CARDIOVASCULAR CENTER

CAR DIAC SURGERY A GUIDE FOR PATIENTS CAR DIAC SURGERY | A GUIDE FOR PATIENTS

CARDIOVASCULAR CENTER

Beginning with the world's first mitral valve surgery in 1923, the Division of Cardiac Surgery at Brigham and Women’s Hospital is New England’s oldest and largest heart surgery program. Our mission statement is quite simple — to provide the highest quality patient care while advancing the frontiers of cardiac surgery practice, science, and technology . We provide the complete spectrum of adult cardiac surgery. We care for patients with coronary artery disease, valvular heart disease, heart failure, aortic aneurysms, adult congenital heart dis ease, and for patients requiring circulatory support and cardiac transplantation. Our goal is to provide you or your loved ones — our patients — with the highest level of com passion, care, and competence that modern medicine has to offer. CARDIAC SURGERY A GUIDE FOR PATIENTS

Table of Contents

Your Heart | 1-1

Diagnostic Tests | 2-1

What is Coronary Artery Disease? | 3-1

What is Valvular Heart Disease? | 4-1

What is Thoracic Aortic Aneurysm? | 5-1

What is Congenital Heart Disease? | 6-1

What are Tumors of the Heart? | 6-5

Preparing for Surgery | 7-1

In the ICU | 8-1

After the ICU | 9-1

Example of Daily Schedule | 10-1

At Home | 11-1

Frequently Asked Questions | 12-1

Information and Resources for Patients and Families

Glossary of Terms | 13-1

Cardiovascular Resources | 14-1 YOUR HEART T OR F EA R H OUR REAP RING P Y Y OUR H EART S 1-1 NT TIE A P s om ng r OR u l F to F s T to ng R lu EA er ood w H bl To o E back l dy H o T blood GU ID E b To GH A the U blood | HR O T oxygen-rich W pumps LO It F send . y upper D dy O oxygen-poor Y GER UR To bo hat LO t bod S B s urn t er m dy m o w re dy your o Fr lo bo Fr upper bo vessel ns of s DIAC vei R ood part A bl The C all he f. t to tsel . i a are es d o o l b heart. body nto a i r blood ri i s our e heart d e l t a y n l a the e z e d further art c your he t e l n the d n a e i om . d de fr pumps ar l a c e u q s ded . The ry e e vi an ts: t r a nsi ta ding i r a r body di ood that s r e b arte or par s s r e H a i bl s k r o W e st l c s u m ta m a veins. our e inclu e b ta y ta r u ch d rt or mbers h c the m f hr s or , y uscle ta a orta a t n or ge ar chambe r a o a e l a s. a a h a er t r a e o Y m l RT or h ch c h a s to ng g en-ri f lled bod ng a H r he nto rc a e w o t ing i rest o mb l ts: a c ic yg r lu A is e h T x r e b ar is four e p p endi the s t . ed o he omina ry p rac rt tic rterie end u t s endin u o E o w t Cha ta s a re e te and of Y o a a r t to abd tho aor desc asc h ar r a P rie m a h c s hea OUR e h r rt two desc aor divid w t l c i r t t rt e o ug o is car ea d • • • • • H Y A Fou pa our h The int w o H g lar m o r f t n e v The I I e h T There e h T n a It hear It Y ll thro a the 1- 2 Y OUR H EART C RA DIAC cha allo Yo I and bac Fou • • • • u m kw w r c b h lose b h t move T le move T h t to T rig the move T r d.ar er eatr l ft he he he he ood S e e Va ht mo of vent lun a o b URG t lv a m pu t o a t r o ha ve r th or ve ou o fr o fr to yd . es ic it pr gs s n lmon e ric tic uspi ra t f f tri mo m m evnt o hea o r t n a o le. l o ur cl E f t t va m va ve d he he get tr e. d t y ar RY v he lve t lve . t alv wfaorr d val bl e h he l ri The eft oxy l ght od e val e n al ve al s, | ri f t lows a se low t ght ge A whi ve t o ve al atri rium fr valv n. h t ntri thr U G al om s ows ch ve um bl e bl ows es o ntri od cl e r ope i od flow ugh nto E D I blod e open into t s cl into bl n f o to e to the ing each o t o to th R O F to d e T N E I T A P P va val T atr R ul r l i ic v gh v mo i e e u u S t m s pi nic d C A H M B R E S R v A en N i gh D t r t V icl LV A e E S O F A T or H A E t o H a r E t R A ic va Mi T L v va e ef lv a L tra n l t v t ef e t r e r iu l t ic m le CAR DIAC SURGERY | A GUIDE FOR PATIENTS

The Heart Muscle and the Coronary Arteries

Your heart is a muscle and needs oxygen-rich blood like other muscles in your body. Your heart muscle gets its blood supply from large blood vessels called the coronary arteries. These coronary arteries come from the aorta and wrap around your heart to feed it with oxygen-rich blood.

Internal mammary artery Left coronary artery Right

coronary Y artery Circumflex O artery U R H E

Left anterior A

descending R

artery T

Posterior descending artery

(FRONT VIEW )(BACK VIEW ) CORONARY ARTERIES

There are two main coronary arteries: • The right coronary artery (RCA) supplies blood to the bottom and right side of the heart, including the right ventricle. • The left coronary artery (LCA) supplies blood to the rest of the heart, including the back of the heart and the left ventricle.

1-3 DIAGNOSTIC TESTS S ES T T OR F IAGNOSTIC REAP RING P D CAR DIAC SURGERY | A GUIDE FOR PATIENTS

DIAGNOSTIC TESTS

Chest X-ray Electrocardiogram (ECG)

What is it? What is it? A chest x-ray is a picture of your heart and An electrocardiogram, also called “ECG”, lungs. In an x-ray, your doctor can see if records the electrical activity of your heart. your heart or aorta is enlarged. Your doctor It can show irregular heart beats or changes can also see if there is fluid or abnormal air in your heart muscle such as enlargement in your lungs. or damage.

What will happen? What will happen? When you have a chest x-ray, you will be asked When you have an ECG, you will be asked to stand or sit in different positions. An x-ray to lie down and electrodes, which feel like D technician will point the camera toward your sticky patches, will be put on your chest, I A

chest and ask you to hold your breath while arms and legs. Wires will be attached to these G the picture is taken. electrodes. These electrodes connect you to N O

the ECG machine. You will be asked to lie S T

still while the ECG machine records the I

Echocardiogram (Echo) C electrical activity of your heart. T

What is it? E S

An echocardiogram, often called “echo,” T uses sound waves to see how well the heart is S working. It measures: • the heart’s size and shape • how well the heart valves are working • how well your heart fills and pumps blood out to your body (this is known as the “ejection fraction”)

What will happen? During an echo, a cool gel is put on your chest. A wand called a “transducer” is moved around your chest while pictures are taken. The gel makes it easier to move the transducer around. If you are thin, you may be more sensitive to the pressure of the wand. Echocardiogram (Echo)

2-1 CAR DIAC SURGERY | A GUIDE FOR PATIENTS

Cardiac Catheterization

What is it? A cardiac catheterization, also called cardiac cath or coronary angiogram, is a procedure where dye is injected into your veins and then x-rays are taken of the coronary arteries. Coronary arteries are the blood vessels located around the outside of your heart that supply oxygen-rich blood to the heart muscle itself.

A cardiac catheterization shows if you have blockages in your coronary arteries. It also shows which arteries are blocked and how severe the blockage is. The test tells your doctor how well Cardiac Catheterization Lab your heart muscle and valves are working. S T

S What will happen? E The procedure room is cold. This is because the equipment used for your T catheterization needs a cool environment. You will be given warm blankets. Once C I

T you are in the cardiac cath room, you will be moved onto the procedure table. S You will lie on your back with a pillow under your head. The nurse may give you O

N medications through your IV line to help you relax and make you drowsy. You will G

A still be able to talk, answer questions, and follow instructions like, “Hold your breath.” I

D Next, the site of the procedure (either your wrist or groin) will be numbed with a local anesthetic, similar to what your dentist may use. During the procedure, you should feel only pressure in your wrist or groin. Please let the team know if you have a lot of discomfort. You may feel some warmth in your chest, arms, or body for a few seconds as the dye is injected.

When the procedure is finished: • An assistant will put pressure on the area for 5-30 minutes to stop any bleeding. • A nurse will frequently check the pulses in your feet and arms and the procedure site for bleeding. You may have a bump under the skin and bruising. This is normal and will go away in about a week.

If the catheter is inserted in the leg: • You will have to lie flat and you will not be able to sit up in bed for 6-8 hours • You will not be able to get up to go to the bathroom for 6 hours.

2-2 CAR DIAC SURGERY | A GUIDE FOR PATIENTS

Stress Test

What is it? A stress test is a test used to detect coronary artery disease or to determine a safe level of activity for you following a heart attack or heart surgery. During the stress test, your heart’s electrical activity or ECG is recorded while you exercise on a treadmill or a bicycle. If you are unable to exercise, your doctor may order other tests to see how your heart and blood supply work under stress.

What will happen?

ECG wires will be placed on your chest and arms D to monitor your heart. If your stress test is being I A done with medication, it will be given through an G N

IV in your arms. This medication will increase O your heart rate without exercise. S T

Stress Test I C T E S T S

2-3 CAR DIAC SURGERY | A GUIDE FOR PATIENTS

Computerized Tomography (CT Scan)

What is it? A “CT” or “CAT” scan is a special x-ray that can see parts of your body that cannot be seen on regular x-rays. CT scans of the chest are often used to examine and measure aortic aneurysms.

What will happen? Images of the Heart The CT scanner is a doughnut-shaped machine. During a CT scan, you will lie on your back inside the machine while pictures are taken. The CT scan table can feel hard, but a CT scan is painless. Sometimes dye is used to see parts of your body more clearly. Dye may be put into an IV, or you may be given the type of dye that you can drink. S

T It is very important that you do not move during the test. S E T C I T S O N G A I D

CT Scan

2-4 CAR DIAC SURGERY | A GUIDE FOR PATIENTS

Cardiac Magnetic Resonance Imaging (MRI)

What is it? The cardiac MRI uses a combination of radio waves in a magnetic field to see a clear picture of the size, shape and thickness of the heart muscle. In addition, your doctor can look closely at the parts of the heart and how it works.

A cardiac MRI takes movie- like pictures that help doctors find many heart problems

such as a heart attack or a D blockage in a blood vessel. I A

Sometimes dyes are used to G N

see your heart muscle and O how well it is working. MRI machine S T I C T

What will happen? E An MRI machine is a long sliding table with a large circle S T at one end. You will be asked to lie on the sliding table. S Someone will help you get into a comfortable position. The person taking the pictures will leave the room, but you will be able to talk to him or her at all times.

As the MRI machine takes the pictures, you will hear loud clicking and tapping sounds. You will be given earplugs to lessen this noise. There is no pain during the test, but you may notice a warm feeling. This is normal. If it bothers you, tell the person taking the pictures. It is very important that you do not move during the test. The technician will ask you to remove any metal on your body, including jewelry.

