After coronary artery bypass surgery (CABG) in Assuta

13 minutes

793 views

“Currently, about 30% of people (28% men and 34% women) aged 15 years and over in the world were not physically active enough. Approximately 3.2 million annual deaths are associated with insufficient physical activity" (World Health Organization)

Myocardial infarction is necrosis (death) of the heart muscle (myocardium), which occurs due to acute insufficiency of coronary blood flow.

Read more about myocardial infarction, risk factors for its development and rehabilitation here: “Rehabilitation after myocardial infarction”

Physiotherapy exercises for myocardial infarction begin on the 2nd or 3rd day. First, exercises that are feasible for the patient are carried out, ensuring mobility in small and medium-sized joints, then the exercises become more complicated.

Wider use of physiotherapeutic rehabilitation begins from the 30-45th day from the onset of acute myocardial infarction in rehabilitation departments, sanatoriums or clinics. During this period, a set of measures is used, including strictly dosed walking, therapeutic exercises, and physiotherapeutic procedures.

Recommendations for physical activity, types of exercises and their duration are developed by the doctor, based on the age, weight of the patient who has suffered a myocardial infarction, the severity of damage to the heart muscle according to clinical, biochemical and electrocardiographic indicators, and the presence of concomitant diseases.

The Cardiological Sanatorium operates a medical program “Recovery”, within the framework of which the rehabilitation of patients who have suffered a myocardial infarction is carried out.

Treatment

Treatment with coronary artery bypass grafting is carried out by a cardiologist. This operation is quite complex and requires serious skills and abilities. In addition, the procedure requires a lot of effort on the part of the patient, because the recovery stage lasts several months.

The recovery stage after any surgical intervention includes a whole range of procedures aimed at maintaining the vital functions of the body and stabilizing the human condition. To do this, the patient is given drug therapy, the main objective of which is to prevent inflammation and quickly restore cardiac activity.

Why do you need therapeutic exercises after bypass surgery? For a speedy recovery, as well as to improve the condition of the heart muscle in the postoperative period, proper and effective rehabilitation of the patient, which includes therapeutic breathing and exercise therapy, is of great importance.

Health-improving physical education after coronary artery bypass surgery allows you to:

• include in the work of all circulatory organs;
• gradually increase the load on the myocardium, so that the body gets used to it;
• ensure stable operation of all circulatory organs, including extracardiac ones - this can significantly reduce the load on the heart muscle;
• prevent the development of inflammatory processes in the chest;
• restore metabolic processes in the myocardium;
• produce a general strengthening of the muscular system of the heart for optimal myocardial contraction;
• reduce the number of complications after surgery;
• quickly restore the overall immunity and strength of the body.

In addition, therapeutic exercises after CABG can reduce the risk of developing thrombophlebitis of the veins of the lower extremities, infiltrates, promotes the healing of scars and the normal fusion of tissues damaged during surgery.

Treatment in a sanatorium

Rehabilitation after heart surgery is impossible without taking a course in a sanatorium. It is aimed at stabilizing the patient’s general condition, minimizing the risk of complications, restoring working capacity, improving the functioning of the cardiovascular and respiratory systems, and restoring the psycho-emotional state.

As part of sanatorium rehabilitation, various procedures are carried out - massage, exercise therapy and gymnastics, therapeutic baths, aromatherapy, inhalations and so on. The course is developed depending on the timing of its completion.

Individual and group psychotherapy is mandatory, since heart surgery is a consequence of serious, high-risk diseases, which means that most patients have a fear of death and a depressed state. Exercises alone and procedures after surgical treatment will not help, since much of the recovery depends on the psycho-emotional state of the person.

Training rules

Rehabilitation, including physical activities, after heart surgery are prescribed within a few days after the procedure. First, this process consists of simplified minimal physical tasks aimed at normalizing the patient’s proper breathing, as well as at fully restoring the body’s strength.

