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Coronary Bypass Recovery: What to Expect

By , Caring.com senior editor
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Practical tips after coronary bypass surgery

If someone's doctor informs him that his coronary arteries (the arteries that provide blood flow to the heart) are severely blocked, he may need to undergo coronary bypass surgery. Also known as coronary artery bypass grafting, this surgical procedure diverts blood flow around a section of blocked or diseased artery. According to the American Heart Association, more than half a million of these operations are performed every year.

Bypass surgery is a major operation: The surgeon usually makes an incision along the breastbone (sternum), spreads the rib cage, stops the heart, and uses a heart-lung machine to circulate the blood during the operation. In some cases, the surgeon may remove a section of a long vein from the leg and use it as a bypass graft.

In this procedure, one end of the leg vein is grafted to the aorta (the large artery leaving the heart), and the other end is grafted to the coronary artery past the blockage. Alternatively, the surgeon may detach one or both of the internal mammary arteries (arteries that branch from the aorta) from the chest wall and attach the open end directly to the coronary artery downstream of the blockage.

Recovery from coronary bypass surgery depends on a number of things, including what type of bypass was done, the patient's physical condition before the operation, and whether he complies with his doctor's recommendations following surgery. A general timetable may help you plan for the future, but remember that there's no set schedule for recovery. Whether the patient experiences some or all of the following issues, here are some practical tips to help you both.

Physical issues after coronary bypass surgery

Loss of appetite or constipation

What you can expect: It may take several weeks for a patient's appetite to return to normal. He may complain of nausea at the smell of food for a few weeks after the surgery. Constipation can also be a problem, and he should avoid straining on the toilet because it can elevate blood pressure and stress the heart.

What you can do:

  • Offer frequent, small meals instead of three large meals a day.

  • Ask him what foods are the most appealing.

  • Try bland foods with a soft consistency, like applesauce or oatmeal. Steer clear of spicy foods or those with a strong taste or smell.

  • To relieve constipation, offer lots of fluids and foods high in fiber. Prune juice contains a natural laxative.

  • Ask the doctor if the patient can take an over-the-counter laxative or stool softener.

Weakness, fatigue, and shortness of breath

What you can expect: Nearly all patients recovering from bypass surgery will experience weakness, fatigue, and shortness of breath.

What you can do:

  • As soon as you get the doctor's okay, encourage the patient to get moving. Just getting out of bed, taking a shower, and dressing may be exhausting at first. In the first week, he should begin walking for five minutes, five times a day. Although this won't seem like much activity to you, it can be very difficult for him. Acknowledge that he's having a hard time while encouraging him to continue. After a few days, you should notice a significant improvement in fatigue and shortness of breath.

  • Be patient, and encourage him to do the same. He's just been through a major ordeal and you should both expect recovery to take time.

  • Within a few weeks, he should be able to begin a modified exercise program. If he has always been fairly sedentary, he may resist this idea. You might motivate him to exercise by:

    • Helping him set specific, realistic goals.

    • Exercising with him.

    • Keeping a journal of his progress.

    • Getting him moving first thing in the morning.

    • Helping him find exercise he likes to do -- for instance, if he hates walking, ask him if he'd enjoy a swim instead.

  • Recognize that it's not all up to you. You can encourage him to exercise, but ultimately he'll have to decide he wants to do it.

Leg swelling

What you can expect: He may experience swollen legs for a few weeks after the operation. If the surgeon removed veins from his leg, the blood flow returning to the heart may be slower, causing fluid to accumulate in the ankles and lower legs. The swelling can be extremely uncomfortable.

What you can do:

  • While he's resting on the bed or couch, place several pillows under his legs to raise his feet higher than his heart. Do this for an hour at a time, at least three times a day.

  • Remind him not to sit in one position for a long time or cross his legs, which can impair blood flow.

  • Once the doctor gives the OK, encourage him to walk as much as possible. Even short jaunts around the house or yard can help promote circulation.

  • Ask the doctor if elastic support stockings might be helpful. You can buy these at any medical supply store and even at some drugstores.

  • Notify the doctor if swelling worsens significantly or persists even with regular activity and elevation of the legs. Fluid buildup in the legs is a symptom of heart failure.