2-5 2- 6 D IAGNOSTIC T ESTS C RA DIAC in br br wel th ho Th mask Th inj Th A Quan Th Aor th is th a ao c cur e e e a ea ea V r ec w to e is e is tic / ao blo ao t the the t you sec fi w t w w i at Q ed the s w agrm rst t a r t a r o d el a el a tia hile . on S isec y Lun in n p d y int Yo , . ge pa ox a ar th URG see d inva a X-ra flo ny a o lo u t t r t a ygen e n g ti pa th w tes d n. a ve wi sm on b st win is Sc sive t r ys lo vein e ou u r to l Thi s ca an al . o a ai i E mask. e ar Per g c s b t n l d l your r tural . te e RY cal d amount (V ed cl in i fl st n tes t asked tak ear ti aor ows fusi enti l your ed a and usi l Pi ab e | ungs v vi i n e l s a ng e ctur c at A to on nor nt sual pa to of out pe ane of m ar ion il your a U G tir c can fusion r ati mali br the iz Lu radi cathe s y ur of and eath at on wi so ul E D I ng dye be ion y ti l oact arl sm. l ungs. our tha l e scan ter Q s be y t scan Scan aken. of as t of uan iv u hr R O F lung to t sef ul p e aken and i blo the Dye ou t es ictur ti g i an tra nj as tai gh s ta aor d ect show in d vel when T N E I T A P w as is v sh a flo il eva luatin g e n r s you dye o l e o Sca wi f w. l b oxygen s ws wil easd e yo ho th int n l u ) in w be o S CORONARY ARTERY DISEASE ? SE SE A I D Y ER RT A OR RY F A IS ON ARING HT A OR REP W C P CAR DIAC SURGERY | A GUIDE FOR PATIENTS

WHAT IS CORONARY ARTERY DISEASE ?

Coronary artery disease (CAD) is a condition where fat and cholesterol, called “plaque,” build up inside your arteries.

What Happens to the Heart Damage and death to heart tissue in Coronary Artery Disease? shown in shaded area below Plaque build up in W

With coronary artery disease, oxygen-rich blood the coronary artery H no longer flows easily to the heart muscle. blocking blood flow A T Cholesterol or fat builds up on the inside of and oxygen to I

the heart S the artery making the opening too narrow. C

Sometimes the artery can be completely O

blocked by plaque or a blood clot. This blocks R the blood flow to the heart muscle. It can cause O N

discomfort, pain, or pressure in your chest A called “angina.” It may also cause damage to R Y the heart muscle known as a myocardial A infarction (MI), or a heart attack. R T E R

What Causes Y

Coronary Artery Disease? D

PLAQUE BUILDUP IN CORONARY ARTERIES I S

Causes you can change: E • High fat and/or high cholesterol diet A S

• Smoking E ? • High blood pressure What are the Symptoms? • Being overweight • Lack of exercise Symptoms can vary from person to person. • Excessive alcohol intake The most common symptoms are: • Chest pain Causes you cannot change: • Chest pressure or discomfort • Family history • Jaw pain • Gender (CAD is more common in men; • Back pain however, the risk in women increases • Arm pain after menopause) • Shortness of breath • Age (rate of CAD increases with age) • Indigestion • Diabetes • Nausea or vomiting

3-1 CAR DIAC SURGERY | A GUIDE FOR PATIENTS

Women with CAD are more likely than men to have nausea, vomiting, shortness of breath, and back or jaw pain. Sometimes people do not have any symptoms at all. Your coronary artery disease may be discovered during a check up or when you come to the hospital for another surgery.

How is Coronary Artery Disease Diagnosed? ?

E Electrocardiogram (ECG)

S •

A • Stress test E

S • Cardiac catheterization I Cardiac magnetic resonance imaging (MRI)

D • • Exercise echocardiogram Y R

E For more information about tests, look in the T

R “Diagnostic Tests” Section of this booklet. A Y

R How is Coronary Artery Disease Treated? A

N CAD can be treated one of four ways or O in combination. R

O 1. Making lifestyle changes such as: Internal C • Quitting smoking mammary

S artery I • Eating a low fat/low cholesterol diet T

A • Exercising regularly H 2. Taking medications to help ease the work of

W Vein your heart and to lower your cholesterol. graft Blocked 3. Angioplasty or stents to open your arteries. coronary arteries 4. Coronary Artery Bypass Surgery (CABG). CABG C ORONARY ARTERY BYPASS GRAFTS How is Coronary Artery Disease Treated with Surgery?

When surgery is the treatment of choice, new pathways are created around the blocked artery that allow blood to flow to the heart muscle, bypassing the blockage.

3-2 CAR DIAC SURGERY | A GUIDE FOR PATIENTS

This new pathway, or bypass graft, is created Internal with an artery or vein that is taken from another mammary part of your body, such as your leg, chest, or arm. arteries

The blood vessels most commonly used in bypass surgery are:

• Internal mammary arteries located inside your chest. Radial • Saphenous veins located in your legs. arteries

These veins are taken out through a small W

incision (endoscopic) in your leg. This H A

procedure is called “endoscopic vein T

harvesting.” I S

• Radial arteries located in your arm. Saphenous C

veins O R O

Incision for CABG Surgery N A

The breastbone or sternum is separated so that R the surgeons can reach your heart. This is called Y a sternotomy (stir-not-o-me). A R T

ARTERIES AND VEINS USED FOR THE BYPASS E R Y D I S E A S E ?

STERNOTOMY

3-3 VALVULAR HEART DISEASE ? E AS SE I D T ve l a v l e AR v e l E r wing o e h they g ll t H i h Fo . h c t wha OR u to m F hear r a AR a the e m mil f f si o IS UL u s e r ts ing, den V e en i ur L l-b b l at HT A p te A we REAP RING f o dia our e W V P of g n ” imm i l e e f rity st. n a pa s e majo th ake l l a r e v o t y in vast d n e er a ed y n y th g r jo , y su r t i v i t en Coh lve d c a a ha f o . Dr V ge sur “ CAR DIAC SURGERY | A GUIDE FOR PATIENTS

WHAT IS VALVULAR HEART DISEASE ?

Heart valves guide the blood forward through the heart’s four chambers. The valves open and close like one-way swinging doors to make sure the blood only flows in one direction through the heart. Valvular heart disease occurs when the valves do not open and close correctly.

What Happens to the Heart in Valvular Disease?

When you have valvular heart disease, two things can happen: W H

1| Your heart valve does not open all the way. A T If your valve does not open all the way, the blood has to flow I through a smaller opening than normal. This is called “stenosis.” S V

2| Your heart valve does not close all the way. A L

If your heart valve does not close all the way, the blood will flow V both backwards and forwards through the valve instead of only U L forward. This is called “regurgitation.” A R

Both conditions make it H E harder for your heart to A pump blood to the rest Left R atrium T of your body. Sooner or D

later, your heart will Mitral I S

become weaker and larger. valve E A S

Leaking E Left ? valve ventricle

VALVULAR HEART DISEAS E –LEAKY VALVE

4-1 4- 2 W HAT IS VALVULAR H EART D ISEASE ? C RA DIAC bes blo ec r you Yo to ned su W On Ho he If Ho What cer ho Val • • • • • • • • • • • • • rg your u w b hat om tain o o t ce r r w w vula e yer r d f IV V Rh F Diz In Ch In P S Ca B In w a or s t r s w th a alp m alve ge, o urgeo ir th el epa he . cr fect cr int is D po lc do elin S euma ar est th are dr e enda you. be zi in easd easd Your ita ium oes r y ing wil URG h st Val int e d ir nes ct ug e ion def deg ou pa eal f t H en g er or n ix io th , ti the ti in a ect or ed o eart th osi w ve h t d or ns sur o enra c m b Your o h h ti sho e f ear ns il use r , ears e fev ed r edicat yo pl s a l E geon in Ca lif ep r er nd Di surge Sym also or t r t about aque ur RY er esty nes ti D val your nes an an lace uses on sea e r whet Do l isea i egs w take on gurgi le e on pt es abnor on | ill di choar d. , of w v cto A her o and be alv and ar hi w te of the int br m e il e? tai ch ll e for Treatd U G e l mal r e worki y Va s? o yo abi ankl ath e r v our tr on D alv conside u com ogram E D I eatm making l l he i it v w e sco r e v y e ng. each s t ar al hic me to Disease? ves ent ? R O F ver h soun ra to t nd es ake va ti ne i s se a on lves d, e d T N E I T A P V S ALVE R EPLAC EM ENT U SING M ECHAN I C AL D E V ICES W HAT IS VALVULAR H EART D ISEASE ? S 4-3 NT TIE A P OR F E E V V AL V AL V VE AL IRED AL VE L V R GU ID E A T A EP I V R A Y M F F | AK O E O L AIRING EP R I R AEP R UTURING S Y GER UR S DIAC R A , r l C ace or l to a d you the wil to repl meta like issue use of t of and repair valve ves be e ng o work ri parts t geon sur val he alv a t it v can , s d cial ve fi thod, heart : thods thod make al V me arti around me o t me your valve damage of on ves d aced ve, first valve. sted ge val lves pl l u second a mm e your val kinds s va ia e dj i m th co a ve lves eart al th ur ee ific da h In re va rt yo wo hr mo a ssue nic In l. t t a ur lve. f al e an ti . re o e e ha ca c Repair Replacement it va y m an ar ar l or e valve. ni itsel pla th ve ve Mec A Hum ten ac e re l th, wi p • • • carefully There al V o T al V mechani There it heart clo valv tigh norma re CAR DIAC SURGERY | A GUIDE FOR PATIENTS

Incisions for Heart Valve Surgery

Heart valve surgery can be done using one of three surgical incisions: Mitral

I Sternotomy (stir-not-o-me): An incision is made down the center of your chest separating your breastbone

I Ministernotomy (mini-stir-not-o-me), sometimes called minimally invasive valve surgery: A 3-inch incision is made ?

E either at the top or bottom of your S

A breastbone depending on which valve is E

S being treated. I

D • Minimally invasive aortic valve

T replacement or repair is done through

R a small opening that goes from the top Aortic A

E of your breastbone down to the third rib.

H • Minimally invasive mitral valve

R replacement or repair is done through A

L a small opening that runs from the U bottom of your breastbone. INCISION LOCATIONS FOR V

L MINIMALLY INVASIVE SURGERY

A Some advantages of this type of surgery are: V • Less trauma to the body S I • Less blood loss during surgery T A • Better physical appearance H of the scar W • Less pain at the incisions • Shorter hospital stay • Faster recovery

I Thoracotomy (thor-a-COT-o-me): An incision is made in your rib cage from under your arm around to your back.

4-4 THORACIC AORTIC ANEURYSM ? NEURYSM A ORTIC A ” HAT IS HORACIC W T Dr. Bolman The Thoracic Aortic Disease Program at Brigham and Women's Hospital brings together all the specialists withtreatment of interest aortic diseases. and We bring expertise together all in these the individuals so that we can offer the veryfor best, each and individual least invasive, patient. treatment “ CAR DIAC SURGERY | A GUIDE FOR PATIENTS

WHAT IS THORACIC AORTIC ANEURYSM ?

