I struggled with suicidal thoughts and mood swings. After my most recent surgery, I finally got the therapy I needed after years of not seeking help. If you are struggling, please find help, be open with your doctor and make sure you have someone to talk to.
Exercise After Cardiac Surgery
For six to eight weeks:
- DO NOT LIFT, PUSH, OR PULL objects heavier than 10 pounds .
- Avoid trunk twisting.
- Use the incentive spirometer four to five times a day.
- Each session, do 10 slow, deep breaths. Be sure to relax your shoulders.
- Take your time between breaths.
- Placing your hands over your chest incision, perform two or three strong coughs.
- BMC also offers Breathing Exercise classes.
Mobility and Flexibility Exercises
- Do these exercises before and after walking.
- Do not hold your breath .
- Do 10 repetitions of each exercise two times a day.
Walking Program
- For the next four to six weeks before starting cardiac rehabilitation, you will be doing a walking program twice a day.
- Measure walking in terms of time not distance .
- If you have chest pain, shortness of breath, lightheadedness, or palpitations, STOP YOUR ACTIVITY!
Helpful hints about walking
- Wear comfortable clothing and shoes.
- Wait at least one hour after meals to do your exercise and walking program.
- Avoid hilly areas and excessive stair climbing. Pace yourself when climbing stairs.
- Exercising in cold and windy or hot and humid weather puts stress on your heart. If temperatures outside are below 40 degrees or above 75 degrees, then exercise indoors.
- Riding a stationary bike or walking on a treadmill is an acceptable alternative to walking.
Cardiac Rehabilitation
Cardiac Rehabilitation consists of:
Rest
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Who Needs Cardiac Rehabilitation
Anyone who has had a heart problem, such as a heart attack, heart failure, or heart surgery, can benefit from cardiac rehabilitation. Studies have found that cardiac rehabilitation helps men and women, people of all ages, and people with mild, moderate, and severe heart problems.2
However, some people are less likely to start or finish a cardiac rehabilitation program, including:
- Studies show that women, especially minority women, are less likely than men to start or complete cardiac rehabilitation.3,4 This may be because doctors may be less likely to suggest cardiac rehabilitation to women.
- Older adults. Older adults are also less likely to join a cardiac rehabilitation program following a heart problem.5 They may think they are unable to do the physical activity because of their age, or they may have other conditions that can make exercising harder, such as arthritis. The need to address other physical conditions makes cardiac rehabilitation especially useful for older adults, since it can improve strength and mobility to make daily tasks easier.2,5
One of the benefits of cardiac rehabilitation is building healthier habits, such as finding a physical activity that you enjoy, to help you stay heart-healthy for life.
Sternal Precautions May Vary
Your sternal precautions may be different depending on your surgeon or the facility in which you are participating in acute cardiac rehabilitation. Some healthcare providers stress the importance of pain and your own body signals in determining activity. Others may allow you to reach one arm overhead or lift up to 10 pounds.
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The Four Phases Of Cardiac Rehabilitation
Posted On: March 13, 2018
It takes time, persistence, dedication, and patience to recover from a heart attack. Your cardiologist at UPMC Western Maryland will help to facilitate a four-part cardiac rehabilitation program so you can return to an optimal state of health after a cardiac event.
A team of specialists work together to improve your mobility, decrease risk factors for a future heart attack or another serious health problem, and assist you and your close family members with psychological concerns as you adjust to a new reality after a heart attack. The first phase of your recovery begins before you even leave the hospital.
Protecting The Sternum After Surgery
Your healthcare team may guide you in sternal precautions meant to prevent excessive pull on your healing breastbone, called dehiscence.However, cardiac experts have different approaches on how to protect your sternum after you’ve had open heart surgery, so be sure to follow the specific advice you’ve been given.
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