This booklet has been compiled to help you and your family following your heart attack

Open Heart Surgery Advice Booklet Lancashire Cardiac Centre INTRODUCTION
You have been advised to have open-heart surgery, either to replace
one or more of the heart valves or to have coronary artery bypass grafts
(CABG), or both.
This booklet has been compiled to offer information, advice and
reassurance to you and your family both before and after your heart
surgery. The nursing staff are always available to answer any queries or
help with any worries.
If you have a problem and are unsure what to do or you wish to speak to
someone concerning your recovery, you can contact the Patient Care
Telephone 01253 657718 (office) or through the main hospital
switchboard 0n 01253 300000 and ask for bleep 825.

Coronary arteries are the blood vessels, which carry blood to supply the
muscle of the heart with oxygen, its source of energy. There are 3 main
 Right Coronary Artery
 Left Anterior Descending Artery
 Circumflex Artery
Coronary arteries can become narrowed or blocked, by the build up of a
fatty substance in their walls. When the blockage is severe it causes
chest pain, as the blood supply to the heart muscle is restricted.
In coronary artery bypass surgery, a bypass graft is carried out. At one
end the graft is attached to the aorta (the main blood vessel coming out
of the heart) and the other end is attached to the coronary artery beyond
the blockage. A bypass graft is created for each of the main coronary
arteries affected by coronary artery disease.
The Surgeon will use a blood vessel from the patient’s own body as the graft. This is usually a vein removed from the leg. The leg veins lie just under the skin and may be removed without interfering with the health of the leg.Some patients may have long incisions in their legs, but some may have several very small incisions if your surgeon is using the Endoscopic Vein Harvesting technique (EVH).In some patients, perhaps because of varicose vein problems, leg veins may not be suitable and other vessels are used. An artery, which runs inside the chest wall, known as the internal mammary artery is usually used for a graft on the LAD ( left anterior descending artery). SURGERY FOR HEART VALVE DISEASE

The heart pumps blood around the body. Within the heart there are four
valves, which ensure the blood flow is unrestricted and goes one way.
Heart valves can become damaged or diseased and this may cause
them to leak or block up. This abnormality causes strain on the heart,
which the patient may recognise as breathlessness on exertion and
tiredness. The names of the most commonly affected valves are the
mitral and aortic.
Port Access valve surgery is a new way of performing heart valve
operations, which allows the surgeon to operate through small holes or
ports in the chest wall between the ribs. This type of surgery involves
similar steps as the traditional open chest heart surgery but does not
involve a large incision in the breastbone. Because it requires a smaller
incision it may shorten your stay in hospital and reduce the recovery
time. In some patients the surgeon may start a Port Access valve
operation but due to clinical circumstances the surgeon may have to
change to a traditional open chest procedure.


For both CABG and Valve surgery the Surgeon will explain the operation
to you and the associated risks, and you will then be asked to sign a
Consent Form. You must be satisfied with the details given to you and
understand the operation and its implications before signing. More
information is available on a separate information leaflet.
Please feel free to discuss any concerns or worries you may have with
any nurses or medical staff involved in your care.
Your Consultant will already have explained the risks associated with
your operation when he saw you in clinic, or on the ward. If you or your
family require any further information please ask to speak to your
Named Nurse or one of the Doctors caring for you.
Please tell the Doctor or Nurse if you have any allergies, for example to
any drugs or to elastoplast tape. They will also want to know about your
past medical history, any operations and the medications you are
presently taking. (Please bring the medications with you). You will be
asked about your social circumstances. If you think that you will require
any assistance or convalescence arranging on discharge, please tell
your Named Nurse on admission.
The Nursing Staff will shave your chest, arms and legs and ask that you
take two showers using antiseptic soap scrub. Towels are provided.
You will be asked not to eat or drink prior to surgery. If your operation is
in the morning you will be starved from the previous night. If you are to
be operated on later in the day you will be given tea and toast at 6am.
You will be able to drink water until your operation. The nursing staff will
inform you of these times. A pre-medication will be given on the day of
your operation and your Nurse and a porter will escort you on a trolley
up to the Operating Theatre.

An anaesthetist is a doctor who is specially trained in anaesthesia, the
treatment of pain, and the care of very ill patients (intensive care). An
anaesthetist will visit you prior to your surgery and carry out a careful
evaluation of your past medical history and general health. You will be
asked question about the following areas:
General health: how well have you been in the last 6 months?
Heart problems: i.e. how long have you been suffering them, what
makes them better or worse. You will be asked about your blood
pressure control, previous heart attacks, and strokes.
Medical History: Do you have additional medical problems such as:
diabetes, epilepsy, gastric reflux, asthma or previous surgery?
Previous Anaesthetics: Any problems or reactions that you or your
family have had in relation to anaesthesia.
Medications: These will include G.P. prescribed, over the counter, or
complementary therapies.
Allergies: any reactions to medicines, foods, substances such as latex.
Dental Work: It is necessary for your anaesthetist to know if you have
any loose teeth, caps or crowns, so that damage may be avoided with
breathing tubes.
In addition you will be examined. Particular attention will be paid to your
heart and lungs, and assessment of your ability to open your mouth. You
should also inform the anaesthetist of any neck stiffness or pain when
moving your neck.
Pain Control: The anaesthetist will discuss pain control with you. After
the operation your anaesthetist will ensure you receive strong pain killing
drugs to keep you comfortable, they are given in the following ways:
Infusions: Powerful pain killing drugs (eg. Morphine) are given by a
patient-controlled system (PCA), whereby once awake, a patient can
press a button to deliver a dose of pain killer when he/she feels the need for it. Safety features are built into this system to prevent overdose. The side effects of morphine, nausea, vomiting and itching, we can usually treat with medication. Drowsiness may also occur. Intrathecal (spinal) morphine: Strong pain- killers are given to you before your operation an injection into the lower back. The signals from the nerves coming out of your spinal cord are numbed by pain- killers and this will prevent you getting pain from your operation site. The effects of this injection last for around 24 hours. The advantage of this method is that a very small dose of morphine may be used directly to the nerves, therefore, side effects, such as, itching and nausea may be reduced. However there is a small risk of a headache. Nerve damage is a rare complication of spinal anaesthesia. IN THE OPERATING THEATRE