The aorta is the largest artery that carries oxygen-rich blood out of the heart to the rest of the body. The aorta extends upwards from the heart and then arches downwards through the chest and into the abdomen or belly. The part of the aorta in the chest is called the thoracic aorta. The part of the aorta in the abdomen is called the abdominal aorta. W What Happens to the Heart H A

in Thoracic Aortic Aneurysm? T I An aortic aneurysm occurs when an area of the aorta weakens S Aneurysm T

and enlarges like a balloon. An aneurysm can occur anywhere H along the aorta. When the aneurysm is small, your doctor O R

will order a CT scan or MRI every 6-12 months to monitor A the size of the aneurysm. This will help your doctor know C I when treatment is necessary. Once an aneurysm gets to a C certain size or is growing rapidly, it is at risk for tearing A (dissection) or bursting (rupture). These can cause life O R threatening internal bleeding. T I C • Thoracic aortic aneurysms (TAA) occur in A the chest. N

FUSIFORM ANEURYSM E

• Abdominal aortic aneurysms (AAA) occur in U

the abdomen. R Y

Aneurysm S • Thoracoabdominal aortic aneurysms (TAAA) M

includes both the chest and the abdomen. ?

There are two types of aortic aneurysms. Aneurysms can be one of the two following shapes:

I Fusiform aneurysm: an aneurysm that extends around the entire wall of the aorta and looks like an even bulge around the aorta.

I Saccular aneurysm: an aneurysm that looks like a small blister on the side of the aorta. It is usually caused by trauma, such as a car accident or bad fall, that weakens the aorta and can cause bulging. SACCULAR ANEURYSM

5-1 5- 2 W HAT IS T HORACIC A ORTIC A NEURYSM ? C RA DIAC th If What War Man What Cond sy • • • • • • • • • • • • • • • • • • mpto at you ni y fu f Dif P f Dif Co c Tub S Ma H S A H F H T At be G Ag P au it yph m a ulsa ain ra p end t r exp ea igh igh bi her mil g ms ion e eopl S ugh sc oking are are ses fa r uma her icu icu er t r cu sy ils en r o URG tin erin y osc n fa b may c s mpt r sp a r d ing lty lty u e lo h eval t g isea t t Syn (m wi C the lo t id ist en h ler do di o ed sen br swa at aus si o c d d o o or or et n der t ao ua osi e se dr ms eni he cur. r not E eat o p can sat any e y: Sym t r t hoarsen l n ome: esur r s RY ion es n ow com che may hi ic peol – es a ion g hav ng we of r de har val of i an The egul can ng st, pt i | mon an e in n e i the aken the v ncl e A d o e such sy the y s be i ar t w m nhe ni se ( our mptos ude ype Ri aotr a 2 U G i i ng n basi t s done m sy t h v sk as he ri me : alv chest o id mpto is a ted of E D I s. f a and fami e a r n or . e the car T t or fo l la cone t of e h ha m up afl t r malfunctioning l R O F e ic oraci ac y ar s, a n d et Thor hi c thora w te er y wome t s i cti o ou dent stor al rie i c nste the v hest, T N E I T A P c s e shoul aci and ci y Aorti n) ti or c ad of l oca sue a c b fa or caus a of d a neur Aortic ti l ck ti not of on 3) di c c e or sor S the a Aneurysm? if ysm y neur of an y sho der he y t aneur s he our Aneurysm? ul ar sh t sm. hat ders ane t oul doct v alve ys How ur d m: ysm or s ev so . r, W HAT IS T HORACIC A ORTIC A NEURYSM ? S 5-3 NT TIE A P OR F YSM R YSM R NEU NEU A A TIC TIC GU ID E OR OR A A A | NG ta SCENDI ESCENDING A l l i . n o i D aor w of e h t Y GER UR u o y t i d n o c n ess S l. tn al , r a e t e h W w g n i n f o e e shor . d e e n , m th is e g r a l e DIAC e p y t l l i in er ated . a rt o a th t a e r h ery pain g of c w v ysms: R w t - pa ce. e h r st the of lo e h t lo res A ran t e s s e f i l on e t u c a sympto i h ui and ack y e h t e n c ayers a f o C l n aneu at b the ease n a s can eq i tom r e cr n n, he i mai t l l a w pain, v a ms de t n e m t h o pai neurysms and s i h T Severe begin aortic i m r e t e d symp st en e h neurysm t . A l st The a a e r u o can n t of mpt y che c ocated twe l i w tear l i e The che pai t Sy must f I n i h t the a s . y a be n? re h t i and . ons e m s d. re st i w d. aorta. io ry d w a or e m n sm ct ysm Aor . n o i s u f n o c sev r a e low ru y cor a sms, e g r a che f l ede sev s e t se locati our i e aorta t h g c rys e n o tur y ge sur s a is i r a ne t e r o as d n a , inal eu D s i v a h bl egs is of : l leg egs aneury Aneur rup sp od l aneury c n severe t a e An l l i c a c o oracic ti lo are such on re g y r l l a m s ic w f c i rt o a he ti i t occur eurysm he the b to ove possi b rt ti rti t s th t o e tic rt u s e f gerr y o Thoraci ll m b an r a e t o or n o a o Aor re a d t h t . y ws in ao c e s s h f su om Aor p a o oms n o t t sul n a Aor i d of at llo pt f o you g a c e e n er s r e p ing ng e y s a a eurysm ply c re gerr f ness ent a l l is of ne mpt , ulses a i it n o an ilit ding su r a e sym s typ p end sup upp t i t i rt o w sy ding h t g ur endi at no a lowin e ions en of on c umb o e sc nt u m o ars, nab ti ften od a c o e as m N N I fol this the l cen ese de o Wh n A o Y te a e r b h T hav t p o lo ge r f ften or th b In A p u o • in typ is • • o fr Desc As The I I e h T m y s Locat If 5- 4 W HAT IS T HORACIC A ORTIC A NEURYSM ? C RA DIAC on exam. a P Ho I Thor e CT Te • • • • • For “Di ople e. w st on S Che you a Th MRI Ec w Th Ao surg “C Y sc nd a om aci mo s o il Oft gno D ho w ur a is is S T” r a r n, ta sho y er st ho help e r et oes c i r URG en d c s d ou st a gr im ard oct MRI, or X oc i n an i A w ha nfo t it c am -r ti ha es sho yo t ortic o “ Your iog Te st ne ve a or x-ra ay is r. ny CAT t mat r a ur E w discove sh c an may c ra th hest s” hest y b RY d ou h m o u oc u ane ” o secti ion A ra lg Do sing ld w di Scan tor neurysm x ci es x-ray | y ur -ray, scove e r l be c on about arge cto A i d deci n a ti aor sm done. of dye duri your U G duri or r r a de t may c an t hi D t ca est or ng horaci E D I ane n on s t aor i r ? ysm aneur g sco s, b dia contra not a oklet u a l the ok m ysm r a. c ch R O F c ver ed c kn ec a athe ty in neur st . ic ow kup pe is al whi a the on teri T N E I T A P fo of te tha y wi sm und ch xt a zati th r su ou th is on ch ey ti . ne have as S W HAT IS T HORACIC A ORTIC A NEURYSM ? S 5-5 NT TIE A P A YSM OR T OR A F NEUR N A R O T TIC N OR OR A EW GU ID E S NG S I I A FT | UL G B RA HORACIC T G HE T sm THE G IN OF C A IR Graft Aneury Y GER UR EP L A EP R R S DIAC r R o m s ast or ll in A r y f f d n e c n e ill e v l a v r size de wi legs. be his C th rai w ou Y led you scan e h t ow y T may The are fo r . ou ood d clu ur h s n ru e n a y sm the in pl ace cal a o bl in n o ma rt a e h du ri ng y m m o c e to CT ed. r syntheti to in or e h t here and a rowing. lo ok aorta e r sur e. aorta. of a blockages t geon sur a l l i g , These will such eury o xed rest es your de geo sur red . ow th w r u o y t drugs If onitor , drain is th fi or sis s n r thy fl i pr our y ma in d s wi dsi m our ight u o y n e h w r o y al smoking. k c A wi ons on gersur y es. y t be our am sm re o ve bar be , e l y heart t he we lowe c o oo d eri ng ll on e h c rati arly l paral er i Repai val d heart ti um scribe fore b can io gr e ndati blood rtic l i h w w to the r laced de art e to the , ery our of and gul be y ng lp A e aneury sur ep pr at u o d e d n e m quit a r ne owev r Ao to . sk y your heart he th ey ra in ysm ci g sur your ri ram ght res consi H e n o d be d ng the p her necessary sm back , l l a to t and og is and e es, ex check hei and m o c e r the ei rec omme sewn ch y acic he your r medi pl coronary i m s into o are eri t rdi may rowi ut s iet Th t u d y l f i lower wer a s e n er se l g o s d i . . ery neury o u s Aneur t ur coro nary wh ui om se y? art lo s t a yo ord er ea ors i imeters. c to e fl t iven a est t yo r hoc ha yo fat est t a m s l g ur Thor cu g sur g a Other t rea - t h, in , s an rs ecr on ec e ent . e i h c a m fac s e w roo m s in is d i a r e n e g t ec a c lly your alt ina you h b and ol n his s d is s lo tic be) ay ra cke her t s i a 5 hes ro nary m urysm he is n ru e n y er in d o a Surger ed? so y s or wit ona T ot a thi l so and g n u l ys age (tu a co lly bl 2 . other al re the e al - t iti h he ane r r lest ng er cti o ta ck t ft ce e i er ati ng eur ecking d ll ues h t to n ac clude aced n reat eta lo g r u the overal pl cerebrosp S When wi f I tak op 1 aor How re T ch MRI cho an Usua ra e h an Add may ea t b wi ord gra Si in fu b you iss you 5- 6 W HAT IS T HORACIC A ORTIC A NEURYSM ? C RA DIAC In Endova Afte What Th cr ane th th cal les th Usu fol aor eatin o e at led l is ec r o ta. ra y ur g blo al r w su t oi r ci your ype ent a y, T g sm y rger u od S c n. H his p yo ane a ath et scu ye URG of vi witho apens new A los a u is sit ars, n ur i ep r ste d eu s s, t lar e s o ysm. o r. do pa l nt ysm r a ai ut a es n ensur n C E ne t r ot -graft t d R h at eatm r major RY is traum epair tes het ers A for The ne i ns is used e fter ide r t bl is d | epai hat ben on ysurger nt od t A use to are o your t th o has r no a g U G e d tr fit o d, the r i e fl nste r d e e t new ow. s t a be o gul t aor . An o y t E D I of “E our a se en abd the t or ar al t a ane eu n h de dovasc basi us doct a, omi is f of in ICU R O F rysm y ur vel in an t to y t na g pe or op he d sm t a o a a ul l a sma ll f e w of T N E I T A P a a te t moni ar d sho hi is nd ne il h r r l to n, ave r ep ysm ur the r Repaird? ep t r desc ec inc r to l ai e ong ep ai om dev r r p r isi on r” end ai o r r i yo nc e , me r el S c tub e me ced ur yover l an ope i u n i nd n de ans g e ur d. . . CONGENITAL HEART DISEASE / TUMORS ? RT EA H E ? H SE T L A SE A I OF IT D EN RS T IS ARE G O M EA R HT A HT A ON U C H W W T CAR DIAC SURGERY | A GUIDE FOR PATIENTS

WHAT IS CONGENITAL HEART DISEASE ?

Congenital (con-GEN-it-al) heart disease means that you are born with a heart condition. Often, these conditions are found at birth and fixed with surgery as a child. Other times, they are not fixed until the person is an adult.

