Cardiac Rehabilitation

After discharge from the hospital now you are at home. You are discharged from the hospital when your doctor and clinical supervisor have full confidence that you are medically stable. As you were initially told that the cardiac operations are major ones and thus during the initial recovery phase you will feel tired and drained. And you might be getting exhausted easily, but need not to panic, gradually you will start gaining strength and sense of wellness. Though the defect in the heart is fixed nicely but the actual subjective and objective benefit of the surgery takes time to come in effect usually 6 weeks to 3 months .

So it is very important that you stay confident and active during this recovery phase so that the health blossoms faster.

After reaching home first you have to inform your local regular physician or cardiologist , and show all your documents so that they can understand what treatment has been done , so that in case of any urgency he/she can attend you well. And always you have to meet your local doctor first in case of any problem.

A balance between rest and exercise is the key to faster recovery. Adequate exercise as mentioned in the physiotherapy brochure and 1 to 2 hr afternoon and 8 hr night sleep is enough for you. follow this schedule for approximately 1 month of surgery.

Walking in moderation is the best exercise for you initially. This increases the muscular blood supply , and reduces the chances of blood clotting in leg veins. You should walk as directed in the physiotherapy protocol which includes a mix of slow and brisk walking. If you feel pain or extreme tiredness during walking then the duration can be adjusted according to your heart rate and Blood pressure during exercise. For that the doctor or the physiotherapist can be consulted. Its always better to walk in company of friends or family members , it makes exercise enjoyable and you feel secure that somebody is along if some problem happens.
While walking its important that you wear comfortable shoes or sandals. Better to wear stockings to prevent leg swelling.
Before walking episodes better to do breathing exercise with spirometer or you can try Anulom –Vilom yoga.
Better you walk on a plane surface like walking path, Road or in society compound. Walking in fields , grounds should be avoided because due to uneven surface you may fall. During extreme weathers like summer heat, rains or winter better to adjust timing as per convenience rather than following a fixed timing. Morning and evening walk schedule is just better than rest.
Daily routine work like reading, writing, table work or computer operation for some time, teaching kids , watching TV can be done according to convenience. You should not be bed-ridden , it actually harms you in many ways.
Any work in which you can sustain jerks in shoulder or chest must be avoided. Like washing clothes, jumping or jogging, lifting buckets or any weights, swimming, gardening , tying shoe laces stooping down etc. should be avoided. Usually these kind of activities re allowed after 2 to 3 months. But yes you can do office table work after 1 month or so.

You can climb stairs up or down , it is perfectly O.K.
Before you go home , your physio must have taught you how to climb stairs up and down.
While getting up or down through stairs you better hold railing for support, climb for 5 to 6 steps and then stop for a while then again start , this way you don’t get tired and breathless. If you feel tired stop for some time then climb again, stair climbing if done slowly does not cuse jerks to the chest.

For next 6 weeks you should not lift weight more than 5 kgs.
After 3 months you can lift 10 kg weight.
Weight lifting as normal person will only be allowed after 6 months.

As you are weak , even smaller exertion as small as bathing or brushing will make you feel tired and drained. It means you need adequate rest so better do works in alternation to resting episodes. Try to avoid taking frequent naps, it usually freshens you up but at night it will cause insomnia or difficulty in getting sound sleep. In afternoon after meals you can have a long nap.
After you get-up in morning you may feel heaviness in chest around the incision site. Need not to worry after you start mobilizing it reduces .it is due to muscle stiffness, which gradually with exercise reduces.

For the first month of discharge you should not ride or drive.
After 1 month you can drive a four wheeler yourself , but always wear seat belt to avoid jerks. You can sit pillion in a tow wheeler but don’t ride it yourself.
After 2 months only you can ride a two wheeler yourself. Avoid bad roads .
If you are traveling for long distance always remember that you need to take stop for 10 – 15 minutes after every 2 hr journey, and walk for 2-5 minutes.

You will have loss of apetite and bad taste initially, stomach will fill very easily and even you may feel nausea and vomiting, these all are due to some medicines which are given initially like antibiotics and pain killers. Need not to worry much gradually it improves.
Initially eat what you like , don’t follow any dietary restrictions (Except for diabetics should not eat sweets and sugar), as you have bad taste and dislike for food if you get food of your liking you will eat little better. If you feel full after small meals eat at frequent intervals. I personally advice all dietary restrictions after 1 month as by then the apetite, taste improves and you start feeling better.
For water its better you drink according to instruction given to you from doctor. Because too much or too less of water intake , both are detrimental to heart in initial days.

Always take medicines in time.
The medicines which are mentioned as” to continue” must not be stopped before meeting your surgeon in follow up , if the baught medicines are over , better buy new ones till you see the surgeon in follow-up.
The medicines wich are mentioned for specific durations, like ”for 3 days or 5 days”. Should be stopped after mentioned days , need not to continue beyond the mentioned time.

Atleast for the first 2 weks after discharge measure your weight in morning after getting-up. Any sudden increase of 2-3 kg of weight from the time of discharge should be alarming and should be communicated to the physician or concerned surgeon.
Reduction in weight signifies dehydration due to diuretics (Drugs which increase urine output), and weight gain means water retention and selling of body (due to over water and salt intake, or low dose of diuretic) and has to be addressed.

By the time you get your discharge mostly the skin of the incision site is healed. So don’t worry and take daily bath, apply some soap on the site and clean it. After bath wipe th area of surgery with soft wipes or soft towel. As the skin is healed water will not go inside the wound don’t worry.
Do not apply any ointment or cream on it, its useless.
If you see some redness in or around the scar, pus or water discharge or holes in the scar site, it signifies the wound is not healing and may be it is infected and you need to see your doctor early.

After discharge actually you are able to involve in sexual acts, if you find yourself comfortable you can have sex. But mostly the patients are weak and afraid of their health and sex is among the last things in their mind. So better you need to regain your strength and when you feel comfortable in day to day activities then this pleasure definitely can be added on. But you need to be careful that there should be no compression or strain at the chest. And if you feel too much palpitation or you get tired in the act better stop .

STRICT NO .. NO. tobacco is your enenmy now onwards atleast. It damages your heart, lung , blood vessels and brain. So after you ave undergone such a major operation it is advisable not to indulge in tobacco addiction again.

In ladies for initial few months the menses may be irregular, that may be due to weakness and medicines. No need to panic only you need to inform your gynaecologist she will sort it out .

Metallic valve produce ticking sounds, which actually is noise produced because of the closure of the valve, the noise is more prominent in the night. It appears like wathtik-to.don't be afraid it's normal, gradually you will get used to it.