The Ward Nurse will hand over your care to the Theatre Nurse after
checking your details. You will then be taken into an anaesthetic room
where the Anaesthetist will administer you anaesthetic and from this
point you will be aware of nothing until the operation is over. At this time,
you will be placed back in your bed and transferred to the Cardiac
Surgery Intensive Care Unit (Known as CITU).

You will be looked after carefully in the Cardiac Surgery Intensive Care
Unit for about 24 hours. The Doctors and Nurses require a lot of
machinery, lines and drains to monitor and care for you in the immediate
post operative period, please do not be alarmed at all of the equipment
that you see and the alarms you hear on the unit. The majority of these
lines and drains will be removed the following morning. You will be
assessed and treated by the physiotherapist on the first morning
following your operation.

The Cardiac Surgery Unit is a 20 bedded intensive care unit which has
been purpose-built for the care of patients who have undergone heart
surgery. It is situated on the second floor of the Lancashire Cardiac
Centre at Blackpool Victoria Hospital.
The staff members include the Consultant Surgeons and anaesthetists,
surgical registrars, sister and/ or charge nurses, staff nurses, nursing
assistants, physiotherapists, technicians and other support staff.
Our aim is a trouble-free recovery following your heart operation. Please
feel free to ask any member of staff about anything that you are worried
or unsure about.


Visiting hours on the unit are between 2pm – 4pm and 6pm-7pm.
Children under the age of 12 are not permitted. Some people feel that
seeing their relatives after the operation puts their minds at rest,
whereas others do not wish to visit until the following day when the
patient may be back on the ward. Perhaps discussing the matter with
the nurses before the operation may help.
Your relative may telephone at any time by dialling direct on 01253
657770, visiting can be discussed with the nurse caring for the patient,
and we will do our best to accommodate relatives' wishes. We allow 2
visitors per patient (close family only please) anytime. There is no
overnight accommodation available on the cardiac unit.
Most patients get tired after about half an hour with their visitors but do
not be alarmed if the patient dozes off after 10 minutes -this is perfectly
normal. Feel free to ask any questions that you have, we are here to
help and will do our best to do so.
Obviously, everybody is different and some operations take longer than
others, so it is impossible to give relatives a precise time that the
operation will finish. Relatives are welcome to ring at any time and we
would appreciate it if you could restrict the number of people telephoning
to the immediate family and if possible elect a spokes-person that can
communicate with the nurse caring for you, and return information to the
rest of the family.

Every patient is an individual and your recovery time following surgery
varies immensely. Most patients will stay in the unit for a period of 12-18
hours. Once your Consultant or Registrar has seen you and they are
happy for you to be discharged out of the unit, all patients are then
transferred to Ward 38 or Ward 39.


Personal property is not allowed on C.S.U, so all belongings will be
packed away by the ward staff into a locked cupboard once the patient
has gone to theatre and unpacked once the patient returns to the ward.
Gifts of flowers and fruit should not be sent until the patient is back on
the ward. Any valuable items should be taken home where possible
otherwise they will be sent to the main hospital safe.

You may be attached to a cardiac monitor for 24 hours, this is just
routine. You will also have your blood pressure, temperature, pulse and
respiration rate recorded every 2-4 hours. You may still have chest
drains in place but sometimes these will have been removed whilst you
are in the C.S.U. You may also have pacing wires which, if not in use,
will be coiled and covered with a dressing. These are usually removed
about the fourth day after the operation. (These wires are a
precautionary measure in case your heart rate is slow following surgery).
The Physiotherapist will continue to see you on the ward.
Visiting on ward 38/39 is between 2.30pm to 4.30pm and 6.30pm until

It is possible to take a bath or shower after 48 hours of surgery but
following cardiac surgery this generally is not possible for a number of
The nurses on the ward will advise you of when to take a shower or
bath. Before this can happen your wound needs to be healing well with
no oozing of fluid from the wound. All drips and drains need to have
been removed before you can shower or bathe and some patients will
have had pacing wires inserted in theatre. These need to be removed
also. This usually occurs around the 4th day after your operation.
Some general points to note are outlined below.  All dressings need to be removed before having a bath or shower.  Don't use any soap, shower gel, body lotion, talcum powder or other bathing products directly over the healing wound.  It's all right to allow the shower water to gently splash onto the healing wound. However don't rub the area, as this will cause pain and might delay the healing process.  Only have a bath if the healing wound can be kept out of the water. Don't soak the area as this might soften the scar tissue and re-open the wound.  Dry the healing area carefully by patting it gently with a clean

Surgical site infections compose of up to 20% of all infections that
patients acquire while they are in hospital. At least 5% of patients who
undergo surgery develop an infection in the surgical wound. The
majority of these infections are preventable and measures are taken by
hospital staff before, during and after the operation to reduce the risk of
infection. One of these measures is to give intravenous antibiotics
before, during and after the operation. The use of these precautionary
(prophylactic), antibiotics has been shown to reduce the risk of infection
following surgery.
There are a number of things that you can do to look after your wound,
lower the chance of infection and encourage healing.