What Happens to the Heart in Congenital Heart Disease? W

Atrial H The most common congenital heart condition A

septal T is an opening in the wall between the left and Left defect atrium I right sides of the heart. If the opening is S C between the two upper chambers, the atria, O

it is called an atrial septal defect or ASD. N

If the opening is between the two lower G E

chambers, the ventricles, it is called a N I

ventricular septal defect or VSD. T A

Right L ASD is the second most common congenital atrium heart condition, which occurs twice as often H E

in women as in men. An atrial septal defect A

(ASD) is classified by its size and location. R T The size of an ASD can range from small D to large. I

ATRIAL SEPTAL DEFECT S E There are three major types of ASD. The type A S of ASD depends on where the defect is located E ? on the septum:

I Secundum (se-cund-um) This defect is in I Sinus venosus (si-nus vin-O-sis) This defect the middle of the septum. It is the most is located in the upper part of the septum common form of ASD. This type often near a large vein that brings oxygen-poor closes on its own, unless it is large. blood from the upper body to the right atrium. It is rare, accounting for only about I Primum (prim-um) This defect is in the 1 out of every 10 cases of ASD. This type of lower part of the septum. It also involves an defect does not close on its own. incomplete or partial septal defect. The valves that separate the upper and lower heart chambers are not normal. This type of defect does not close on its own.

6-1 CAR DIAC SURGERY | A GUIDE FOR PATIENTS

What Happens If There is a Hole in the Wall of the Heart?

If you have a hole in the wall between the left and right side of your heart, the blood moves back and forth through the opening. This is not the normal way blood should flow. Many types of congenital heart conditions cause the heart to work harder than it should. This stresses the heart, causing the heart ?

E muscle to weaken and the heart to enlarge, S and can lead to heart failure. A

E Left S

I ventricle What are the Symptoms? D

T • Tiring easily R

A • Shortness of breath E • Bluish skin H • Irregular heart rhythm Right L • Decreased ability to exercise A ventricle Septal defect T

I • Chest pain

N • Fainting E VENTRICULAR SEPTAL DEFECT

G • Coughing

N • Swelling in your ankles and/or feet O C S I T A H W

6-2 W HAT IS C ONGENITAL H EART D ISEASE ? S 6-3 NT TIE A P OR F GU ID E A | Y GER UR S DIAC R A t r C s d e s e. ded s i t i a e n a cts ay h t is a r u o h t scl -si me s rt ha y . m i ver is r t ti t ft rt n i sts. h ular t defe n le mu t k g hea s. te he mur a hear t o u o y e e c sco hea al i w ea r ects. i e l k o o ti o l S rr some ar or i x-ray h i b o t and nit the mur , s D p u g r your he def t s more an u if f mal r your r s i h she can i o r e t t nge art is y ght- e t e s n e t s Lun show ou of any de sease? f o ri co k c e h c h i l , e p y cto ion se e e u o el l r a ay or show abnor n ion on Di i ar w b a for e n i cks n o i m If Do ay can ctur . n es w he can izat her r fusi m ere g pi condit c l. o t c o d t c e S ur t u o r o am o c s o h t e n o i t ot ho t t a r th heck m a t s ct or s ” s c Per eter s f t wel ha t i i ha ra a Heart u o ee ogr c ear our Y urm t o do s ha s e y g th g n ra m oc t y h d t. m T r n r h t ive d l n o f al di r ny t a ra o to w i r u c a Ca pin a i w rt d ear n e h n i ita sc oes ur d r ita X- i t s ou Y flo h diog ar f t d o ng W c oca r D iac t re yo o dy e hea e t . pum ge r ki r an ts od gs. e a d r ngen ho th t o d, s g n u l es o m w o n g a o n oun ngenit r r f i t c co d Ches enla Qu typ bl lu in Elec us bea Ca wo r Ec no Co r o F D “ be Ho A hea • o d hea n a • • • • CAR DIAC SURGERY | A GUIDE FOR PATIENTS

How is Congential Heart Disease Treated?

The surgeon may use a special patch or stitches to close the hole in the wall between the left and right side of your heart.

Incisions for Congenital Heart Disease Repair

I Sternotomy: An incision is made down the center of your

? chest separating your breastbone. E S I Ministernotomy : A

E A 3-inch incision is made in your breastbone; S I sometimes called minimally invasive surgery. D T R A E H L A T I N E G N O C S I T A H W

ASD B EING SEWN SHUT WITH PROSTHETIC MATERIAL

6-4 CAR DIAC SURGERY | A GUIDE FOR PATIENTS

WHAT ARE TUMORS OF THE HEART ?

Tumors can occur in the heart. The most common one is called an “atrial myxoma,” which accounts for 40-50% of primary cardiac tumors. This kind of tumor is most often found in the left atrium. Most atrial myxomas are benign. Myxomas are more common in women. About 10% of myxomas are hereditary, meaning it is passed down through families.

What are the Symptoms? W

If there is a heart tumor, some of the symptoms a H Tumor patient may have are: A T

• Shortness of breath A R

• Chest pain or tightness E • Feeling of a rapid heart rate T U

• Small stroke M • Dizziness O R

• Fainting S

• Fatigue O F T How does Your Doctor Discover H HEART TUMOR E

a Heart Tumor? H E

• Listening to your heart with a stethoscope, A R

your doctor may hear an abnormal heart sound T

or a murmur. ? • Chest x-ray • Echocardiogram • MRI

How is a Heart Tumor Treated?

Surgery is recommended to remove the tumor as soon as it is found because small clots called “emboli” can break off and cause a stroke. The incisions for this surgery are similar to those for heart valve repair or replacement surgery.

6-5 “ When preparing for surgery, it's just as important to prepare yourself P R E S emotionally as it is to prepare in other ways. Learning about the surgery P U A R R I and about what to expect during your hospitalization is one way to G N E G R

alleviate anxiety. There are ways you can positively impact your Y F O

recovery, such as relaxation techniques, yoga, reading, listening R to music, or spending time with your loved ones. ” Suellen Breakey

PREPARING FOR PREPARING FOR SURGERY P REPARING F OR S URGERY S 7-1 NT TIE A P . n o g OR , F kin tal ng i . o d i t a u l a v e tsmo r o ui Hosp smoki e v i t s t at ram GU ID E /q ui d a e r te q A a r e p og r si g or men’ o t P | to eb g w o W ens. o e r p n i ing e nce a & h t r th e sta wom o f am sit 617-732-9694 m o Smok assi t n s vi gh
ri mand or Y GER UR ant B Quit w e S gha g n i r b h u t bri o t ll yo t a . w e m t n i o p p a c If n a ww DIAC n a w e y R a A v a h m C u o l l i w Y or f u o y a . s r u o h i n o , y r e r 4 nurse u o of p . l m u l o t y g r u , s y a r - s s or l e othe x ou he w y e n p p u at d n a to s a r u o s a . u o y r u o y e k y ask FOR chance ogram) h ro y ne a t ests doctor ll t t l l a n o i t a u ci . h c u s e n o d t i w wi his se cardi your n a c : e d e r o f e b s n your er s t l g n i r OP he m ro medi o l a v E s t s e cal s t u l b k t ING k y i t on t n e GERY l e ST e c n k e ect exa u s e r i As a c nd eases iti i -ra a l . had wor El x s a e medi al ct cr R e w ( ke, t s e e l p ic v i t a t l i w ra in o a r e v e s m t n i o , G ion . p l p m o t i our ood gerr y hest c l C s hav smo w t U y e v ng p p r e p d n a Phys C B E i v REAP R su a u quit a h s n o i t oking rmat o t r urse s G oki S P yo u you out n g n i v l l ca fo • • • • p o e r i h a h after Sm in yo Sm If A P U ab T i w u o Y If lo C E CAR DIAC SURGERY | A GUIDE FOR PATIENTS

Blood Donor Center

You may be able to donate blood for your own use in case you need it during or after your surgery. This is called “autologous” blood donation—meaning it is your own blood. Your cardiac surgeon can tell you if you are able to donate blood. If you cannot donate blood because of your medical condition, your family and friends may donate blood for you.

TO DONATE BLOOD , please contact the Brigham and Women’s Hospital Blood Donor Center

Y to make an appointment at least R

E 2 to 3 weeks before your surgery. G 617-732-6912 R
U S R O F Advance Care Directives G N

I There are two types of advance care directives: a healthcare proxy and a living will. R A

P is a form that allows you to choose a person who will make

E A healthcare proxy

R healthcare decisions for you if you are unable to make decisions for yourself. This P person is someone you trust and who knows the treatment choices you would make for yourself.

Be sure to ask the person if they are willing to be your healthcare proxy.

A living will is a written guideline that states the medical care you would want to receive if you became sick and were not going to get better. In addition to completing a living will, it is important to talk to your doctors and family about the treatments you would prefer if you were unable to make your own health care decisions.

Every patient will be asked if he or she has a healthcare proxy or a living will.

IF YOU HAVE . . . a living will or a healthcare proxy, bring copies of these forms with you.

IF YOU DO NOT HAVE . . . a healthcare proxy or a living will, these forms will be available for you to fill out at Brigham and Women’s Hospital.

7-2 CAR DIAC SURGERY | A GUIDE FOR PATIENTS

Medications

At your appointment for preoperative evaluation, a nurse will ask you for a list of your medications. It is important to let us know if you are taking herbal supplements, vitamins or over-the-counter medicines like Aleve or Motrin.

Coumadin (warfarin) If you are taking Coumadin (warfarin), you may be told to stop taking this medication three days before your surgery.

My Coumadin Instructions: P

Surgery Confirmation R E P

Plavix A

One business day before your surgery, call R

If you are taking Plavix, call the Cardiac Surgery office I

the Cardiac Surgery office to confirm the N

to set up a plan to stop Plavix before your surgery. G time of your surgery and the time you

617-732-7678 F
should arrive at the hospital on the day of O

My Plan to Stop Plavix: your surgery. If your surgery is scheduled R

on a Monday, call to confirm on the S Friday before. U R

Insulin G E

If you have diabetes, the nurse practitioner at your
617-732-7678 R preoperative evaluation will give you instructions Call the Cardiac Surgery office Y about taking your insulin the day of your surgery. by 4:30 pm.