There are a number of rules required for the correct implementation of physical activities after coronary artery bypass surgery:

• any, even minimal exercises after surgery should be performed only after the advice of a specialist, who selects the complex individually for each patient, based on his condition and the complexity of the operation;
• the dosage of the load, as well as a set of tasks, is prescribed by the doctor, the training should take place under his supervision;
• classes should not be of a training nature and should not place a high load on the muscular system of the body;
• tasks should be performed in minimal quantities, gradually increasing the load on the body;
• performing health-improving physical education should be done regularly (exercises should be done periodically) for the most effective results;
• It is recommended to do gymnastics in the morning 20-30 minutes before meals or 1-2 hours before bedtime;
• when performing exercises, it is necessary to carefully and regularly monitor the patient’s pulse, blood pressure and heart rate;
• if even a minimal deterioration in the patient’s condition occurs, you should stop exercising and check the functioning of the body systems;
• Gymnastic movements should be carried out with parallel drug treatment and diet therapy prescribed by the attending physician.

Memo to a patient who has undergone cardiac surgery

Memo to a patient who has undergone cardiac surgery

After heart surgery, you may feel that you have been given another chance to prolong your life, and you will want to get the maximum results from the operation. If it was coronary bypass surgery, then it is important to change your lifestyle, for example, lose extra 5-10 kg, start regular exercise, change eating habits that lead to high cholesterol and weight gain, etc. The days ahead will not always be easy, but you must steadily move forward to regain your strength and health.

Emotions

It is normal if you feel upset or depressed after discharge. Temporary low mood is normal and will gradually go away as you get back into your regular life and work.

However, sometimes a depressed mood can slow you down in returning to normal life. If your depressed mood only gets worse and is accompanied by other symptoms that accompany you every day for more than a week, you need treatment from a specialist.

Without treatment, depression will only get worse. For heart patients, depression can result in the development of a heart attack. Your doctor may refer you to a specialist to determine the treatment you need.

Diet

Because you may initially experience loss of appetite and good nutrition is important in wound healing, you may be discharged on an ad libitum diet. After 1-2 months, you need to switch to a diet with a small amount of animal fats, sugar and salt. Products high in fiber, complex carbohydrates, and healthy vegetable oil (corn, olive, sunflower, flaxseed) are beneficial.

Anemia is a common condition after surgery. It can be partially eliminated by foods high in iron: liver, red meat, rose hips, pomegranate, etc. If you have been prescribed an iron-containing drug, remember that it can turn the stool black and cause constipation, as well as dyspepsia. In this case, take the medicine with food.

How to care for a seam

The following is very important:

• Keep the seam area clean and dry.
• Use only soap and water to wash the area.
• Do not use ointments, oils, rubs or compresses until you are specifically told to do so.

Shower: Wet your palm or washcloth with soapy water and gently scrub up and down the seam area. Do not rub the seam area with a washcloth until all the crusts come off and the seam is completely healed. The water should be warm - not hot and not cold. Water that is too hot or too cold can cause you to faint.

Contact your doctor if signs of infection appear:

• Increased discharge from the wound
• The edges of the wound have separated
• Redness and swelling appeared in the suture area.
• Increased body temperature (above 38 degrees Celsius)
• If you have diabetes and your sugar levels are much higher than usual.

Pain relief

At first, you will experience discomfort in the chest muscles, in the suture area and in the chest as a whole with active movement. Itching, a feeling of stiffness in the suture area, or loss of sensitivity are normal after surgery. You should not have chest pain similar to what you experienced before surgery. Before discharge, you will be advised to take painkillers and anti-inflammatory medications. If you have had CABG surgery, then in addition to pain in your chest, you will also have pain in your leg, where the vein for the bypass was taken from. Daily walks, moderate activity and time will help you manage your leg discomfort.

Be sure to consult a doctor if you experience mobility or clicking in the sternum when moving.

Swelling

You will return home with some swelling in your legs and feet, especially if you had a vein removed for bypasses. If you notice swelling:

• While resting, try to keep your leg(s) in an elevated position. The easiest way to do this is to lie on a sofa or bed and prop your feet up on some pillows, or lie down on the floor and prop your feet up on a sofa. Do this three times a day for an hour and the swelling will noticeably decrease.

(Important: just lying on your back does not elevate your legs enough).

• Don't cross your legs when sitting.
• Walk daily, even if your feet are swollen.
• Use compression stockings.

Contact your doctor if your legs become swollen and become painful, especially if you experience shortness of breath when moving.

Activity

Gradually increase your activity every day, week, month. Listen to what your body says: rest if you are tired, have shortness of breath, or have chest pain.

First week at home

Walk on level ground 2-3 times a day. Start with the same time and distance as the last days in the hospital. You can do 150-300 meters. If necessary, stop for a short rest. Always take these walks before meals. You are shown quiet activities: drawing, solving crosswords, reading, etc. Try walking up and down stairs. Go out with someone in the car for a short distance.