Not all surgical wounds need dressings. The purpose of a dressing is to:
 Provide ideal conditions for healing  Protect the area until the wound is healed  Prevent stitches or clips catching on clothing
The sternal wound and leg wound dressing are removed after 3 days
providing that the wound is dry and not soaked with blood or any other
liquid. Once the dressing is removed it is important that you do not touch
the healing wound with your fingers. The healing wound can then
usually be left without a dressing.
Some people like to continue wearing a dressing over the area for
protection, especially if clothing is going to rub against it.
If this is the case, apply the dressing carefully and don't touch the inside
of the dressing. There is no need to use antiseptic cream under the

Most surgical wounds heal without causing any problems. However,
wound infections are one of the most common complications after
surgery. This means that germs have started to grow in the wound and
this can delay normal healing. Wound infections are usually treated with
a course of antibiotics, but occasionally further surgery is needed.
A surgical wound is the cut made in the skin by your doctor during an
operation. At the end of the operation, most cuts are stitched to allow the
skin edges to come together and heal.
The skin edges usually form a seal within a day or two of the operation.
This time varies from person to person and from operation to operation.
Certain people are more likely to develop wound infections and your
Doctor will discuss this with you.
Those at higher risk include people who:
 Have a condition or treatment that affects their immune system,  Have a major operation, such as cardiac surgery. Your Doctors and Nurses will do everything that they can to prevent your wound from becoming infected while you are in hospital, but it is important that you know how to tell if you are developing an infection after you go home. If a wound becomes infected, it may:
If you are concerned about your wound or if you develop a high
temperature, or notice any of the signs listed above, you should contact
the helpline number or, your GP. Wound infections can be treated
successfully if they are diagnosed early.

The medical term for stitches is sutures. Other methods used to close a
surgical wound include metal clips or staples, and adhesive dressings or
Some stitches are dissolvable and don't need to be removed. Other
types of stitches, and clips or staples have to be removed by a nurse or
doctor. If this is necessary the hospital will arrange for the district nurse
team to remove them when you are discharged home.
Stitches, clips and staples are usually removed between 5 and 21 days
after treatment, depending on the type of operation you have.


Dissolvable stitches will usually disappear on their own in 7 to 10 days.
Non-dissolvable stitches may not be removed for up to two weeks.
You may see small pieces of the stitch material poking out of the healing
wound, which has dissolvable stitches. Don't be tempted to pull on
these. Wait until they fall out on their own. If the stitches cause you pain
or discomfort, contact the helpline or, your GP for advice.
The sternal and leg wounds will either have dissolvable sutures, which
do not require removal, or one wound suture, which will require
removing. If they are not removed before discharge, you will be visited
by the District Nursing Service at home.
If after going home your wounds become red or inflamed and begin to
weep contact the helpline phone number 01253 657720 or your GP. As
long as your wound is healthy and closed, it is preferable that you have
a bath or shower each day. This will help with healing of your wounds.

Your consultant will assess your condition and when he is satisfied with
your recovery, he will give you a proposed date for discharge. This is
normally anytime after the 4th or 5th day following your operation (if you
are well enough). It takes up to three months to fully recover from heart
surgery. During your recovery in the hospital, together with your Nurse
and your family, you will be able to plan for your discharge. We ask that
someone come to collect you, or if you require transport or any
assistance on discharge, please let your Nurse know as early as
Most patients are mildly anaemic on discharge and can therefore expect
to be easily tired and short of breath on exercise. The anaemia will
improve spontaneously as long as you are on a balanced diet. Some
GPs will want to prescribe iron supplements if the anaemia is
If you have had Port Access surgery there are no restrictions to your
after care. Please get back to living a normal life as soon as possible.
You may be able to return to work after 1 month.
If after discharge following valve surgery your symptoms change and you develop a continual temperature, feeling of lethargy and being generally unwell - please contact your GP or Cardiac Liaison Nurse to arrange blood tests as infections can occur following your operation. It is not unusual to be faced with fear and uncertainty when you first arrive home. Indeed, some people feel very unsafe away from the hospital environment. Apprehension about the future can cause mood changes with periods of irritability and frustration mixed with feelings of elation and optimism. Sometimes there is a tendency to feel weepy, often for no apparent reason. Concentration may be reduced and sleep disturbed. These feelings are considered ‘normal’ reactions to the physical and emotional trauma you have experienced and will not last. However if the symptoms persist they may interfere with your recovery and you should talk to your doctor. Family members tend to be overprotective when you first go home. Remember- they have had a worrying time too and need time to realise that you can undertake certain activities. Talk to your partner/family about how you feel, be open and honest about your feelings. It is normal to have good and bad days. Remember the good days are to remind you that you can feel normal. If you do too much on a good day, it may be followed by one or two 'bad days’, so learn to pace yourself. If you wake up one morning and feel that you could cope with anything, just do a little more than the previous day. RECOVERY