My Insulin Instructions

ACE Inhibitors Call the Cardiac Surgery office to set up a plan to stop this medication before surgery: My Surgery

J benazepril (lotensin) J moexipril (univasc) Date: J captopril (capoten) J perindopril (aceon) J enalapril (vasotec) J quinapril (accupril) Time: J fosinopril (monopril) J ramipril (altace) J lisinopril (zestri l/ prinivil) J trandolapril (mavik) Arrival Time:

J other ACE inhibitor ______

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ng ect mor vi o t sit f Bri hei co ed Cari e w mun dg r when i nfo l ov S ng e w. websi mati r ed Bri cari ica a one dg lo ng te te on ved e, bri mesa s' . , a V cond con dg one is no e. to ge tac org it -pr i rs s s, io r wh of write ec Pat ns i ei t, o a ie vin nd h t ha e e fr nt/Fam jo e g ve write na ur s i v / y l i m a f med on be a C -line l i ic their n ent ly l l al ovide pr h t Relations rie o t i viceser ca e own s e.r I r U C s and o l u r f n o eg m P REPARING F OR S URGERY S 7-7 NT TIE A P OR F GU ID E A | Y GER UR S DIAC R A C s nt at ial he be - t e e v a e n l nt de rooms at o ghest patie world design car of t Franci the y mai y focused t l hi esse must gui il he d ng d e t c e n n o c t n e r a p s n a r ’s to or ly on the y the T t ent ti t. o an e understands am d e si a the tal fami d n f s. e k s a ectful i e r a bl the e vi nd re a pati e i . be s fami supp s de il ortant St e b esp a d n a ons. staff of r abl on ocate ities to t behi l Hospi possi y a can mp and Shapir fam i advance be or is provi riends the m Center acil staff f g n i d l i u f ecovery s l e v e l o the occasi eir r b time t ent mf one care d to me ost e Francis force cused ter esence s r o he s ere r ti th y se m lar d t co m so an fo er n pr Ruth t i s r e w H ca pa or o w t a e ro ved fest ho m . er f i v r nd Cen o l rd cu re aj t he in ily over ient’ ar a aske a lo sa t of o . er la at ive r o m fro at r u f r ro d ct ma oss e h T ge re w re p and fo o a in o vas fam t a n ent nts Cent pi scu a ext o Y cr re a a s s . e phy n C a a J io tie The brid room for tions ty d to of w Sha the one me iova h g u et oso labl tors pa s ti d the il apiro es i ur le . e c n a r t rt . t n e i t ste re r ass lin Sh Li a p quali avai yo care. all ab Visi member pa Card The of that Carl direc St care o r h t n e gl ph It fo car CAR DIAC SURGERY | A GUIDE FOR PATIENTS

Guidelines for Visiting and Overnight Stays

I One support person may stay overnight in the patient’s room. He or she must be at least 18 years old, able to care for themselves, and free of any illness or infection.

I Overnight visitors must manage their own personal needs and belongings; toiletries can be purchased at the gift shop, and food can be purchased at the hospital cafe teria or other cafes. (For a listing of local eateries or shops, please call Patient /Family Relations at 617-732-6636.)

I Appropriate clothing/sleepwear and shoes must be worn at all times in and out side of the patient’s room, as this is also a work environment for hospital staff. Y

R I This is a fragrance-free environment. Visitors should avoid using E products with scents before and during the visit. G R I The patient’s bathroom and shower may not always be available U

S for visitor use. Please check with the nurse daily for the best time

R to shower, and remember to lock the door when using the bath - O room or shower. F

G I Please use the bed linens in the sofa drawer to make up the bed. N

I Place bed linens in the sofa drawer for reuse or in the laundry R

A hamper each morning. P E I

R Please keep personal items neat and away from the patient care

P area. For storage of large luggage, contact Patient/Family Relations at 617-732-6636.

I There are refrigerators in the nourishment stations to store personal food items. Please place the food in a plastic bag (provided) and label it with name and date. Food will be discarded after 24 hrs. Food may not be stored in the patient’s room.

I The patient will need care during the night; staff will need to turn on lights to assess the patient and provide care. We understand that this may interrupt sleep. Many families choose to sleep at home or a local hotel so they are well rested.

I For patient safety, please never touch medical equipment and keep 3-4 feet away from medical equipment when using cell phones.

I Quiet is important for healing. Please speak quietly, keep TV volume low, and place cell phones on silent or vibrate.

7-8 YOUR ICU TEAM

Director of the ICU — An attend - ing physician who oversees the care of all cardiac patients in the ICU. Attending Physician /Surgeon — A doctor responsible for your care while y ou are in the ICU. Your attending physician will see you

daily to examine you, to discuss I your progress, and to notify you of N T any plans for tests or changes in H E

your treatment. I C House Staff — Doctors-in-training U who work in a team and are super - vised by your attending physician. They include Fellows, Residents, IN THE ICU Interns and Medical Students from Harvard Medical School. House staff will visit you daily as part of their rounds. ICU Nursing Staff — Nurses with special training who will care for you throughout your stay in the ICU. She or he will make sure that you receive the appropriate medications, any medical treatments your require (such as dressing changes), and the diagnostic tests ordered by your physicians. Intensivists Staff — Doctors who specialize in Critical Care. They will work closely with your surgeon to provide the best quality of care while you are in the ICU. CAR DIAC SURGERY | A GUIDE FOR PATIENTS

IN THE ICU (I NTENSIVE CARE UNIT )

From the operating room, you will go directly to the ICU to recover from your surgery. In the ICU, you will be cared for by a team of doctor and nurses who specialize in the care of cardiac surgery patients.

How Long You Will Stay in the ICU

In most cases, you will be in the ICU for 1 to 2 days. You will be moved to the step-down unit when your team of doc - tors and nurses feels you are ready. I N

How You May Feel and T What You May Hear H E in the ICU I C

• You will hear sounds and alarms from U the machines. Your nurse knows what the sounds mean and will be listening to them carefully.

• You may feel confused and drift in and out of sleep. This is normal and is due to the anesthesia and pain medication.

• You will have many tubes and intra - venous lines (IVs) in place including a breathing tube in your throat.

• Sometimes wrist restraints are necessary to keep you safe while the breathing tube is in place.

8-1 CAR DIAC SURGERY | A GUIDE FOR PATIENTS

Pain Management

It is normal to have some pain after surgery. We want you to be as comfortable as possible. Your nurse will give you medication for your pain.

You will be asked to rate your pain using a 0-to-10 pain scale. Zero means no pain. Ten means the worst pain.

No Moderate Worst Pain Pain Pain

0 1 2 3 4 5 6 7 8 9 10

NO HURT HURTS HURTS HURTS HURTS HURTS LITTLE BIT LITTLE MORE EVEN MORE WHOLE LOT WORST

U Tell your nurse if you have any pain or discomfort so he or she can

C give you pain medication. Do not wait until it gets bad before I

E asking for medication. It is important to take pain

H medication to decrease your pain so you can do

T Ventilator activities. It is normal to have more pain the day N

I after surgery as you increase your activity. It is Breathing tube important to cough, take deep breaths and move around to help you recover.

Tubes & Monitors

Breathing Tube You will have a breathing tube in your throat when you wake up. It will be connected to a machine called a ventilator that is helping you breathe and giving you oxygen.

You will not be able to talk, but you will be able to communicate with your nurse and your family by nodding yes or no. You should not try to talk because it will make your throat sore. The breathing tube will come out as soon as you are breathing safely on your own. This is usually within the first day.

8-2 I N T HE ICU S 8-3 NT TIE U n A g d P te IC e to g n es in b la will soo etes. e e uc l od loo s l ed nd to th cu ab a b i v a h th e r lo OR ed i d wi hey n pe di r b in c F ur to ne ie T y y l g p o d n a De ur p rse tl y ave el ts. ma s. h achi sfer h yo ap erin nu lo can t u ng s m c i vel fi n o i t c ey a yo cov no tran d h le the ni GU ID E g , T s, make eeve e f n i Re to oo keep ar . si do ou sl el A y bl n a at 0 ed ev s | can sug th l ICU CU a th o you I l cks s. ry g n i ar f c n he vent t e i nect e an15 t ood e h on t e re the n g r th n . sug soon g p bl ar i C t con n f su i s show ss cati e eve as o i d f od l e . le uni ar o p our o and gar ve n l an oot e c y i u boots riv l b ved n s ha Y GER UR Su a o ess od r ar g evel you r s ng own comp h g l le e S d mob c u insu st i r r ou umo le -d emo blo o r r cki er y d r e p eu yo hi ga ga h e e n he s u t u on c Blo ot W Th s s take Stu u o y th be s a you P Pne DIAC R A n C om f o t o n e ai Vs fr l I t s e b u t p have been nage in help deep abl s e r u s s e you r e d d a l b ” l i w g m o t or tu bes r p is your luid . n a p d e b has drai will The f Deep are hu will . ow t o b . take r u o l protec e s e h T used u o y and eceive s l y special s r o y r e h t . s ou r and day s the The pi hi and Y tubes. open you e h t lps r ow heart pain. 2 you T . connect , e m y a d tube g and p fl o t n i t a he i t may e ugr e . s g n u l l 2 to l a n i r u the s monly in ood h c t a w es that rate hat when hel our un gs . d e r ion. t l 1 cough your e y bl ronge o t ow l of s s i h t or whi “ chest ou Y d n a ll e h t wi s n st n com ugh 1 art s e b u t ow e blood . al t l a wil pi for s ump se s g n day ou r s r u n i on as rt e s n i e t s he a r a y P the Co pil r o f e groi si 4 drain whe ase se ng i r u e h ce mov congest g n i s u ci you ur d r e t e h c dside o o . of The n i re di gram) D or n r t t place re c r u o y i a. ghi 4 e r u pe yo t decr and io be . e pan d h. e h t 2 n ive u wn b devi p in bec om t u o val lea ni d in a re ar n heart e o y g g o o o t l c b est c l e t n ex sha nd o ug c nd i r i ar l y a a r s neck t h isio th a he a in Balloon 2 a u t- mo e- efo l l i w ch it s co t r oc h y r e e sta b ry wil nic d n u nd rt a and ic inc hea r you by Remo tr out r o ear a ur bes y v a v a n on to r ha rt t i h nd ors. o e r e t e d h h r u o y o r a ision pneu rs rse lly r o w eat r a wrist, hea t n o yo e l l a es. u T ma elec lp l l h t te s B hest fu atio to gersur ( n i -a nu you om o t inc mec is c o m a c s i w i w ic t he c nst r he a e r a r ni r ra g ep monit pump a r d your your u u u ygen vic e u u ai eathing eaths event hear This in ox we ak en Chest o Y Int to o y ECG de until to pr e h T Mo in lun br br yo This ag De o Y wil l wil l e h t performed decrea Cat o Y med o t e h T d e e n CAR DIAC SURGERY | A GUIDE FOR PATIENTS

Diet

• After the breathing tube comes out and your stomach wakes up, you may be able to start slowly drinking and eating.

• At first you will only be allowed to have a few ice chips and then some sips of water or juice. Your mouth may feel very dry from the medications used during your surgery. You may feel hungry and want to eat and drink right away, but your stomach will not be ready for food. If you try to eat or drink too soon, you may have an upset stomach. • Once you begin to pass gas (a sign that your stomach is waking up), you will be able to progress to a regular diet. • If the doctors are concerned about your swallowing U or you are over 80 years old, you may need to have C

I a special test. This test checks if you can swallow E normally, without food and liquids getting into H

T your lungs. N I Activity

• While you are in bed, your nurse will change your position about every two hours. This helps prevent skin redness and skin sores. • As soon as you wake up, the nurse will remind you to wiggle your toes and move your feet up and down, like you are pushing on a gas pedal in your car. This helps to prevent blood clots from forming in your legs. • As early as the first day after your surgery, your nurse will help you sit on the edge of the bed or get out of bed and into a chair. • Little by little, you will increase your activity. You will walk 3 to 4 times a day with your nurse or patient care assistant until you are strong enough to walk independently. It is important to try to do a little more activity each day.

8-4 YOUR STEP DOWN TEAM

PAs — Physician Assistants will be the primary medical provider when you are in the step down unit. They will manage your care with your surgeon's supervision.

Nursing Staff — Nurses will continue to care for you during your stay in the step-down unit. Your nurse will also teach you skills you will need to know to prepare for discharge. You can contact your nurse by pressing IN THE the call button attached to your bed. AFTER THE ICU Care Coordination Staff — A F T

Nurses will assist in your care E while you are in the hospital and R T will help coordinate arrangements H E

when it is time for discharge plan - I C

ning. They can help arrange home U care or, if necessary, help you or your fam ily select an appropriate rehabilitation or skilled nursing facility. Social workers are avail - able to help you with other issues, including your emotional needs and access to support services.

