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Patient Instructions

Your doctor took a vein or artery from another part of your body to create a detour, or bypass, around an artery that was blocked and could not bring blood to your heart. Your surgery was done through an incision (cut) in your breastbone. Your breastbone was reconnected with wire, and your skin was closed with stitches. You also had an incision made in your leg or arm, where the vein used for the bypass was taken from.

After surgery, it takes 4 to 6 weeks to completely heal and start feeling better. It is normal to:

• Have pain in your chest area around your incision
• Have a poor appetite for 2 to 4 weeks
• Have mood swings and feel depressed
• Have swelling in the leg that the vein graft was taken from
• Feel itchy, numb, or tingly around your incisions on your chest and leg for 6 months or more
• Have trouble sleeping at night
• Be constipated from pain medicines
• Have trouble with short-term memory or feel confused ("fuzzy-headed")
• Be tired or not have much energy
• Have some shortness of breath. This may be worse if you also have lung problems. Some patients may use oxygen when they go home.
• Have weakness in your arms for the first month

You should have someone to stay with you in your home for at least the first 1 to 2 weeks.

Learn how to check your pulse, and check it every day. Do the breathing exercises you learned in the hospital for 4 to 6 weeks. Shower every day, washing the incision gently with soap and water. Do NOT swim, soak in a hot tub, or take baths until your incision is completely healed. Follow a heart-healthy diet.

If you feel depressed, talk with your family and friends. Ask your doctor about getting help from a counselor.

Continue to take all your medications for your heart, diabetes, high blood pressure, or any other conditions you have.

• Do not stop taking any medicine without talking with your doctor or nurse first.
• Your doctor may recommend antiplatelet (blood-thinning) drugs, such as aspirin or clopidogrel (Plavix), to help keep your artery graft open.
• If you are taking a blood thinner, such as warfarin (Coumadin), you may need to have extra blood tests to make sure your dose is correct.

Know how to respond to angina symptoms.

See also:

• Angina - when you have chest pain
• Aspirin and heart disease
• Clopidogrel (Plavix)

Stay active during your recovery, but be sure to start slowly.

• Do not stand or sit in the same spot for too long. Move around a little bit.
• Walking is a good exercise for the lungs and heart after surgery. Don't be concerned about how fast you are walking. Take it slow.
• Climbing stairs is okay, but be careful. Balance may be a problem. Rest halfway up the stairs if you need to.
• Light household chores, such as setting the table, folding clothes, walking, and climbing stairs, should be okay.
• Slowly increase the amount and intensity of your activities over the first 3 months.
• Do not exercise outside when it is too cold or too hot.
• Stop if you feel short of breath, dizzy, or any pain in your chest. Do NOT do any activity or exercise that causes pulling or pain across your chest, such as using a rowing machine or weight lifting.
• Keep your incision areas protected from the sun to avoid sunburn.

Do not drive for at least 4 to 6 weeks after your surgery. The twisting involved in turning the steering wheel may pull on your incision. Ask your doctor when you may return to work, and expect to be away from work for about 6 to 8 weeks.

Do not travel for at least 2 or 4 weeks. Ask your doctor when travel is okay. Ask your doctor before starting sexual activity again. Usually it is okay after 4 weeks.

For the first 6 weeks after your surgery, you must be careful how you use your arms and upper body when you move.

• Do NOT reach backwards.
• Do NOT let anyone pull on your arms for any reason -- for instance, if they are helping you move around or get out of bed.
• Lift anything heavier than 5 to 7 pounds.

Brushing your teeth is okay, but do not do other activities that keep your arms above your shoulders for any period of time. Keep your arms close to your sides when you are using them to get out of bed or a chair. You may bend forward to tie your shoes. Always stop if you feel pulling on your breastbone.

Your doctor or nurse will tell you how to take care of your chest wound.

See also:

• Surgical wound care

If you had a cut or incision on your leg:

• Keep your legs raised when sitting.
• Wear elastic TED hose for 2 to 3 weeks until the swelling goes away and you are more active.

Call your doctor if:

• You have chest pain or shortness of breath that does not go away when you rest.
• Your pulse feels irregular -- it is very slow (fewer than 60 beats a minute) or very fast (over 100 to 120 beats a minute).
• You have dizziness, fainting, or you are very tired.
• You have a severe headache that does not go away.
• You have a cough that does not go away
• You are coughing up blood or yellow or green mucus.
• You have problems taking any of your heart medicines.
• Your weight goes up by more than 2 pounds in a day for 2 days in a row.
• Your wound changes. It is red or swelling, or it has opened, or there is more drainage coming from it.
• You have chills or a fever over 101 °F.

Off-pump coronary artery bypass - discharge; OPCAB - discharge; Beating heart surgery - discharge; Bypass surgery - heart - discharge; CABG - discharge; Coronary artery bypass graft - discharge; Coronary artery bypass surgery - discharge; Coronary bypass surgery - discharge

Ferraris VA, Mentzer RM Jr. Acquired heart disease: coronary insufficiency. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 61.

Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of paAtients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007 Dec 4;116(23):2762-72. Epub 2007 Nov 12.

Updated by: Larry A. Weinrauch MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.