The breastbone (Sternum) which was divided during the operation takes
8-12 weeks to fully heal, and is now held together with stainless steel
wires. These will remain in your chest. We advise that you support your
sternum whilst coughing with a cushion or rolled up towel.
Patients often experience muscular pain, discomfort and numbness -
particularly in the chest, neck, back and arms. This is a part of the
healing process and should gradually improve. If the symptoms persist
or get worse following discharge, then you should consult your GP.
The best form of exercise you can do is walking. This will have played
an important part of your recovery in hospital. Walking will help you to
gain the maximum benefit from your heart surgery and will improve your
quality of life.
Discomfort may also be experienced in the leg from which the vein has
been removed for the coronary artery surgery. You may experience
feeling of numbness or pins and needles around the leg wound. This is
quite normal. A degree of swelling of the leg may also be experienced
often persisting for some months. This can be alleviated by wearing
support stockings and by elevating the legs whilst sitting in a chair.
Generally your stockings should be worn for about 4 weeks from your
operation, night and day, until the swelling subsides. Then for the
following 2 weeks the stockings should be taken off at night time, but
should be put back on first thing in the morning. When resting try to keep
your legs up (the higher they are the quicker the swelling will go down).
You will be assisted with your hygiene needs and your mobilisation
within the first few days after the operation. You may seem a little
unsteady and weak at first but this will improve.
Early mobilisation is important as it prevents complications. In the first
few days after surgery you will be sat in a reclining chair. As your
condition improves you will gradually be assisted back to full mobility
and independence by the time you are ready for discharge. You should
feel well enough to wear your own clothes, i.e. tracksuit or loose fitting
shirt and shorts or skirt. Ladies may feel more comfortable wearing a
soft bra or crop top.
The first walk at home should be that of a similar distance to the walk you have already done in hospital. An adequate distance is that which a steady pace makes you feel slightly breathless. REMEMBER you always have to return. You may walk in cold weather, but wrap up well. Have a daily walk and increase the distance gradually -approximately 30-50 metres. You may initially be breathless after walking upstairs or getting dressed, but this should settle within 5 - 10 minutes and you should not be gasping. If it is lasting longer than this, contact your own GP, Ward 38 (01253 657738) or Ward 39 (01253 657755), The Cardiothoracic Liaison service on 01253 657720. By gradually increasing the distance you are walking, you could be walking 2-3 miles by your clinic appointment, remember everyone is an individual, some people may be doing more, others less. Occasionally, a few days after open- heart surgery, you may feel very depressed and down. This is quite normal after major surgery, it will gradually improve. The Ward Staff are always available if you want someone to talk to about this. You may find you run on quite a short fuse immediately after you go home. Once again this is normal. If you can, talk about it. Although you have to suffer the physical pain and all that major surgery entails, it is important not to forget how those at home have also suffered, but in a different way. It is equally as frustrating, tiring and lonely and it is important for your partner or carer to have a break during the day, instead of pushing themselves too far. DO'S AND DON'TS:

Whilst waiting for your sternum to heal.
(approximately 8-12 weeks after your operation)
 NO digging the garden
 NO heavy lifting e.g. the grandchildren  You can do light household duties e.g. dusting or washing-up.  Ten weeks after your operation you can usually cycle or start swimming. Start of easy and build it up, just like with your walking.  Three months after your operation - you can play golf again, but start at the driving range before playing eighteen holes.
Build up all the activities gradually but keep active, and establish a
regular exercise routine.For specific activities discuss with your

This depends on the type of work you do, but is usually approximately 6
weeks to three months after the date of operation. Most people should
be able to return to their previous occupation, although you should avoid
excessive overtime. The time needed to prepare for return to heavy
work will obviously be rather longer than for a desk job. If you have had
Port access surgery your return to work will be sooner. If you require a
medical certificate, ask the Nursing Staff.
You should discuss your individual circumstances with your Consultant,
GP and your employer. If a change of employment is suggested, then
the Employment Advisor at the Job Centre may be able to help you.


Most people are able to enjoy a holiday abroad approximately 10-12
weeks after surgery. Under normal circumstances, you should then be
able to fly. Confirmation of safeness to fly is usually given at the post-
operative visit. Do check your holiday insurance before you travel. Long
haul flights are not recommended for 6 months after surgery.

DVLA guidelines state that you are able to drive at 4 weeks post heart
surgery, providing there are no other disqualifying conditions. This is for
group 1 licence holders only i.e. motorcycles and cars. For further
information visit the website
write or telephone the DVLA.
But the following Consultants would recommend that you do not drive
until you have had your follow up appointment, this is approximately 6- 8
weeks post op.
Mr Au
Mr Duncan
Mr Tang
Mr Sogliani
Mr Bittar
Mr Alexiou
Mr Zacharias – will allow his patients to drive at 4 weeks post op, but
you must have had your GP check that your sternum is stable prior to
Mr Millner – adheres to the DVLA recommendations and will allow you
to drive at 4 weeks post op, but there should be no other disqualifying
We recommend that you inform your Insurance Company of your heart
surgery, just to ensure there is no possibility of you invalidating your
Holders of LGV and PCV licenses or must inform DVLA. The phone
number for the DVLA Medical Section is 08706000301 or


You may resume when you feel fit enough although don't be too
energetic at first! Ensure you are the passive partner to begin with. As a
rough guide, if you are able to climb two flights of stairs with out any
problems you should be able to resume sexual activity. Occasionally
Beta-Blockers can cause impotence. If this problem is experienced
speak to your GP as this can be treated.

If you are on anticoagulants post- operatively, you will be given an
appointment for the Anticoagulant Clinic (at your local hospital or GPs
surgery) on discharge. If you require transport, please inform the
Nursing Staff.
Always carry your anticoagulant booklet with you whether you are going
to the Clinic or not.