Second week at home

Lift and carry light objects (up to 5 kg). The weight should be evenly distributed on both hands. Increase your walking to 600-700 meters. Do light housework: wipe the dust, set the table, wash the dishes, cook while sitting.

Third week at home

You can do chores in the yard, but avoid straining and prolonged bending or working with your arms raised. Start walking at a distance of 800-900 meters.

Fourth week at home

Gradually increase your walk to 1 km. You can lift things up to 7 kg. If your doctor allows it, you can start driving on your own. Do things like sweeping, vacuuming, washing the car, cooking.

Fifth to eighth week at home

At the end of the 6th week, the sternum should have healed. Continue to continually increase your activity. You can lift weights up to 10 kg. Play tennis, swim. On a personal plot you can weed and work with a shovel, at home you can move furniture (light). If your job does not involve heavy physical activity, you can return to it. It all depends on your physical condition and type of work.

Medications

You will need to take medications after surgery. Your doctor will tell you how long you will have to take the medications - just for the first time or for life. Make sure you understand the names of the medications, what they do and how often you should take them. Take only those medications that have been prescribed to you. Discuss with your doctor whether you need to take the medications you took before surgery. Do NOT take new medications (dietary supplements, pain relievers, cold medications) or increase the dosage of old ones without consulting your doctor. If you forget to take a pill today, do not take two at once tomorrow. It is recommended that you carry a list of your medications with you at all times.

Here is a list and characteristics of the most commonly prescribed drugs:

Antiplatelet agents are medications to prevent the formation of blood clots. They affect platelets, reducing their ability to stick together and attach to damaged artery walls. These include aspirin and clopidogrel. The drugs have a negative effect on the mucous membrane of the stomach and intestines and can cause the formation of erosions and ulcers. If you have a high risk of developing gastrointestinal ulcers, you need to take gastroprotectors : pantoprazole, lansoprazole, omeprazole, etc.

Medicines that lower cholesterol levels: statins (atorvastatin, rosuvastatin, simvastatin, lomestatin), fibrates (fenofibrate). They reduce the level of “bad” fractions of blood lipids and can increase “good” cholesterol. It is especially important to take these drugs for patients after coronary artery bypass surgery.

Beta blockers . By reducing heart rate, blood pressure, and the force of contraction of the heart muscle, these medications reduce the load on the heart. These include metoprolol, bisoprolol, nebivolol, carvedilol, etc. When taking them, it is necessary to monitor the pulse. The optimal frequency is 60±5 per minute at rest. The dose of such a drug is increased gradually, and withdrawal should not be abrupt. When prescribing this group of drugs, it is necessary to take into account the presence of diabetes and asthma.

Angiotensin-converting enzyme inhibitors (enalapril, lisinopril, monopril, perindopril, ramiril): reduce blood pressure, help reduce the load on the heart, and prevent thickening of the walls of blood vessels. The most common side effect is a dry cough. When it appears, it is possible to use sartans that do not have this side effect (valsartan, losartan, candesartan).

Calcium channel blockers : amlodipine, lercanidipine, nifedipine sustained release. They relax the walls of blood vessels and reduce blood pressure. When taking them, swelling in the legs, dizziness, and headache are possible.

Diuretics (diuretics ). Designed to remove excess fluid and salt from the body. Used to treat arterial hypertension and heart failure. The most commonly prescribed drugs are furosemide, hydrochlorothiazide, indopamide, torasemide, and spironolactone. If you have signs of heart failure and are taking diuretics, be sure to weigh yourself regularly; weight gain may be due to excess fluid in the body. Possible side effects - convulsions, spasms.

IMPORTANT! If you have had heart valve surgery, you need to prevent any type of infection to prevent the development of infective endocarditis. This includes taking antibiotics before you have any invasive procedure, dental procedure, or surgery. Your doctor will explain in more detail how to reduce the risk of complications.

So: follow your doctor's recommendations, lead a healthy lifestyle, eat right, be positive, and you will help your heart beat confidently and for a long time!

Prepared by S.A. Brishteleva, a cardiologist at the RCC of the Central District.

