A patient’s guide

Stay active

While waiting for your heart operation it is important to remain physically active. The stronger and fitter you are before the operation, the sooner you are likely to go home afterwards.

‘Physically active’ means continuing as much as your symptoms allow with the activities you would carry out in your normal daily life. If your symptoms include chest pain or tightness or shortness of breath it is important to discuss your level of activity with the doctor or nurse you see in the clinic.

Get practising

After heart surgery most patients have a wound down the centre of their chest over the breast bone. An important part of the soft tissue and bone healing is the restriction of the activities you do with your arms after the operation. This is because certain activities put a lot of stress on the bone that is trying to heal.

The main restriction is NO lifting, pushing or pulling with your arms for the first three months after the operation to allow the wound to heal successfully. As a guide you should not lift any object that is greater than 5lbs (2.2kg) in weight.

Some of the actions this will affect include getting in and out of bed, standing up and sitting down to a chair or toilet, carrying shopping bags and general everyday activities within the home.

Getting out of bed

To make getting out of bed easier after the operation it would be beneficial to practise the correct technique beforehand. The usual technique we advise is for you to roll onto either side and gently lower your legs off the edge of the bed, then push down through your elbow and come up into a sitting position on the edge of the bed. For lying down the same process is followed in reverse.

Getting out of a chair

To help with getting up without using your arms we advise a technique of sitting on the edge of the chair or toilet with your arms crossed on your chest. Then with your feet firmly flat on the floor, rock gently backwards and forwards three times with your nose coming forward over your toes. On the third rock forward push up strongly through your legs and come up into the standing position.

Be prepared

Start to make plans for going into hospital and for coming home after your operation

  • Think about how you will travel to the hospital. It might involve an early start so try to get some rest the day before
  • Think about what you will take into hospital. Make sure you have a pair of well fitting, flat, comfortable slippers or shoes. If normally you use a walking aid or have glasses or contact lenses, dentures or hearing aids, then make sure that you bring these with you
  • Think about how you will get home from hospital. You will be given the date that we expect you to be discharged. Make sure your friends and family know when this will be
  • Check that you have enough support in place for when you get home as you might need extra help
  • Before going into hospital it is sensible to stock up your freezer if you have one so that you don’t have to worry about shopping immediately after being discharged
  • If you are finding it difficult to manage at home prior to your operation, or you cannot get up out of a chair easily without using your arms, please mention this to the nurse at your pre-admission clinic appointment
  • If you are the primary carer for someone else think about how this person will be looked after while you recover from your operation.

In hospital treatment

Physiotherapy is an important part of the recovery after your operation. This leaflet will repeat some of what the therapist has said in the video on the DVD you will have seen. Please read it and ask any questions if it is not clear to you

There are three main areas of physiotherapy treatment:

  • Chest
  • General mobiliy
  • Fitness

Chest

People often get ‘chesty’ after an operation and it is important that any phlegm that is on the chest is coughed up before it becomes infected.

The reasons people get chesty include

  • Anaesthetic gases increase the amount of secretions on the chest
  • In the early stages whilst in bed you do not take breaths as deep as you do when you are up and about
  • The discomfort from your wound will stop you taking deep breaths automatically
  • Smoking or any previous chest problems will increase the amount of secretions

Walking and being out of bed is the best way to increase the volume of air in your lungs and your ability to clear phlegm after the surgery. However if this is not possible then you may be taught deep breathing exercises to help to prevent chest infections.

If you practise the exercises before your operation you will find them easier to remember afterwards.

Breathing exercises
  1. Sit upright in your chair, comfortably supported, with your shoulders relaxed.
  2. Take a slow deep breath in through your nose.
  3. Hold your breath for a few seconds.
  4. Gently ‘sniff’ in a little more air to top up the breath. Do this a couple of times until you can take no more in.
  5. Breathe out through your mouth and relax.
  6. Breathe normally five or six times.
  7. Complete four to five deep breaths per session.
Coughing or huffing

Good effective coughing or huffing is extremely important to clear any secretions present.

  1. When you cough after the operation we will ask you to support your wound with your hands or a pillow.
  2. Sometimes a ‘huff’ is more effective and less uncomfortable than a cough.

To ‘huff’ you need to:

  1. Take a normal size breath in.
  2. Breathe out forcefully through your mouth, as though steaming up a mirror.
  3. This ‘huff’ must be long enough and fast enough to move the secretions in your chest.

After your operation you must ask for pain killers if you are unable to take a deep breath or cough because of the pain.

General mobility

On the first day after your operation a physiotherapist or nurse will assist you to sit in a chair. You will be given circulation exercises to do and may walk on the spot.

You should start walking with assistance or supervision from the second day after your operation. This will help your lungs recover, stop you from getting stiff and increase your independence.

Your physiotherapist will

  • Advise you when to start walking on your own around the ward
  • Advise you how to increase the distance you walk
  • If appropriate, check that you can manage a flight of stairs comfortably before you go home.

Fitness after your operation

Before you go home your physiotherapist will advise you on the best form of exercise to help you to regain your fitness. You will also be provided with leaflets about your recovery at home and improving your fitness with cardiac rehabilitation.

© Papworth Hospital NHS Foundation Trust

Author ID: Senior Physiotherapist
Department: PhysiotherapyPrinted: November 2013
Review due: November 2016
Version: Leaflet number: PI 124
Large print copies and alternative language versions of this leaflet can be made available on request.

Papworth Hospital NHS Foundation Trust

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Tel: 01480830541
www.papworthhospital.nhs.uk
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