You will be sent an appointment through the post, approximately 6-8
weeks after discharge, for a post- operative check.
Mr. Duncan's clinics are held on a Thursday, either at Blackpool or
Mr. Sogliani’s clinics are held on a Thursday, either at Blackpool or
Mr. Au's clinics are held on a Monday, either at Blackpool or Lancaster.
Mr. Millner's clinics are held on a Monday, either at Blackpool or
Mr Tang and Mr Zacharius’s clinics are held on alternate Wednesdays at
Mr Zacharius also holds a clinic at Preston on alternate Wednesdays.
Mr Bittar and Mr Alexiou clinics are held on alternate Tuesdays and
Thursdays at Blackpool.
It would be useful if you could either bring your tablets with you or a list
of the tablets you are taking and at what intervals.

You will be referred to your local Cardiac Rehabilitation team on
discharge and they will contact you at home, (see pg 35/36).

Patients with their own teeth should visit the dentist every 6 months if
they have a new heart valve (either tissue or mechanical). Go to the
dentist immediately if you have any problems with your teeth i.e.
toothache, etc.
Advise the dentist that you
(a) Have a new heart valve or
(b) Are on anticoagulants for either three months or for life.
Expect to have to take Amoxicillin (3gms) one hour prior to any dental

If treatment is not prescribed on discharge it is because it is not required
at this stage.
Please ask your GP or Practice nurse to check your blood pressure
once a week or fortnightly. If your blood pressure rises, they may
recommence treatment.

If treatment is not prescribed on discharge, it is because it is not
required at this stage. You may need to go back on water tablets if your
GP recommends it.
If you start to feel more breathless and both of your ankles begin to
swell, please consult your GP. It is normal for the leg that has been
operated on to swell, but the other leg should not be unduly swollen.
Don't hesitate to ring your GP about any immediate or urgent problems.
If you have any worries after discharge, you can leave a message on the
Heart-line answer phone and a member of staff will call you back.
Tel: 01253 657720 and speak to the Cardiac Liaison nurses
Or contact The Patient Care Advisor on 01253 657718, or Ward 38/39.

It is common for anyone who has recently been in hospital to feel
extremely tired. This is normal and should be the limiting factor to your
progress. Rest as required, particularly after lunch, as you did on the

Don't hesitate to take painkillers, usually Paracetamol or similar. Aim to
take them regularly at first. Try to avoid getting pain, rather than waiting
for it and then treating it. Stronger painkillers can be obtained from your
GP. It is quite common for the pain to get worse when you go home. The
pain can be anywhere between your waist and your neck. Don't be a
martyr, the pain will eventually get less. If the pain persists and is
unrelieved, contact your GP or HelpIine.
You may experience some numbness near or around the scars from
where the vein has been taken. This can also occur around the sternal
scar if a graft has been taken from the internal mammary artery and is
quite normal.
Very occasionally you may still experience some angina after your
operation and this should be reported to your doctor.
If your sternum " clicks" and the pain increases, inform ward 38/39 or
your GP. Usually if it is an occasional click it is nothing to worry about.

The painkillers that you will have been taking may make you
constipated. The painkillers containing Codeine (e.g. Solpadol) are
usually the main cause. Should you become constipated, don't leave if
for more than a couple of days, consult your GP or chemist for advice
about taking Laxatives. Take a high fibre diet, plenty of fruit and
vegetables, walk around the house every hour or so and drink plenty of
fluid. All of these will help.

The Nurse discharging you will give you a seven-day supply of
medication, which has been prescribed for you by the Doctor. The Nurse
will explain the medication, dosage, frequency and continued
administration. Any medication that you have been previously taking
prior to your operation should be discontinued and only the medications
given to you on discharge should be continued. You will also be given a
letter for delivery to your GP. This letter tells the GP about your
operation, medication, and that you have returned home and will now be
under his/her care again. Advice about convalescence and any
appointments that you need to attend will be given to you.
You will then need to contact your GP surgery for a repeat prescription
before the week is over. Never run out of your tablets.
There are different groups of drugs used in the treatment of heart
The doctor decides which combination of drugs is best for you.
 You should always know what tablets you are taking and when to
 Are there any side effects I should be aware of? You should keep an up-to-date list of all your tablets and dosages with you at all time. Never stop taking them without contacting your GP. If you are unhappy about any of your tablets, you must discuss this with your GP, who will advise you. The following section contains a list of the drugs that are commonly used to treat heart disease. ANTIPLATELETS

These make the blood cells less ‘sticky’ which helps to reduce the
chance of a blood clot forming inside your arteries. This helps to lower
the risk of further heart attack.
 ASPIRIN should always be taken with food.
 CLOPIDOGREL Usually given as a 28- day course after angioplasty and stent insertion into a coronary artery. It may also be given in place of aspirin.

These reduce the amount of work the heart has to do by widening the
blood vessels. They can help to lessen the effect of the damage caused
by a heart attack. They can also be used to treat high blood pressure
and heart failure.
 RAMIPRIL (Tritace)
 ENALAPRIL (Innovace)

These act in a similar way to ACE inhibitors. They also lower blood
pressure. Can be used as an alternative to ACE inhibitors.
 LOSARTAN (Cozaar)

These reduce the amount of cholesterol in your blood, which can help
to reduce to reduce the further build-up of ‘fatty’ deposits in the
coronary arteries. They should be used in conjunction with a low fat diet.
You must avoid citrus fruit whilst on this medication, particularly
grapefruit/ grapefruit juice. You can discuss this with your GP.

These are sometimes called ‘water tablets’. They increase the amount
of urine produced by the kidneys, which removes excess fluid from the
body. This helps to reduce the strain on the heart. Some diuretics are
used to lower high blood pressure.

