Recovery from Open Heart Surgery: Common Complications

Issues affecting recovery from open heart surgery

How many of you heard from you cardiac surgeon that you would feel great in a couple of months after open heart surgery? Did  you bounce back fast, or are you finding it a long slow process of feeling like you have recovered? I consistently have told patients it takes a year to heal up completely from open heart surgery. One month for the vessels to heal, two months for the muscles, three months for the bone to mend, three months for blood counts to return to normal and a year for inflammation to settle down, and strength to return. I bet most didn’t hear those comments before going into surgery. This is information gleaned from 20 years of working with post operative open heart patients.

Common complications of open heart surgery

The first few months present the most challenges. What types of challenges? Well in cardiac rehabilitation the challenges we faced most included:

• Heart rhythm problems – usually atrial fibrillation and tachycardia,  followed by heart blocks requiring pacemakers, rarely  ventricular fibrillation and ventricular tachycardia
• Plueral Effusions -A pleural effusion is a buildup of fluid between the layers of tissue that line the lungs and chest cavity. This creates shortness of breath, anxiety, a feeling of drowning
• Anemia – blood counts that don’t return back to normal, produces fatigue, shortness of breath, activity intolerance
• Infections of the surgical site or where the harvested graph occurred
• Pump head – in some patients, the use of the cardiopulmonary bypass pump can cause foggy thinking and confusion after surgery
• Nerve damage – it isn’t uncommon for patient to have their ulnar nerve irritated and experience numbness of the fourth and fifth fingers of their hand. The technical term is brachial plexopathy. My belief it this is due to the prolonged position they are in during the operation places stress on the neck which pinches the nerve.
• Diaphragm nerve damage  due to phrenic nerve injury. This causes the diaphragm to only have limited ability to  work causing permanent shortness of breath problems.
• Vocal cord nerve damage. Cardiac surgery represents a risk to normal voice function as the nerves serving the larynx (voice box) are near the heart.

How to manage complications in recovery of open heart surgery

If you or your loved one is having a hard time recuperating, know that these type of complications do occur, and are not that unusual. Keep notes of the issues you are finding as you recover. Don’t be afraid to report even minor problems to your healthcare provider, as they may be able to be addressed and the sooner they are addressed the better.

If you are finding you just aren’t bouncing back, either due to fatigue, shortness of breath, lightheartedness, anxiety – make sure you talk to your physician about this. Be persistent, come in with a list of what you are concerned about. Often this is where cardiac rehabilitation is very helpful, as the clinicians are very familiar with these complications and can assist in communicating their finding with the physician and educating the patient on the implications to them. This helps to get referrals to the appropriate providers, whether it is pulmonologist, physical therapy, emergency room, surgeons. And we all know how easy it is to navigate through our US healthcare is…..yeah right!

Grief and heart health

There is a link between grieving and heart problems. It wasn’t uncommon when interviewing a new  cardiac rehabilitation client to find many were grieving the loss of a loved one. In cardiac rehabilitation we would make sure to document it in their notes. Grief can be considered a risk factors for coronary artery disease. Often grieving is not addressed well enough from the medical community. Yes we label it on a chart, but what do we offer to help a person who is grieving?  Some suggestions include counseling, support groups, a listening ear, an opportunity to  reflect. It is especially important around holidays or anniversaries as many have increased heart symptoms which most likely are related to the grieving process.                                                                                           

Emotional distress is a common trigger of angina.

With loss many experience increased heart symptoms of chest pressure, chest discomfort, pain, heaviness, fatigue and energy loss.

 “Heartache the emotional pain recognition site in the brain is located near the region that senses and interprets sensations. When we suffer emotionally, the brain responds by releasing neurochemicals we experience in our body as an intense aching in our upper abdomen and lower chest. Grief-related stress can increase blood pressure and heart rate, raise levels of the stress hormone cortisol, constrict blood vessels, and disrupt cholesterol-filled plaques that line arteries. Any one of these changes raises the risk of heart attack.

Grief also makes blood “stickier” and therefore more likely to clot. Acute stress tends to increase levels of the hormones known as catecholamines which causes platelets to stick together. If a plaque bursts, the resulting clot is more likely to cut off blood to the heart.

American Heart Association’s Circulation reports scientists have found evidence that grief might actually break your heart. Studies show that people grieving the death of a close loved one could have a heart attack risk that is higher than normal.

The calculated the risk of a heart attack as 21 times higher in the first day after the loss of a loved one.  Risk declines steadily with each day after a loved one’s passing, but it remains eight times higher one week after the death and four times higher one month afterward, according to the American Heart Association journal Circulation

The link between grief and bereavement was strongest among people who had preexisting risk factors for heart disease and heart attacks, such as high blood pressure or unhealthy cholesterol levels. People mourning the loss of a loved one might further increase their heart-attack risk by sleeping poorly, eating less,  and skipping their medications. Other factors may include binge eating of comfort foods, increased alcohol or tobacco in an effort to comfort oneself from the intense loss.