Other physical issues after coronary bypass surgery

A "clicking" noise or sensation in the chest

What you can expect: A patient may be able to hear or feel the two halves of his separated breastbone "clicking" or "popping." Although not uncommon in the first days after surgery, this sound or sensation should disappear once the breastbone heals.

What you can do: Check in with him to make sure the clicking is going away. Call the doctor if it's not gone within a c ouple of weeks or if it gets worse.

Discomfort and a lump at the top of the chest incision

What you can expect: As part of the healing process, a lump may develop at the top of the incision. This is a seroma, a pocket of fluid that sometimes forms after surgery or traumatic injury. Typically, the lump will disappear in about six weeks, although it may take as long as several months.

What you can do: A lump and some discomfort are normal, but notify the doctor if there's iincreased tenderness, redness, or swelling, drainage from the incision, or a persistent fever.

Emotional issues after coronary bypass surgery

Mood swings or depression

What you can expect: Depression is one of the most common emotions affecting people who've had heart surgery. One out of three patients report feeling anxious or depressed after a heart attack or heart surgery.

What you can do:

  • Distinguish between depression and "the blues." It's not surprising that someone might feel down after bypass surgery. He may be frustrated with the recovery process and unhappy that he can't do the things he once did. But if it's just a temporary case of the blues, his mood should lift as he regains strength and his pain disappears. Depression, on the other hand, is likely to linger.

  • Watch for these common warning signs of depression:

    • Frequent crying episodes

    • Feelings of hopelessness or worthlessness

    • Poor appetite or increased appetite

    • Sleeping too much or not enough

    • Increased agitation and restlessness

    • Loss of interest in life

    • Expressing thoughts of dying or suicide

  • Notify the doctor if you believe he's depressed. Depression is a serious problem that needs to be evaluated and treated.

  • Help him be as physically active as possible. Talk to the doctor and rehabilitation team about what exercises are appropriate.

  • Structure the day around activities that give him pleasure and a sense of purpose. For example, meet friends for lunch, or enjoy a leisurely walk through the mall.

Difficulty sleeping at night

What you can expect: Insomnia and fragmented sleep are common complaints after heart surgery. Normal sleep can be disrupted by pain, stress, or anxiety. He may find it difficult to fall asleep, or he may wake in the middle of the night and not be able to drift off again.

What you can do:

  • Minimize pain and discomfort at night. Arrange pillows to help him find the most comfortable sleeping position. If he has been prescribed pain medication, have him take it 30 minutes before bedtime.

  • Keep him busy so he won't nap too much during the day, but not so busy that he gets overly tired.

  • Eliminate caffeine in the late afternoon and evening.

  • Play relaxing music.

Other mental issues after coronary bypass surgery

Decreased mental function

What you can expect: It's not uncommon for people recovering from heart surgery to feel they aren't as mentally "sharp" as they were before the operation. Heart surgery puts a great deal of stress on the entire body -- including the brain.

What you can do:

  • The best way you can help is to reassure him that his cognitive skills will return with time. Just as the body needs time to recover, so does the brain. Meanwhile, you might relieve some of the pressure by taking over mentally challenging tasks like paying bills.

  • Talk to the doctor. Some medications, including beta-blockers, can decrease mental function. His doctor may be able to prescribe a different medication.

Anxiety and worry about the future

What you can expect: It's normal for a person to feel fearful after heart surgery. He may be worried that the surgery wasn't successful or that he won't recover. He may be afraid that he'll develop future complications like heart failure.

What you can do:

  • Let him talk about his fears. Don't brush off his concerns; keeping his feelings bottled up will make him feel worse. If it 's difficult for you to hear his worries, help him find a support group or online community.

  • Encourage him to keep a journal. Sometimes just writing about negative feelings can defuse them.

  • Remind him -- and yourself -- that his anxiety is most likely temporary. As recovery progresses, he's probably going to feel more like himself again.

  • Encourage him to get back into a normal routine as soon as possible. Getting dressed first thing in the morning, going for a walk outside, resuming favorite hobbies, and socializing with family and friends are all excellent ways to relieve fear and anxiety.

  • If his anxiety persists for more than four weeks, talk to his doctor. He may need counseling or antidepressant treatment.