 WARFARIN Used to thin the blood where there is a possibility of
blood clot formation or evidence that a blood clot may be present. The dose may vary according to the thickness or thinness of the blood, and this will be determined by regular blood tests at the anticoagulant clinic at the hospital, or your GP surgery. ANTI-ARRHYTHMICS

These help to control fast or irregular heartbeats.
 SOTALOL (Betacardone)

 Remember that these are guidelines only, and each person must
reach their own level of recovery and fitness at their own pace.  While some people will recover very quickly, others will take much longer. Use common sense and allow yourself the best chance of a smooth recovery.  In the early stages of recovery, you may find that you are more tired than usual but this should pass as you regain fitness and confidence.

 Stay around your home and garden for the first few days then start
venturing out on the street increasing your daily walks by an extra lamp post a day or to the next house.  Take things easy around the house – light washing up or making a  You may play with your children or grandchildren but not lifting or  Resume gentle hobbies such as sewing, painting and puzzles, playing board games with you children or grandchildren but remember no lifting them!  Avoid heavy housework, such as cleaning or vacuuming or cooking a  Rest on the bed after lunch and have early nights.  Take the stairs gently in the first few days, stopping to rest if you become short of breath or experience any pain/discomfort.  No moving or lifting of heavy objects.  Have visitors but not too many and not for too long.

 Become more active around the house.
 Begin short periods of light housework such as dusting and washing  Gradually increase the amount of food you eat at mealtimes.  Take shorter afternoon rests in the chair.  Continue to have visitors as long as you are able to cope with them.  No moving or lifting of heavy objects.  Walk to the local shops, if nearby, for light shopping, but avoid  Avoid public transport but you may be taken out in the car for a drive.  Start going for daily, gentle walks outside and gradually build these

 Increase household tasks to include mopping floors, light hand and
machine washing. Do not carry the wet washing out of the machine, get help to do this, but you can hang the washing out.  Begin light social activities such as going out for a meal, or to the pub, but do not stay out too long or go out too often.  You can go to the supermarket but do not push the trolley particularly when full and can make short visits into town, but do not carry heavy shopping.  Make beds, but not stripping and changing sheets.

 Trips to the cinema and other social events.
weeks five to SIX

By this stage you should be doing most of your normal day-to-day
activities and be walking up to 3 miles a day
 Washing and polishing the car in stages, with regular breaks. Do not
lift the bucket when it is full of water. AFTER SIX WEEKS

You may push the trolley at the supermarket – even when full!
You should be back to your pre-op level of activity and beyond.

 Healthy eating is an important part of looking after the heart.  It is a good idea to look carefully at what you eat, as often what we  This is one area where the whole family can benefit from changes  The easiest way to make sure that your diet is healthy is to eat as The most important points to remember are:

 One of the most important things we can do to reduce the risk of
heart disease is to reduce our fat intake.  We should consider the total amount of fat in our diet, especially if being overweight is an issue. It is important to look at the type of fat that we eat.
Saturated Fat

 This comes from animal fat and should be avoided.
 This is the type of fat that will build up in arteries and includes
cheese, butter, cream, lard, full fat milk, visible fat on meat, pies and pastries.  Where fat is needed a suitable vegetable alternative should be used. These are “healthier” types of fat and these can be divided into two types.
Monounsaturated Fat

 This will not increase blood cholesterol levels or “clog up” arteries and
may also have a slightly protective effect.  It is found in olive oil and margarine’s made from olive oil. It is also  There may be a protective effect from including a little in the daily Polyunsaturated Fat

 Again, this will not increase blood cholesterol or “clog up” arteries.
 It is found in sunflower oil, corn oil, soya oil and safflower oil and the

Do not use a huge amount of these fats or they will increase your
body weight.

*NB Benecol and ProActive are new margarine products, which are a
little different. They both contain naturally occurring chemicals found in
plants. These chemicals are called sterols or stenols and research
suggests that they may be able to help reduce blood cholesterol. They
are available to buy at supermarkets and can be used as directed on
 Avoid excess fats when choosing foods.
 Use healthier cooking methods. Some suggestions to try are to: grill, dry roast, casserole, boil, poach, steam or use a microwave, pressure cooker or slow cooker.  Include a variety of chicken, turkey, fish and meat.  It is useful to include some red meat, as it is a good source of iron, but buy smaller amounts of lean meat and trim off visible fat.  Use poultry and fish as an alternative.  Oily fish contains a type of oil called ‘Omega-3’, which is thought to be protective against heart disease. It is found in fish such as mackerel, herrings, pilchards, kippers, sardines, salmon and trout. Eating one of these fish twice a week is helpful.  Look for the lowest fat alternatives – especially for foods such as milk, cheese, yoghurt, fromage frais etc.  When looking at food labels try to ensure that food is less than 5 Carbohydrate

 Carbohydrate is found in starchy and sugary foods.  On the whole sugary foods do not provide any goodness, so we should be careful about eating too many of them.  The largest part of your food should come from the starchy foods. These include bread, rice, pasta, potatoes, breakfast cereals and fruit.  These foods provide a lot of nutrients, which are important to us.  Everyone will need different amounts depending on appetite, activity and body weight, but the largest part of the food that we eat should be the starchy part.

 Increase or maintain a high fibre intake. Fibre may help to reduce the
risks of heart disease by lowering cholesterol levels.  Fibre is found in fruit and vegetables and also in wholemeal bread and other foods made from wholemeal flour.  Try some of the many high fibre breakfast cereals. Beans – including baked beans, peas and lentils are also good sources of fibre.  Soluble fibre is found in oats, tomatoes, stone fruit and fruit with edible seeds. It is found to a lesser extent in other fruits and vegetables.  It is thought to be more effective at helping to control blood cholesterol levels than other types of fibre.  Fruit and vegetables are particularly important because they provide vitamins, which will help to protect you from heart disease.  An ideal intake of fruit and vegetables is to include five portions a day. One portion might be one piece of fruit such as an apple, orange or banana, one glass of fruit juice, a small dish or side plate of salad or 2 tablespoons of cooked vegetables. Include a variety of different colours to increase the variety of vitamins!

