After CABG Surgery

What is coronary artery bypass graft surgery?

Coronary artery bypass graft surgery (CABG) uses segments of veins or arteries taken from another part of the body to bypass arteries in the heart that are blocked or narrowed. The bypass allows more blood and oxygen to flow to the heart muscle. The surgery reduces symptoms (such as chest pain) and improves the heart's ability to contract   in people with coronary artery disease (CAD).

Quick facts

  • Coronary artery bypass graft surgery (CABG) creates new pathways around narrowed or blocked coronary (heart) arteries so more blood and oxygen flows to the heart muscle.

  • A 6- to 8-inch segment of a healthy blood vessel taken from another part of the body, such as the chest (mammary artery) or leg (saphenous vein), is used to make a detour (bypass) around the narrowed or blocked artery in the heart.

  • You may have more than one coronary artery bypass done at a time, depending on how many coronary arteries are blocked.

What happens after I get home?

When you get home, you may have:

  • Pain from your chest wounds

  • Muscle pain or tightness in the shoulders and upper back

  • Loss of appetite

  • Constipation

  • Swelling or discomfort in the leg where the segment of vein was removed

  • Tiredness, mood swings, depression or difficulty sleeping

  • Mild confusion, temporary memory loss and poor concentration

Most of these problems go away in 4 to 6 weeks, but a full recovery may take several months. If you have minimally invasive heart surgery, your recovery may be much quicker. When you're ready, your doctor may recommend a cardiac rehabilitation program (exercise and education under the supervision of doctors and nurses).

"It's been 2 months since my surgery, and the difference in how I feel is like night and day. The nurses told me I'd see a real difference after 4 or 5 weeks and that's exactly what happened." George, age 53

These guidelines will help you recover as quickly and completely as possible.

 

1.      Monitor your progress.

You need to be aware of how your body is responding to your bypass surgery. This will help you know when you should contact your doctor.

  • Take your temperature daily, at the same time of day, for the first two weeks. A slight fever (99° to 100° F) is common. Call your doctor if your temperature is above 101°, especially if you have a shaking chill.

  • Count your pulse for a full minute once a day at the same time of day for the first 2 weeks. When you count your pulse, sit in a chair and use the first 2 fingers of one hand to find your pulse. You can find it either on the thumb side of your wrist or on your neck, one inch to the side of your windpipe. Be sure you can see a watch or clock with a second hand. Count your pulse for 60 seconds. Call your doctor if it is more than 120 beats per minute, especially if you have shortness of breath, a cough, or drainage or pain from your incisions.

  • Weigh yourself at the same time each morning after you urinate, for the first month. Call your doctor if you gain more than 3 pounds in 2 days or more than 6 pounds in a week. Your body may be holding on to fluid and you may need to change medicines.

You can feel your pulse by pressing lightly on arteries on the inside of your wrist just above the base of the thumb, or on either side of your windpipe.  Gradually increase the pressure until you feel the pulse.
You can feel your pulse by pressing lightly on arteries on the inside of your wrist just above the base of the thumb, or on either side of your windpipe. Gradually increase the pressure until you feel the pulse.

 

2.       Keep an eye on your wounds.

It usually takes 6 to 8 weeks for your incisions to heal. Check them each morning after you shower. You may notice some redness and bruising of the incision line or a lump at the top of the sternal (chest) incision. This will decrease over time. Light pink or clear yellow drainage from your leg incision or chest tube sites is common. If you have any of these signs, call your doctor:

  • Large amounts of fluid draining from an incision

  • Drainage from your chest (sternal) wound, or any drainage that is thick yellow or bright red

  • Fluids oozing from your leg incision if a vein was removed and used for your bypass

  • A section of an incision that becomes increasingly red, hot or tender to the touch

  • Temperature greater than 101° F

 

3.       Watch for other symptoms.

You should feel much better after 4 to 6 weeks, even though the healing process normally takes up to 12 weeks. While you are healing, you may have symptoms including:

  • Nausea and loss of appetite

  • Pain in your chest or discomfort when you cough, sneeze, burp, laugh or turn

  • Numbness along the leg incision, especially at the knee and ankle

  • Feeling tired, irritable, angry, frustrated or moody

  • Being forgetful or having trouble concentrating

  • A hoarse voice

  • Changes in your sleep patterns

  • Blurred vision or difficulty reading. Postpone any eye appointments for 6 to 8 weeks after surgery to allow your eyes to return to normal.

 

4.       Follow a daily routine.

Here are the things to do each day during your recovery.

  • Shower daily. You may begin to shower during your hospital stay. Use warm, not hot, water so you don't get lightheaded. To help avoid infections, take showers instead of using the bathtub until your incisions are well healed.