Contraindications

Physical education after any operation should be carried out in a particularly gentle manner, but, like all medical procedures, physical education has a number of contraindications that limit the circle of people allowed to perform tasks. The main contraindications for manipulations after coronary artery bypass grafting are:

• the first 3 days after the manipulation there is a high risk of suture divergence;
• serious condition of the patient;
• stable deterioration of the patient’s condition after several exercises;
• early complications that arose after the operation.

Carrying out physical therapy is possible only after eliminating malfunctions in the functioning of systems and organs.

Drug therapy after valve replacement

Patients undergoing surgery must take medications prescribed by their cardiologist.

1. When installing donor valves, the patient will have to take immunosuppressive medications after surgery and for life. This reduces the risk of foreign tissue rejection.
2. If a patient has symptoms of cardiovascular disease after valve replacement (for example, he has angina, arterial hypertension, etc.), he should take appropriate medications regularly and on an ongoing basis. The composition of therapy and dosage of medications are determined by the doctor. If at some point the recommended treatment regimen no longer “works” as before, you should definitely consult a doctor for examination and treatment correction.
3. If a patient needs valve replacement due to rheumatic heart disease, they may need to take periodic antibiotics after surgery to prevent rheumatic heart attacks.
4. All patients with mechanical and biological valves are prescribed anticoagulant therapy. A foreign body is actually introduced into the heart, to which the blood system reacts with increased coagulation. As a result, blood clots can form on the valve, which complicate its operation, can break off and enter the bloodstream, resulting in dangerous and even life-threatening complications - stroke, vascular thrombosis, pulmonary embolism.

Anticoagulants prevent the formation of blood clots, and therefore their use is mandatory. The most commonly used indirect anticoagulant is warfarin. People who have a biological valve should take warfarin for 3-6 months (with some exceptions), while those who have a mechanical valve will need to take the drug continuously.

Anticoagulants are drugs that actually save the lives of patients with artificial valves. However, in addition to benefits, they can also cause harm. The ability of blood to clot is a protective mechanism that prevents blood loss when injured. If anticoagulants are taken in excess, when clotting is suppressed too much, the patient may experience corresponding complications, sometimes even severe bleeding and hemorrhagic stroke.

To avoid this, it is very important to monitor the state of the blood coagulation system. Therefore, patients taking warfarin need to monitor the INR (international normalized ratio; it determines the adequacy of anticoagulant therapy). It is usually maintained at a level of 2.5-3.5 (there may be some variations depending on the specific case). A blood test to determine INR should be taken monthly.

Some patients are also recommended to take antiplatelet drugs - aspirin-based drugs - after valve replacement.

Breathing exercises

This type of physical education is quite important in the healing process after surgery. Breathing exercises, as a type of health therapy, help normalize metabolic processes in the heart, which brings sufficient saturation of the blood with oxygen and leads to the fastest healing. In addition, therapeutic breathing movements stabilize the electrolytic balance of the heart and help normalize the rhythm.

Breathing exercises can be performed both in a supine position, when a person is in the early postoperative period, and in a standing position, in a later period.

The main tasks for performing breathing exercises after surgery include:

• close your right nostril with your finger, take a maximum inhalation through your left nostril, then close your left nostril and make a gradual, full exhalation through your right nostril; repeat the exercise in reverse order;
• if it is possible to raise your limbs: slowly raise both arms up, while taking a deep breath, then gradually lower your arms, quietly exhaling air; repeat the exercise 5-7 times;
• lying on your back, take a deep breath and hold your breath for a few seconds, then exhale slowly; repeat this task 5-7 times;
• lying on your back, legs straight, arms along the body; slowly take a deep breath and bend your legs at the knee joints, performing a sliding movement with your feet, then exhale deeply, at this time taking the original position of the torso; repeat the task 5-10 times.

If during breathing exercises the patient feels dizziness or nausea, or blurred vision, the exercise should be stopped. If the exercise goes well, then the set of exercises will help the heart return to normal quickly after surgery, as well as restore normal blood flow and oxygen exchange in the tissues.

A little about the operation

CABG surgery is performed for medical reasons to treat coronary artery disease and improve myocardial performance. An intervention is prescribed for poor blood supply to the heart, when the operating surgeon creates a bypass arterial pathway (shunt) instead of a natural analogue clogged with atherosclerotic plaques.

The patient is connected to a heart-lung machine for the duration of the intervention. All surgical interventions are performed on an open heart, that is, with an open chest. The incision is usually made along the costal cartilages on the left.