 Avoid excess sugar, as it is high in calories and will increase weight.

Excess should be avoided, particularly if taking painkillers. If you are on
anti-coagulants - don't binge. It is safer to drink the same amount daily
i.e. a pint per day or one measure of spirits, than to save it all for the
 Drinking some alcohol in moderation is not thought to be
harmful in heart disease.
 Alcohol contains a lot of calories and can cause weight gain.
 Spread the alcohol over the week do not drink the
whole “allowance” in one go!
 Have 1 – 2 alcohol free days each week.
 Keep within the recommended guidelines – which are no more than
14 units of alcohol per week for women and no more than 21 units per week for men. One unit of alcohol is equal to  1 small glass of wine  ½pt of regular beer or lager (not the strong varieties)  1 pub measure of spirits  1 pub measure of sherry or port
Body weight

 Aim to keep your weight within reasonable limits. Following a healthy
eating plan will help keep your weight under control, especially avoiding too many high fat foods.
 Your personal target weight is ……………………

 Common table salt is made from sodium chloride and the sodium part
of salt may be a factor in high blood pressure. “Lo-Salt” could be used instead.  We tend to eat far more than we actually need. Many foods have a natural salt content so we should be very careful about adding any salt in cooking or at the table.  Those people with a raised blood pressure should be taking steps to  All processed foods contain salt or sodium in other forms especially foods such as bacon, processed meats, cheese, and packets of dried foods such as soups. You will benefit from a healthy diet, which is low in fat e.g. high in white meat, fish, vegetables and fruit.

The normal levels are between 3.5-6.9. If you have had bypass surgery,
it is essential that it be kept at 4.0 or below. If you don't know what your
level is, ask your GP to check it about three months after heart surgery
and again at a later date.
If your cholesterol level is raised, it can be reduced initially by a low fat
diet and if necessary tablets. All patients who have had Coronary artery
bypass surgery should be on a cholesterol-lowering tablet. Your present
cholesterol level is ……….

When the Consultant saw you in the clinic and advised an operation, he
would also have advised you to stop smoking from that time. This is very
important as your recovery could be prolonged if you continue to smoke.
Use this opportunity to give up smoking completely.

Smoking increases the tendency of the blood to clot in the blood
vessels, especially in arteries that are already furred up.
Carbon monoxide in cigarette smoke increases the oxygen needs of the
Nicotine increases the heart rate and blood pressure.
However, once you have stopped smoking you halve the chance of a
further heart attack.


Whilst you are in hospital, if you are finding it difficult because you are
unable to smoke, talk to the nursing staff.
You can contact the Smoking Cessation Team on 0845 601 2186 for
support and information. You will need to make the phone call yourself.
You need to think about a day when you are going to stop smoking.
Most people use the day of their heart attack.
The sooner you stop the better. It is never too late.
Identify any smoking patterns you may have, and this will help you to
deal with different smoking situations.
We do understand that stopping smoking is hard. We are here to
support and encourage you, but it has to be your decision to stop.
If you do not feel ready to stop, you need to talk to a smoking cessation
adviser in order to gain the support you will need to help you quit.
Stress is difficult to define or measure, as what is stressful to one person may not be stressful to another. Also each individual’s causes of stress can alter. Stress is a necessary part of everyday life. Indeed a certain amount of stress is considered to be a good thing as it can motivate and help you perform at the peak of your ability. Too much stress, however, affects your health and well-being and can cause emotional, psychological and physical problems. Although it is difficult to prove, stress does seem to contribute towards high blood pressure, angina and coronary heart disease. It is useful to recognise the causes of your stress and realise that almost any event can cause stress. Some causes are obvious, for example redundancy, bereavement, divorce or illness in the family, whilst other causes will require careful thought to bring them out into the open. Stress can also be caused by events that are thought of as pleasant, like getting married, moving house, going on holiday. You may also need to take into account the fact that events tend to be particularly stressful when they are: -  Unpredictable People deal with stress in different ways, they find their own ways of tackling stress and learn ways of coping in different situations. There are many ways of coping with stress – some of these deal with the stress and others simply make you feel better. Here are a few suggestions, which may help you to deal with stress and hopefully improve your quality of life: - Take regular exercise Learn a relaxation technique Pursue hobbies and leisure activities Enjoy time with family and friends Try to keep things in perspective Take on less responsibility – delegate tasks, learn to say ‘No’ Make time for yourself Take short breaks throughout the day Make small, regular changes to your lifestyle
Don’t be worried to seek medical help if you are worried about your

There are a few general exercises you can start a few days after your
operation to prevent stiff shoulders, neck and back. They should be
done gently and not too often. Do the exercises twice a day, repeat each
exercise 3 times. This should only take a few minutes.
Start by slumping in your chair so your whole spine is bent forwards,
then sit up making your spine straight and take your shoulders back.
Now you are in the correct position to start the exercises.
1.Turn your head slowly to look over your right shoulder, hold at the end
of the movement for a few seconds, then turn to look over your left
shoulder and hold for a few seconds.
2. Looking straight ahead, take your chin down to your chest, then lift
your head to look up at the ceiling.
3. Looking straight ahead, take your right ear down to your right
shoulder, then take your left ear down to your left shoulder.
4. Lift your right hand up above your head, keeping your elbow straight
and your arm close to your head, then bend your elbow and stretch as
far down your neck/back as able. Return to the resting position. Repeat
with the left arm.
5. Place your right hand on your right shoulder, take your elbow out to
the side, away from your body; until approximately level with your
shoulder, and do a circle forward 3 times, then change direction. Repeat
with the left arm.
By this stage you should be commencing the Cardiac Rehabilitation
Exercise programme.