Patient Care Assistant (PCA) — The patient care staff will assist your nurse in providing your daily care. He or she may help with bathing, taking vital signs, or taking you to and from your tests. CAR DIAC SURGERY | A GUIDE FOR PATIENTS

AFTER THE ICU

After the ICU, you will go to the step-down unit until you leave the hospital. On the step-down unit, our team will continue to help you recover from cardiac surgery and prepare you and your family for going home.

How You May Feel

• You may be tired or weaker than usual. Simple tasks may be very tiring.

• It is normal to be forgetful or to have trouble concentrating while reading or

watching television. A F • You may have difficulty sleeping in the T E hospital environment. You will likely be taking R T

lots of naps, which also makes you less tired H

at night. Most people sleep better when they E I

return to their own sleep routines at home. C U Pain Management

• It is normal to have pain during the first few uncomfortable. He or she will ask you to rate days. It will get a little better each day. your pain using a 0-10 scale and will then give you the medication that will work best for you. • It is important to take pain medication when you begin to feel pain and to use your cough pillow • It is also helpful to take pain medication before to deep breathe and cough. Please a sk your you walk and at bedtime. nurse for medication when you start to feel

No Moderate Worst Pain Pain Pain

0 1 2 3 4 5 6 7 8 9 10

NO HURT HURTS HURTS HURTS HURTS HURTS LITTLE BIT LITTLE MORE EVEN MORE WHOLE LOT WORST

9-1 9- 2 A FTER THE ICU C RA DIAC cath bla on and asi A Ch the wi rh an st Th you expan Yo If op wh I Tre atm I I I I I I ph Yo hea you inc Th ar ho Yo oc e ythm. res you d Cat Ch Pa Hear E Ch Dep tub ce o en ys u u u i e d is est ic s t r r not r fr king ked r r l et ta i l io ic w h ast pi mpr un m cem l -sha ont t pa n n est est that er eg yo e d nt he het al t il n have low wi oni urse urse ubes r gs l c in ic S t m and s up s ur in I wh th Br a 1 ov wil h l d en a p Tub P ped t for . Monit wi er . led ovin tor URG a S to ave ker ra oc erap i A hysic t Dep h re lu e t eat s ile had toc o hel wil wil l o i w ts l elp c ke na a 48 the ng p a t le he be a p 2 es i a a a w g hysi hin ll smal yo Wi ttached l l ps ba ki t il y ke ge ar You s pa d a lp c e s ir ta gi pr hour al lo a or h o a ci and at ng u a b f g. E ound.r C pr res elp ppli s f a p ve ul cemake g cian’s has t ys w rcu evnt eathi r hetr Th ny l hem t your your ABG, RY s otec ake on ly Your b an p tha / s. you afte dr ed i Wi lati ox laced de t erap mucs. and Ace to d Thes your ai is de out assist j cr on ng nurs a | pneumoia. that r wi ohnni n C l r your fter a y you nurse your i l ease ysurger m ou A y if ou cl fluid l W “cough on p in and e l H 2 t por e e back it ant ur n drai rap 48 hel br U G ghin ar wi hug Thi d, your ave w ch to e. is y i nci eaths wi our atc from l coug t p s hour l es ant usual wi s nee n he 4 . s E D I have on to l to t. si agins h l t ll is l days p he egs. on take t hear conge ded. Y t you il tak he r hing ba s. c o ar a ly ed ou l al ow. nd ur Ace ound l and do tt R O F e p in uc Ela r af e t out er will in A t h d y c tha ” te hem sti you w e 2 wh ies e our e oug wra stic phys c dec r T ar il swe t on, hest f c the your t o l r surg hi il t with r a T N E I T A P om h p c h. e r out 4 lu e r rat s che lling an ician’s s r el y you i ng day ase o p s yer e he your it n be st a a s s. atr in n . d S af If t er y ou coughin, p e e D he a r b a e r h t a clikng t e l g n i you n a r d nois nurs o c u e h g e. n i g CAR DIAC SURGERY | A GUIDE FOR PATIENTS

I IVs A large IV will be in your neck that will be taken out by your nurse in 1 to 2 days. You will also have a smaller IV in your arm until the day you go home.

I Dressing Changes You will have dressings covering your incisions for 1 to 2 days. Your nurse will change the dressings every day.

You may also have Dermabond glue covering your chest incision. Wash your incision gently to remove the glue as it begins to peel.

Tests You Will Have Every Day

I Chest X-ray will be done to look at your heart and lungs.

I will be done to monitor your heart rhythm. A

ECG F T

I will be taken to monitor your blood levels. E

Blood R

I will continue. The nurse or T Blood Sugar Checks H

patient care assistant will do a finger stick to get a E I

small drop of blood for the blood sugar test. C U Diet

Your food in the hospital may be low in salt, fat and sugar. It may taste different than what you are used to eating at home. You may also be asked to limit the amount of liquids that you drink. It is very normal if you do not feel like eating big meals for about two weeks after surgery. Plan to eat many small snack-size meals until your appetite returns.

If you have questions about what you can eat, ask your nurse to have the nutritionist talk with you. The nutritionist can help you choose heart-healthy foods.

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EXAMPLE OF DAILY SCHEDULE

This timeline is an example of your plan.

STEP DOWN DAY 1 STEP DOWN DAY 2

• Cough and deep breathe with your • Cough and deep breathe with your cough cough pillow every two hours while you pillow every two hours while you are awake. are awake. o • Ask for pain medication so you can cough d

o • Ask for pain medication so you can and move more comfortably. t E

d cough and move more comfortably.

• Pump your ankles every hour while you are X e e A

n • Pump your ankles every hour while you awake. M u

are awake. P o • Participate in your bath and moving in bed. L y E s

g • Read the “After ICU” section and the items O n i

in your patient education folder. F h T • Ask a family member or support person to D

come in and review teaching and discharge A I

planning with the healthcare team. L Y S

your nurse, patient care your nurse, patient care C

With the help of With the help of H

s assistant or physical therapist: assistant or physical therapist: E e D i t i • Get into the chair for all meals.

• Sit in a chair at least once today. U v i t L c • Walk in your room. • Walk around the unit at least three times E A today. • Bathe yourself and brush your teeth.

• Congratulations, you have transferred • Members of our cardiac surgical team e

g out of the ICU. will review your discharge needs with you. r a h

c • If you are going home, plans will be made s i for a visiting nurse. d r

o • If you are going to a rehabilitation f

g facility, someone from one or more n i

r rehabilitation facilities will come and see a

p you. The staff from each facility will check e r to see if your medical needs and insurance P coverage meets their criteria.

10-1 10- C 2 E XAMPLE OF D AILY S CHEDULE RA DIAC

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s e i t i v i t c A e g r a h c s i d r o f g n i r a p e r P o d o t d e e n u o y s g n i h T s t n e m t a e r T AT HOME A T H O M E CAR DIAC SURGERY | A GUIDE FOR PATIENTS

AT HOME

What to Expect at Home

Healing and recovery from your surgery may take up to three months.

The day after you get home, a visiting nurse will contact you to make an appointment for your first home visit. During your appointment at home, the visiting nurse may:

• Check your blood pressure, pulse, and lungs • Check your incisions A T

• Draw blood if necessary H O • Review your medications M

• Review your activity schedule E • Review your weight and temperature log Visiting nurse

Managing Your Pain Keeping Your Weight and Temperature Log • Weigh yourself once a day It is normal to have some discomfort, itching or numbness along your incision. • Take your temperature twice a day Medications like ibuprofen (Advil, • Record these numbers in your log Motrin) or acetaminophen (Tylenol) are usually the best choice for pain relief. W EIG H T C A L END A R PATIENT If you need something stronger, you may be sent home with a prescription pain Date Temperature / Time Temperature / Time Weight medicine. In this case, check with your nurse if you have concerns.

If you have had angina pain before your surgery, you should not have this type of pain in your chest after surgery. (An example of the log in the back of this book)

11-1 CAR DIAC SURGERY | A GUIDE FOR PATIENTS

Caring for Your Incisions

It is normal to have a small amount of swelling at the top of the chest incision. You may feel a hard ridge along the borders of the incision.

If you had a vein removed from your leg, you may notice some bruising, swelling and/or bumps along your incisions. If you had an artery removed from your arm, you may notice some bruising, swelling and slight numbness. These will go away with time. The incisions will fade over the next 6 to 12 months.

What Should Your Incision Look Like? E M

O NORMAL SYMPTOMS: SIGNS TO CALL THE CARDIAC SURGEON: H T

A • A little redness and soreness along the • Increased redness or warmth at the incision sites incision sites

• No drainage at the incision sites • Any drainage at the incisions sites

• Swelling at the top of the chest incision • Increased swelling along the incision sites

• A hard ridge along the borders of the • Increased pain along the incision sites chest incision • Any opening along the incisions

• If you have a fever of 100.5 or higher

11-2 CAR DIAC SURGERY | A GUIDE FOR PATIENTS

What Should I Do to Care for My Incisions?

• Look at your incisions every day. Use a mirror or have someone else look for you.

• Clean the incisions in the shower daily with mild soap and water.

• Gently remove the dermabond glue as it begins to peel from your chest incision

• Dry your incisions completely by gently patting instead of rubbing.

• Do not apply ointments, lotions, oils, salves, or dressings unless your doctor or nurse tells you to do so.

• Avoid direct sunlight to your incision A site for one year. Use sunscreen whenever T you need to be outside. H O

• Remember to take care of the incisions M in your legs, arms and groin too. If you E have an incision in your leg or arm, it is Women will need important to elevate your leg or arm to wear a bra to help while you are resting. This will help support the muscles prevent swelling in your ankle, arm or around the breast leg and improve your circulation. and prevent pulling on the chest incision and muscles. When you wear a bra, place some padding, such as a clean bandage, over the incision area that comes in contact with the bra.

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Lifting • Do not lift more than ten pounds (such as a gallon of milk) for 3 months. • Avoid doing activities that require lifting both arms over your head at the same time. • Do not do exercises that use your upper body and will pull on your breastbone, such as lifting weights, swimming, tennis, skiing, rowing or golf for three months.

Driving • Do not drive for 3 to 4 weeks. • If you have had minimally invasive surgery, you can drive at 3 weeks. • You should not be in the front seat of the car if airbags are in use. • Always wear your safety belt. Place a small pillow between your chest incision site and the strap crossing your chest.

Work • Returning to work depends on the type of work you do. This should be discussed at your first follow up visit with your doctor. • Return to light physical work if you feel up to it 4 to 6 weeks after surgery. • Return to work that involves heavy lifting after 3 months. A T H

Sex • You may have sex when you feel up to it. O

• It takes the same amount of energy to have sex as it does to climb two M

flights of stairs. E • It is important to position yourself so that you are not putting pressure on your chest.

Travel • When you are traveling long distances, take time to walk every hour. • If you are on a plane, get up and walk around every hour. If you are in a car, stop every hour to walk. • Do your foot exercises frequently.

Childcare • Have children come to you and sit next to you rather than picking them up. • Have someone place a smaller child in your lap. Remember you should not lift more than 10 pounds during the first 3 months.

Constipation Pain medication, iron pills, and decreased activity can cause constipation. Things that can help reduce constipation: • Take a stool softener like Colace (bisacodyl). • Increase your activity. • Eat more fiber like whole grains and vegetables.