You need to understand that any surgical intervention poses a certain risk to human health and sometimes life. After CABG, the following complications may occur:

• vascular thrombosis;
• stroke;
• heavy bleeding;
• heart attack;
• incomplete fusion of the sternum;
• unstable hemodynamics;
• atrial fibrillation;
• narrowing of the shunt;
• renal failure;
• memory problems;
• wound infection.

Physical exercise

Therapeutic gymnastics after bypass surgery is carried out both in the postoperative period, when the patient is in bed, and during the period of normalization of the body systems and restoration of the patient’s ability to get up.

An approximate set of exercises in a supine position:

Exercise therapy must be carried out in loose clothing that does not restrict breathing and movement. For best results, do 2-3 approaches throughout the day. Physical exercises should begin with the simplest tasks for the patient, gradually increasing the load as the muscles warm up.

• perform flexion and extension of the feet, 5-10 times for each leg;
• flexion and extension of the hands, 50-10 approaches for each;
• perform flexion and extension movements of the arms in the elbow joints, while touching the shoulders with the hands; perform 5-10 times.
• take a deep, slow breath in and out, raising your arms perpendicular to your body;
• bend your leg at the knee and then slowly lower it to its original position; repeat the exercise for the second leg. 5-10 reps.
• lying on your back, place your hands with your palms up, then take a slow breath and straighten your arms in different directions, simultaneously turning your feet outward, then return to the starting position, while exhaling deeply;
• move your legs bent at the knees randomly in different directions for 1-2 minutes;
• raise your hand and touch it to the leg bent at the knee, located on the same side of the body, then take the usual position; repeat the task for the second half of the body; quantity – 5-10 times for each half;
• lie down straight; As you inhale, stretch your arms in both directions, while turning your head to the right side, and as you exhale, return to the starting position. Next, complete the task by turning your head to the left; perform the movement 4-6 times;
• clench your hands into a fist and make quick circular movements with both hands for 30 seconds;
• bend your knees; carry out voluntary extension of the limbs at a free pace; execution time 30-60 seconds;
• tighten your gluteal muscles, then relax; repeat 5-10 times.

Exercises while sitting

These physical movements should be performed in parallel with breathing exercises. The lesson includes:

1. Press your arms bent at the elbow joints to your shoulder, then smoothly spread your elbows in different directions, while taking a deep breath; gradually lowering your hands, exhale; repeat 5-10 times.
2. Make circular movements with your arms, slowly raising and lowering them, perform the exercise for 30 seconds.
3. Perform a circular movement of your arms, then hold your hands on your knees; make a gradual tilt of the torso towards the knees, then slowly take the starting position; repeat 4-5 times.
4. Alternately raise your shoulders to your head, then lower them, do the exercise for 30 seconds.
5. Gradually bend your leg and bring your knee to your chin, inhaling, then straighten it, exhaling; repeat 4-5 movements for each leg.

The main goal of therapeutic exercises is a targeted action on the restoration of the body. It is important to remember that all movements should be performed at a quiet pace and should not cause the patient a feeling of discomfort or heaviness. Only full and regular training with a gradual increase in load will have a positive effect and will contribute to adequate medical therapy.

Physiotherapy

During the recovery period after myocardial infarction, physical therapy exercises are recommended. To speed up the rehabilitation process, it is important to start aerobic (which enriches the blood with oxygen) physical activity for 20 minutes.

Before starting physical exercise, you should consult a doctor. Self-study after a myocardial infarction should be started only within the time frame and volume specified by the doctor. In this case, exercises must be selected strictly individually and carried out under the guidance of an experienced specialist.

During the first few days, it is very important that the patient be monitored by the attending physician during exercise, monitoring his pulse, blood pressure and, if possible, recording an ECG.

In the future, if twenty minutes of physical activity is well tolerated and after consultation with a doctor, the patient can increase its duration to 30 minutes a day.

To calculate the target heart rate during exercise, there is a special formula: from the number 220 you need to subtract the patient’s age and calculate 70% of this number. For example, if the patient is 53 years old, 220 - 53 = 167. 70% of 167 = 117.

Therefore, to get the maximum benefit from exercise, a fifty-three-year-old patient should maintain his heart rate at 117 beats per minute for 30 minutes. And at the same time he should feel comfortable, and he should not have any cardiac complaints.