♥ The type of exercise which benefits your heart is
♥ This means that you should feel pleasantly breathless and sweaty. ♥ Your pulse rate should rise significantly and should be sustained for ♥ Exercise must be increased slowly and gradually, both in intensity and duration, particularly for those who have previously undertaken very little exercise.  Swimming Suitable cardiovascular exercise  Dancing ♥ Golf and bowls are not classed as aerobic exercise as they are stop / ♥ Sports that are highly competitive impose a sudden severe load on EXAMPLES OF THIS ARE: - Squash Water skiing Take Note: ♥ Activity is not the same as exercise. ♥ Such activities as housework, gardening, and D.I.Y do not cause a significant rise in heart rate over a prolonged period of time as they are stop / start in nature and do not benefit the heart in the same way as prolonged exercise. BENEFITS OF REGULAR EXERCISE

♥ Helps to lower cholesterol levels. Helps to reduce angina/ breathlessness ♥ Helps to normalise blood pressure.

What is it?
Cardiac Rehabilitation is offered to people who have had a heart attack, cardiac surgery and angioplasty & stent. The aims of Cardiac Rehabilitation are: -  To help improve your quality of life by increasing your confidence to exercise regularly in order to strengthen your heart.  To help you understand what coronary heart disease is and the  To help you become aware of the risk factors that, might have contributed to you heart problems and make relevant changes to your lifestyle to reduce them. How do you join the programme? Whilst in hospital your details will be collected and referred onto your local rehabilitation team. Your local Cardiac Rehabilitation team will then contact you at home to check your progress and explain what will happen on commencement of their Cardiac Rehabilitation programme. Below are the local Cardiac Rehabilitation Centres and their contact numbers. If you have not heard from your local centre within 2 weeks of discharge from hospital, please contact them directly. Local Contact Numbers: Other ………………………………………………………………………………………… PATIENT TELEPHONE HELPLINES AND WEBSITES UK and Overseas Heart Society - Heartlink  Heart British Heart Foundation Telephone number: 08450708070 ask for Medical Information Department.  Angioplasty  stents  bypass  pacemakers  Links  Help and support (including online chat)  Information including recipes H.E.A.R.T. UK Telephone number: 01628 628638  Membership available  publications  Information about heart disease British Cardiac Patients Association Telephone number: 01223 846845 Hearts for Life  An owners guide to understanding the heart and its problems  Print out sheets * Recommended Coronary Prevention Group Website: Telephone number: 08711 220 0355  Questions and answers an coronary heart disease and lifestyle Heart Information Network Website: (American)  Patient guides to conditions and treatments  Heartinfo news
Alcohol Support Groups

Telephone number: 020 79073700
Local Support Group (Blackpool, Wyre & Fylde): 01253 752100
North West Lancashire Smoking Cessation Service
Telephone Number: 0845 601 2186
Quitline: 0800 00 22 00
NHS Smoking Help Line
Diabetes Support Blackpool Victoria Hospital Helpline Telephone Number: 01253 303486 – 9.30 - 12 noon. Monday - Friday Diabetes UK Telephone: 020 7424 1000 Website: NHS Direct Telephone Number: 0845 4647 Website: BOOKS  Stop that Heart Attack! ISBN: 1-872362-85-0  Heart Health at your fingertips ISBN: 1-85959-009-8  The Light Hearted Cookbook ISBN: 0-948817-41-0  The Everyday Light Hearted Cookbook By Anne Lindsay ISBN: 0-948817-78-X  ISBN: 0-7513-0826-9  Rosemary Conley’s Low Fat Cookbook ISBN: 0-7126-8462-X  I’m Too Busy to be Stressed We hope that this booklet will help to alleviate any fears you may have about your operation and recovery; but if you or your family have any questions or worries about anything, please do not hesitate to ask. Compiled by: Bernie McAlea, Cardiac Liaison Sister Joanne Bottomley and Tricia Davies, Senior Physiotherapists The Cardiac Rehabilitation Team at Blackpool Victoria Hospital If you have any suggestions for amendments or further inclusions you feel would benefit future patients, please send them to: MATRON CARDIAC DIRECTORATE OFFICE


Only the Westlaw citation is currently available. In re ZYPREXA PRODUCTS LIABILITY LITIGATION. This Document Relates to All Actions. MDL No. 1596. ORDER REGARDING DAVID EGILMAN, M.D., M.P.H. *1 Upon consideration of the moving party's request for an Order to Show Cause, the response of David Egilman, M.D., M.P.H., and having heard oral argument, IT IS HEREBY ORDERED that: 1. Dr. Egilm

Microsoft word - tn jul.doc

TRIGEMINAL NEURALGIA ASSOCIATION TEXAS SUPPORT GROUPS NEWSLETTER JULY 2006 SAN ANTONIO SUPPORT GROUP MEETING – DATE CHANGE The San Antonio Support Group will meet next on August 1 not August 8 as originally planned. Jonathan White, M.D. with UT Southwestern in Dallas will be the guest speaker. For more details, please check the meeting flyer. FORT WORTH

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