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Broken Heart Syndrome; 

Takotsubo Cardiomyopathy is a type of heart failure caused by grief or stress where the left ventricle balloons out taking on an unusual shape like a Japanese fishing pot. The symptoms are the same as a heart attack but an electrocardiogram does not always show the problem. You experience chest pain, shortness of breath, arm pain, and sweating as in a classic heart attack but its different. Postmenopausal women who are grieving are the main patients who experience this type of heart failure. It is caused when experiencing grief, stress, emotional trauma, or physical stress. The best test to confirm this heart problem is a contrast echocardiogram or an angiograph which takes pictures of your heart. The recovery for this type of heart failure usually takes less time than a classic heart attack.

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Depression: Depression is part of the grief process. This grief causes a dark sadness, insomnia, lack of appetite, and weight loss. It is considered part of the normal process of healing. After months if the person does not heal, it can become permanent and steps need to be taken by a professional level.  Meaning it is time to discuss it with the healthcare practitioner, consider counseling and  consider medications. Some people even lose their will to live. To heal, grief must be addressed. It is not an expectation that it will end but it should decrease to where it isn’t always overwhelming and effecting quality of life or daily activity. At what point does grief turn into permanent depression that is life threatening? There is no simple answer to this question. It is generally advised, if the person has not begun to come out of their grief by a year, they probably need to seek professional help. The elderly have more challenges with grief and depression as there may be problems adjusting to life.  After spending 30 to 50 years with a spouse, they simply don’t know how to live without them. They often don’t eat healthy, skip medications, become isolated, consume more alcohol or tobacco which undermines health.

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Resilience

Stress is everywhere today especially following a heart problem. It is possible for people to find ways to be resilient and thrive and even grow from the stress that you experience following a heart problem.  The  stress of heart disease can impact both mental and physical health. It is possible to find and create well-being in the midst of all the stress and health challenges you face.

Psychological resilience is an individual’s tendency to cope with stress and adversity. Resiliency is the ability to recover quickly from disruptive change, illness, or misfortune without being overwhelmed or dysfunctional.  This coping may result in the individual “bouncing back” to a previous state of normal functioning, or simply not showing negative effects.  Resilience is most commonly understood as a process, and not a trait of an individual.

It is important to learn and understand how to be resilient to avoid the tendency to struggle through from one crisis to the next, but develop skills to survive and become a stronger person along the way.

 

 10 Steps to Resilience

Heart disease is frightening you have a choice, a choice to be resilient or defeated.

Tips for Resiliency: Bouncing back

1. Expect ups and down in your mood. These are normal emotions to experience, if you don’t experience them that could be a problem.  Quiet the voices in your head that are negative. Acknowledge the  negative thought you have, stop thinking negative, give yourself a pep talk and focus on the positives in your world.
2. Taking control.  Focus on what you have control over. You may not have control over your heart disease, but you do have control on how you manage it. Set your goals to exercise, eat healthy, relax, stop smoking, take your medicines and love those in your life.
3.  Surround yourself and educate yourself with a good team, Cardiac Rehabilitation programs are great for this. Consider finding a support group or an online forum. Resist the urge to isolate yourself
4. Consider what you are grateful for such as surviving, stopping smoking, weight loss, improved diet and your relationships. Fifty percent don’t survive their first heart attack. Daily find something at the beginning or end of the day in which you are thankful for.
5. Keep a journal and keep track of your thoughts and progress.
6. Think about your character’s greatest strengths.
7. Find things you love to do. It could be some hobbies or favorite pastime. If you cannot return to these activities, what else is important to you? Who knows your favorite book, movie, inspirational quote,  songs, spiritual beliefs. Share your loves and passions with others.
8. Stop saying “why me?” and start asking “Why not me? How am I going to handle this?” Many get bogged down in thinking but I did everything right and still had a heart problem. Consider maybe that is why you survived the heart problem.
9. Keep your mind occupied. Don’t make time to feel sorry about yourself. Helping others is a great way to boost your resilience. Mentor another who is going through a heart problem.
10. Forgive, Accept and Adapt. It is easy to get angry and bitter. The best thing you can do to have resilience is to make the decision to forgive and then have the willingness to reinvent yourself. There are many inspirational heart patients out there who have thrived since surviving their heart condition.

For about 20 percent it comes naturally; people are glad to get back into the swing of life pretty quickly, feeling stronger for having weathered the storm. For others, it’s a long, slow slog through the blues until you come out the other side.  Consider counseling if you continue to struggle. Fortunately, everyone can learn how to gain the health benefits of resilience: less stress, lower risk of heart disease, less depression and anxiety. Here are three ways you can strengthen your ability to bounce back:

•  Cultivate an optimistic outlook, which is a key part of being resilient. Looking on the bright side is enhanced with daily meditation.

• EXERCISE Keep your body strong  and limber by eating a diet powered by lean protein and lots of veggies, fruits and 100 percent whole grains. When you feel physically strong, your self-esteem increases, another vital part of resilience. Fuel your body with healthy foods avoid junk food, comfort food, alcohol, tobacco.

• Nurture your social connections. They provide security and love, and help keep emotions on an even keel. Blood pressure goes down; ability to cope goes up. So reach out and touch someone, physically and emotionally. Call a friend, go out, visit your family, talk to others about your experience.

Read more: Secret to Longevity: Resilience

http://heartfitclinic.com/reversing-heart-disease-with-resilience/#

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