  • Wash your incision(s) gently with mild soap every day. Rinse with clear water and pat dry with a clean towel. Don't use lotions, ointments or powder on the incisions until they are completely healed, unless prescribed by your doctor.

  • Do breathing exercises. To keep your lungs inflated, use a spirometer at least four times a day (10 slow deep breaths each time) for the first two weeks after you go home. You may feel somewhat short of breath, especially with exercise or after eating. This will improve over time. Deep-breathing exercises and coughing are important to help speed your recovery. Coughing reduces your chances of pneumonia. You may find it easier to cough if you hold a pillow tightly against your chest. Coughing won't harm your incision or bypass grafts.

  • Control your pain. Good pain control will speed your recovery. Chest pain and stiffness decrease after the first week, but your chest, shoulders and back may continue to be sore. This is because your ribs and muscles were stretched during surgery. Soreness in your leg incision may last for several weeks. Take your pain medicine at least twice a day (in the morning and at bedtime) during the first week that you are home. If you need more pain medicine, call your doctor for a refill, or try using acetaminophen (TylenolÔ).

  • Control constipation. After surgery, people often become constipated from their pain medicines. To prevent and control constipation:

    • Take stool softeners while you are on pain medicine.

    • Eat more fresh fruit and high-fiber foods, such as bran cereal and whole-wheat bread.

    • Use a laxative if you need it.

  • Physical Activity. During your first few days at home, you should walk the same distance at home as you did at the hospital. Gradually work up to walking at least 30 minutes a day. You may choose to walk several times a day for 10 to 15 minutes each time. Use a physical activity log to help you track your progress. To be sure you walk every day, set a regular time to walk and make it part of your daily routine.

    • Physical activity tips:

      • Find a safe, convenient place to walk. Walking in an indoor mall is often a good option.

      • Wait for one hour after eating a meal before you exercise.

      • During physical activity, stand up straight and breathe deeply. This exercises your lungs and will help improve your endurance.

      • For the first month after your surgery, take stairs slowly and stop to rest if you are out of breath.

      • Pay attention to your body. You can expect to feel mildly out of breath and tired, and have some sweating. You should not feel extreme shortness of breath, chest pain, palpitations (irregular heartbeats), dizziness or unusual sweating. If any of these occur, stop walking and call your doctor.

 

5.       Take anti-coagulant medicine (warfarin), if your doctor prescribes it.

Anti-coagulant medicine thins the blood and prevents blood clots from forming in your body. Warfarin (Coumadin) is a powerful anticoagulant. It usually takes a few weeks to reach a stable dosage. The dose is based on a test called a prothrombin time (protime or PT). You will get an appointment for your first protime test when you leave the hospital.

Once your protime reaches a stable value (International Normalized Ratio (INR) of 2–3 or 2.5–3.5), you will probably have protime tests once a month. If you don't hear from your doctor within 2 to 3 days after taking a protime test, call to find out the results, and when your next test is due.

Take your warfarin at the same time every evening. If you forget, do NOT take an extra dose the next day.

To prevent problems while taking warfarin, avoid activities that can cause bruising or bleeding, such as contact sports and dangerous activities. Use a soft-bristle toothbrush so your gums don't bleed after brushing. Do not take warfarin if you are pregnant or may get pregnant.

Call your doctor if you have

  • Unusual or excessive bleeding

  • Blood in your urine

  • Dark maroon or black stools (bowel movements)

  • Nosebleeds or bleeding gums

  • A bad fall or blow to your head

  • Unusual bruising

  • Vomiting of bloody material

Warfarin interacts with aspirin, ibuprofen and naproxen to produce extreme bleeding. Do not take these products unless your doctor prescribes them. Warfarin may also interact with alcohol and other medicines, so tell your doctor about all prescription and non-prescription medicines you take.

  • For headache and minor discomforts, take acetaminophen (TylenolTM ).

  • If you drink alcohol, have no more than one drink a day if you're a woman, or two drinks a day if you're a man.

 

How can I learn more about coronary artery bypass surgery?

Talk with your doctor. Here are some good questions to ask:

  • Could I be considered for minimally invasive coronary artery surgery?

  • Will I be put on a heart-lung machine?

  • Will you use a vein from my leg or will you use an artery in my chest for the bypass?

  • How many of my arteries will need bypasses?

  • When will my chest heal?

  • When can I go back to work?

 

How can I learn about related topics?

Related topics include: 

 

Publication Source: American Heart Association
Date Last Reviewed: 6/3/2008
Date Last Modified: 6/3/2008