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fe r r h r ma G y m t u o E o ti o ide r at the e n in g to . AT H OME 9 S 11- NT TIE A P OR F GU ID E A | Y GER UR S . b a n a e rs t a h o d t ac g on ur how r had a h e R s, di e e n DIAC in yo facto ive. up. l an can l l i arn jo R you t n Car e u sk i i w l have y A ri sig yo u m a r g o r p o ou Y r Ask ma c a i d r a C . ery diet easing C h e a yo u o Y w u er s i can al. als. you r o f t s t ) g sur decr o Y ” wh help you ient o b a by iac ns. t . l a r r e f e hospi to doctors, d hospi at r o : crease p a ter s, h e R fore car de . er e g a r e v o c “ e the ude close rse for b o bet r o f ase e d or locati t many orkers e d e d i bett st nu el av incl tal t i s n w e i do dise te l v o fe nts el i v ous call of nde t al fe r p ss ed ste so m can hospi et vari re p o - and you , y al soci factors a hear ea st di ( and t st at er locat itation a a at a you sk t s o p of ol fe e r u s s e e aft and pl g ecomme ri n o i r li ise y s e i n a p m r eek at ar s s r p health ab io in t a nd s i w or s r i o c f erc m hy ist t i l u o y me lester wh i ng a lt p ist lud t a ex Reh ehabil d o o ab a h So ram ho you f e c n rn c will R c tes ogra b a h l b ty inc a o hea ly s e m ia ck, s ist hera og i lea pr t a a r u k be Reh t e R oking ors. ou rd n o mi pr igh h g i e besi s e r ia n y c ge a iac s n 3 a m i t att i c a ive H S H O D F Lac t S A ca C ical l iolog fact a u dia t s d a improve thes hab i d r ys d k • • • • • • • • • e an a C Card s t e e m to There ris of car ph to l a v e o M R heart Car ou Y 1-0

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e b v r th r e r e e c a t n er n n o t c a r u Your h g 3 e y– ca i d r a C a s l o i ht y l w c i d 2 tu o h 8 c la .l l a b e g r u s S g n i r e h t c 6 6 - w o l l e F i e e k e e a ya d i r F s ok. r u an t e t c e r a s y a d u t e m t a e g r l l ru o y pa , s r d L .0 6 o sd n no g y r g , no e d FREQUENTLY ASKED QUESTIONS S ON I ES T U Q ASKED REQUENY TL F CAR DIAC SURGERY | A GUIDE FOR PATIENTS

FREQUENTLY ASKED QUESTIONS

Your Next Appointment

When do I need to make my doctors’ appointments? You should make your appointments with all of your doctors as soon as you get home. We recommend you see: » your Cardiologist within 2 weeks. Your cardiologist should adjust all of your medications. If you have questions about your medications when you return home, you should call F

your Cardiologist. R E » your Primary Care Physician within 2 weeks (optional for some patients). Q U E

» your Cardiac Surgeon within 2 to 6 weeks. If you develop any problems with your N

incision, contact your Cardiac Surgeon’s office. T L Y A S

Medications K E D How long do I take the medications I received from the hospital? Q

Take all the medications you receive when you are discharged. When the medications are U finished, have your pharmacy refill them unless the bottle states to take the medication for E S only a certain number of days. For example, Lasix, Kdur and antibiotics may be medicines T I that you are instructed to take for a certain number of days. O N

Pain medications that are narcotics such as Oxycodone can only be refilled with a new S prescription. Pain medications such as Ibuprofen and Tylenol give adequate pain control and are more commonly used.

Should I take my regular medication when I get home? Do not take any medications that you might have taken before your surgery unless your doctor tells you to take them. This includes all over-the-counter medications.

Do I need to take a stool softener? Yes, you should be taking a stool softener. Most patients are discharged on iron medication, which may cause constipation and black stools.

12-1 CAR DIAC SURGERY | A GUIDE FOR PATIENTS

Incision Care

How do I care for my incisions at home? You should take a shower every day and wash with a mild soap. You may have one of the following dressings:

I Dermabond : Your chest incision may have Dermabond glue still in place. You may wash the incision gently and remove the glue as it begins to peel. All glue should be removed within 7 to 10 days.

You may also experience temporary numbness and burning along your incisions and some sen - sitivity if there is clothing touching your chest incision. This is due to swelling around the nerves in your incision area. S N O

I Activity T S

E When can I resume exercising? U

I

Q Walking every day is a great way to exercise. Pace yourself, especially if your walk includes hills.

D I Climbing stairs is okay. It’s up to you how often you feel able to climb stairs. E

K I For the first 3 months, do not do activities that require the following repetitive movements: S

A • putting your arms over your head Y

L • twisting T

N • pulling E

U • pushing Q E

R After 3 months you may resume any of your activities. F At your post-op appointment talk to your doctor about the activities you can do.

How long should I wait before I can lift anything heavy? Do not lift, push, or pull anything over 10 pounds for 3 months from the date of your surgery. Your breastbone was closed with stainless steel wires and needs time to heal.

When can I resume sexual relations? Resuming sexual activities can occur when you and your partner feel ready. If you can climb two flights of stairs without difficulty, you may be physically ready.

12-2 CAR DIAC SURGERY | A GUIDE FOR PATIENTS

When can I return to work? Most people feel ready to return to work either part-time or full-time after 6 weeks unless the job requires heavy lifting over 10 pounds. If you need a letter for your employer, please contact your Cardiac Surgeon’s office.

When can I drive? You may resume driving after 3 weeks if you had a “minimally” invasive operation. If you had the standard chest incision, you may resume driving after 4 weeks. You may wish to place a small towel or pillow between your chest and the seatbelt for comfort.

Sleeping F R E

Is it normal to have trouble sleeping after surgery? Q U

You may have trouble sleeping at night due to incision discomfort or because you are sleeping E in a different position than you normally do. It may help you to take pain medication before N T L

you go to bed and to use additional pillows to prevent you from lying flat in bed. You can Y

sleep in any position that is comfortable for you. Sleeping pills are not encouraged because A S

they can be habit forming. It is not unusual to nap some during the day for the first few K E

weeks, but limit naps if they interfere with sleeping at night. D Q U

Eating E S T I

Is it normal to lose your appetite after surgery? O

After surgery, some patients lose their appetite or report that food doesn’t taste good. You may N S experience a metallic taste in your mouth as well. Eat small frequent meals instead of three large meals a day. Remember to drink enough fluids to prevent dehydration. Once you begin eating a normal diet, it is important to limit your intake of fat, cholesterol, sodium, and sugar.

Feelings

Will I feel depressed after surgery? Depression can be common when you first return home. You may feel you are not recovering fast enough. The best way to deal with these feelings is to talk about them with your family or friends. These feelings usually subside as you get back to doing your normal activities.

12-3 12- C 4 F REQUENTLY ASKED Q UESTIONS RA DIAC mak safe Be How If Is Ot ho of ca re yo spi yo i su her t er, t o u ur o t sa re f al d n h d you o fe , ongoi S eed th ave ef b I at URG u for i bri ma t o a a you ver yo n n n ll me a g nage MRI MRI u to t r m c he E r, ontinue pri to edi RY or . long for ymar ha other The ca pacing l ve the | proble t onl to er care A an hea e m. valuation se y U G wir M tim e doctor lt ms. your es h RI? E D I e con Some i that n p pl w of ditons? r R O F i ace. ill ymar you some of mon your ar car T N E I T A P e i other tor not e m phy you edications able healt sician and t S h o pr m hav and ak obl m e ay e cardiologis em an de hav , M cisi y e RI ou ons changed i can s about t if for you be the while as how have sured manage to in a t pace t t hat he ak me e - it nt i s GLOSSARY OF TERMS S ER M T OR F OF LOSSARY REAP RING P G CAR DIAC SURGERY | INFORMATION AND RESOURCES FOR PATIENTS AND FAMILIES

GLOSSARY OF TERMS

This glossary includes some common terms that may apply to your specific surgical procedure and postoperative hospitalization course. Please review these terms before your surgery. If you need further clarification please ask your caregivers.

Arterial Line: This tube is also called an "A-line", and is placed in an artery of the wrist. The line is attached to tubing and is used to measure blood pressure or to draw blood tests.

Blood Tests: You may need blood taken for tests. This may be taken from a vein in your arm or drawn from special IV lines. It will be tested to see how your body is handling your illness.

Breathing Treatments: Breathing treatments are sometimes ordered to open your airways. G L

Medicine is slowly breathed in by mask or mouthpiece and often followed by Chest PT. O S S

Chest PT: You will receive this gentle tapping on your chest after surgery. Along with coughing A R and deep breathing exercises, it helps to keep your lungs clear. Y O

Chest Tubes: These are tubes that are put into your chest during surgery. Chest tubes remove air, F T

blood, or fluid from around your lung, and are connected to a drainage container. E R M

Chest X-ray: This is a picture of your lungs and heart. After surgery you may have a daily chest S x-ray taken either in your hospital room or in the radiology department. Caregivers may use the x-ray to look for signs of infection, pneumonia or collapsed lungs.

Consent Form: This is a legal piece of paper that gives your surgeon permission to do surgery and other related procedures while you are in the hospital. It tells exactly what will be done to you, and what risks are possible. Be sure all your questions have been answered before you sign this form.

Deep Breathing and Coughing Exercises: These breathing exercises help to prevent a lung infection after surgery. Deep breathing opens the airways going to your lungs. Coughing helps bring up sputum from your lungs.

Elastic Stockings: These tight elastic stockings keep blood from pooling in the legs and causing clots. They may also be called TED stockings.

Fluid Restriction: This is the total amount of fluid that you may take in a 24-hour period. It includes fluids that you drink by mouth and IV fluids. Fluid is restricted after surgery because too much fluid can be very stressful to the lungs.

13-1 CAR DIAC SURGERY | INFORMATION AND RESOURCES FOR PATIENTS AND FAMILIES

Foley Catheter: This is a tube that is placed in your bladder to drain your urine. When the catheter is taken out, you can urinate on your own.

Heart Monitor: This is a machine that allows your caregivers to view the tracing of your heartbeat on a TV type screen. Your heart is being watched to make sure your body is making a good recovery from surgery.

Intra-aortic Balloon Pump: This is a circulatory assist device commonly used in heart surgery to increase the supply of oxygen and blood flow to your heart when your heart is too weak to do its normal work.

IV Line: An intravenous line is a tube that is placed in your vein for giving medicines or fluid. This tube can be capped or connected to tubing and fluid.

S JP Drain: This small bulb-shaped drain may be placed by your surgeon during your operation.

M It will help to drain fluid from the wound. R E

T Lumbar Drain: This is a drain placed in your lower back before your aneurysm surgery. It is F used to decrease blood flow in your aorta as a means of decreasing neurological complications O such as paraplegia. Y R A

S NG Tube: This is also called a nasogastric tube. This tube may be put in your nose and down S

O into your stomach. The tube is attached to suction to keep your stomach empty. L

G Oxygen by Mask or Nasal Prongs: You will receive extra oxygen through a mask or small prongs that enter your nostrils. Your caregivers will monitor your vital signs to determine how much oxygen your body requires while you are in the hospital.

Pneumoboots: These are sleeves surrounding the lower legs and connected to a machine which inflate and deflate with air to improve circulation and prevent blood clots.

Pulse Oximeter: This is a machine that tells how much oxygen is in your blood. This percentage of oxygen is known as oxygen saturation or "sat.” A cord with a clip is attached to your finger, ear or toe.

Vital Signs: This includes taking your temperature, blood pressure, pulse and respirations (counting your breaths). Caregivers may also listen to your heart and lungs using a stethoscope. Your vital signs are taken so that your caregivers can see that you are making a good recovery from surgery.

13-2 RESOURCES ES RC ES OU R OR F DIOAV SCULAR AR REAP RING C P CAR DIAC SURGERY | INFORMATION AND RESOURCES FOR PATIENTS AND FAMILIES

CARDIOVASCULAR RESOURCES

Available in the Brigham and Women’s Hospital The Michele and Howard Kessler Health Education Library

Books • An Arrow Through The Heart: One Woman's Story of Life, Love, and Surviving a Near-Fatal Heart Attack, Heffernan, Free Press, 2002 • Blood and Circulatory Disorders Sourcebook: Basic Information About Blood and Its Components, Bellenir, Omnigraphics, 1999

• Braunwald's Heart Disease, 2005 C A R

• CT of the Heart: Principles and Applications, Schoepf, Humana Press, 2005 D I • The Cardiac Recovery Handbook: The Complete Guide to Heart Disease and Recovery for O V

Patients and Families, Kligfield, Hatherleigh Press, 2004 A S C

• Contemporary Diagnosis and Management of Acute Coronary Syndrome, Cannon, U L

Handbooks in Health Care Co., 2006 A R

• Diagnosis: Heart Disease, Farquhar, Norton, 2001 R E

• Drugs for the Heart, Opie, WB Saunders & Co., 2001 S • Enfermedades Cardiovasculares: Todo lo Que Necessita Saber, Auberti, Grupo Imaginador, O U

2003 R C

• Essential Atlas of Heart Diseases, Braumwald, McGraw Hill, 2001 E S • The Female Heart: The Truth About Women and Heart Disease, Legato, Quill, 2000 • Get Rid of the Blues: Everything You Always Wanted to Know about Varicose Veins and Spider Veins but Didn't Know Who to Ask, Johnson, iUniverse.com, 2000 • Guia de la Clinica Mayo Sobre Hipertension, Sheps, Mason Crest Publishers, 2003 • Heart Attack! Advice for Patients by Patients, Berra, Yale University Press, 2002 • Heart to Heart: A Guide to the Psychological Aspects of Heart Disease, Budnick, Health Press, 1991 • Keep the Beat: Heart Healthy Recipes, National Heart, Lung and Blood Institute, 2003 • Living with Angina: A Practical Guide to Dealing with Coronary Artery Disease and Your Doctor, Pantano, 1st Books Library, 2000 • Mayo Clinic Heart Book: The Ultimate Guide to Heart Health, Gersch, William Morrow & Co., 2000 • Stories from the Heart: Women Heart Patients Describe their Disease, Treatment and Recovery, Roussos, National Coalition for Women with Heart Disease, 2003

14-1 CAR DIAC SURGERY | INFORMATION AND RESOURCES FOR PATIENTS AND FAMILIES

• Strong Women, Strong Hearts, Nelson, Putnam, 2005 • Thriving with Heart Disease: A Unique Program for You and your Family, Sotile, Free Press, 2003 • Varicose Veins, Ellis, Oxford University Press, 1999 • Vascular Medicine: A Textbook of Vascular Biology and Diseases, Loscalzo, Lippincott, Williams & Wilkins, 1996 • While Waiting for a Heart, Power, Xlibris Corporation, 2005 • Women are not Small Men: Lifesaving Strategies for Preventing and Healing Heart Disease in Women, Goldberg, Ballantine Books, 2002 • The Women's Heart Book, Pashkow, Hyperion, 2001

eBooks • Healthy Heart Handbook, Pinckney, Health Communications, 1996

S • Herbs for the Heart: Herbs to Lower Cholesterol and Blood Pressure, Increase Circulation, E

C Prevent Clotting, and Enhance Heart Health, Puotinen, Keats Pub, 1997 R

U • The Heart Disease Sourcebook, Cicala, Lowell House, 1997

O • Understanding Heart Disease, Selzer, University of California Press, 1992 S E • Your Heart: Questions You Have-- Answers You Need, People's Medical Society, 1996 R R A

L Journals U

C • Harvard Heart Letter S A V O

I eJournals D

R • American Heart Journal A

C • American Journal of Cardiology • British Heart Journal • HeartInfo FAQ • Cardiovascular Device Update • HeartInfo Fitness Guide • Cardiovascular Week • HeartInfo Nutrition Guide • Clinical Cardiology Alert • HeartInfo Patient Guides • Harvard Heart Letter • HeartInfo Women's Health • Heart • Journal of Cardiovascular Nursing • Heart and Lung • Journal of Cardiovascular Pharmacology and • Heart Disease Weekly Therapeutics • HeartCare • Journal of Thoracic and Cardiovascular Surgery • HeartCorps • Primary Cardiology • HeartInfo Ask the Doctor

14-2 CARDIOVASCULAR RESOURCES 3 14- S LIE MI A F D AN n e m o W n i and TS e N ? ry sis e l ol s a e r t o TIE g r es gno s re Fi r l s i D tudy ntr Su PA ia tack e lu S g se es du Cont D ai y abe At in ol ur Co aker Home ass F sea n il L n t as udi tt i ng e e r a oce og t ment o e r r yp fe at FOR i s St ng Di ster F r a l u c s a ol ar G B Pr e oki Li y hmi l n eat S sti ssu ssu ood rt - rt zat r Hea v o i ho' ICD Pacem F io He t m ri og T Sm hysi or a e T hyt d r f W at tery tery Pre Pre p d te t Cho a e ol se ur ur e Hea r r rr eeks W Hea t nox o gra n of si ck r o o C A A A an ur U 6 a a y y ht: l op Hear od od io Abl io r ng ve ctr Qui i y y hy g athe n ove d OURCE ai o l h h r r and lo lo o f rd p le n L t F C Att Sm o akers oms ion a ent irst B B ter isot t a esti E na na rol ss t t wei t t t v ro e r e g F wit wit m pt r e rit io RES o o r oc d w ct ar ar ar ar ar ng nt mmo r r er e e e th n t n gh gh h ce ve sin ut e ad ea h c le if if it ou ym D Hi He He L Hi L Ho N O R Pa R S U Y T Ca Co Co He C Co Co F He He Int Co E E AN • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ON k s i R ATI ces M r u o Y Servi OR to NF I ram ol g n i c u d de | r e ry ce og nt e R ase i sease Y Gui or ur ons Pr – se este rv urysm me at Di ail l y Se l Di ne er: tack ery ge Sur F on on on Factors ER re y t A a art r dicati ry Chol At raphy last ibri c sk ar eart anage mi lthy itati itati itati n n ti g Sur rt Cent Sm og op ur g r u S ge r H Ri Me il il il graphy M Afte io io t He y o ris Def or Heart gi gi t yth ar d ems G UR Y e e ab ab ab Su ress at at se Hea A d er to on gio re y Hea ll ll an ul ck rh ear bl l n an S An An St ur ter nd rt a r o a ec ng om il sc a s H isea Be An Art Reh Reh Reh Ar tt rt A P s ea gul ry ry Pr H ou Fa D A c c c c Fibri Fibri d olli id id H Y ling s ise ion i oa nd me ia iover ioversi ia iova ia ia c tr omina rt rt rt ina a ona ona ic bete ery ing nd er er rd rd rot rd rot rd rd rd rd t o r t let rial rial ia or or a a on a a a a a a a ft ft bd rt nt ng t t xer mot a eco DIAC Hea Hea A A Hea A A A A Go A E E Ha A C D C E C C C C C C C C C C B a C ph • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • AR deos C Pam i V CAR DIAC SURGERY | INFORMATION AND RESOURCES FOR PATIENTS AND FAMILIES

• Heart Valve Surgery: A Guide for Patients • Sex and Heart Disease • High Blood Pressure • Signs of a Heart Attack • Holter and Event Monitoring • Tilt-Table Testing • Implantable Cardioverter Defibrilator • Transesophageal Echocardiography • Living With Congestive Heart Failure • Understanding Advanced Heart Disease • Lower Extremity and Aneurysm • Understanding and Treating Heart Failure: • Pacemakers A Guide for Patients and Families • Patient and Family Guide to Cardiac Surgery • Understanding Angina • Peripheral Angiography • Understanding Interventional Cardiology and • Peripheral Artery Disease Drug-Coated Stents • Peripheral Bypass Surgery • Women and Cardiovascular Disease: Live a Heart Healthy Life • Peripheral Vascular Disease S

E • Women and Heart Disease • Primary Pulmonary Hypertension C • Women Take Heart R • Raynaud's Phenomenon U

O • Risk Factors for Heart Disease in Women S E

R Recommended Websites R

A • American Heart Association – http: //www.americanheart.org L

U • U.S. National Library of Medicine, National Institute of Health – http: //www.nlm.nih.gov C S

A • National Coalition for Women with Heart Disease – http: //www.womenheart.org V O I D R A C

14-4 CAR DIAC SURGERY | A GUIDE FOR PATIENTS DISCHARGE MEDICATION LIST

PATIENT : t i g n i / k n a o t s a m e ’ I R y h W : t i e k a / t e o m t i T n e h W : y a d a / s e y c m n i e t u y q n e a r F m w o H : e k a t o t / e h s c o u D m w o H c i r e n e n G o i / t e a c i m a d e N M d n a r B CAR DIAC SURGERY | A GUIDE FOR PATIENTS WEIGHT CALENDAR

PATIENT

Date Temperatur e/Time Temperatur e/Time Weight HOME AFTER CARDIAC SURGERY WHAT TO DO…. Activity

Lifting: No Heavy lifting (greater than 10 pounsa) for 3 months. Driving: No driving for 4 weeks (3 weeks for minimally invasive surgery). Hygiene: Shower daily using mild soap and water. Legs: Elevate legs when sitting. For Bypass patients, wear elastic stockings during the day and remove at night.

Exercise: The best exercise is walking. Your cardiologist may suggest cardiac rehabilitation after your 6-week check-up with your Cardiac Surgeon.

How to do a Self Exam

There are certain things you should check everyday when you go home. Incisions: Examine your incisions for signs of infection: » Increased redness, swelling or drainage » Increased incisional pain

Temperature: Take your temperature twice a day, morning and night. Record it in your log. If your temperature is greater than 100.5°F, please contact one of your physicians.

Weight: Weigh yourself daily. Record it in your log. If you gain 2 pounds over night or 5 pounds in a week, contact one of your physicians.

Sutures: All sutures and staples should be removed, unless specified, prior to discharge.

When to Call

Call your Surgeon if: I Incisions show any signs of infection I Your temperature is greater than 100.5°F » On nights and weekends: call 617-732- 6660 and have operator page the cardiac surgery doctor

Call your Primary Care Physician or Cardiologist if: » Weight Gain of greater than I 2 pounds in 1 day or I 5 pounds in 1 week

Call your 911 if: I You are experiencing angina pain or shortness of breath not relieved by rest

Your Follow-up Appointments

Date Time Cardiologist Cardiac Surgeon 75 Francis Street Boston, MA 02115 www.brighamandwomens.or g/cardiac surgery/default.aspx

© BWH 11/11 0700 218