1Your Heart & Valves

7.2Relief of pain

Some muscle or incision discomfort, itching, tightness and/or numbness along your incision are normal after surgery. You should not have pain in your chest similar to what you had before surgery. You will be given a prescription for a pain medication before you leave the hospital.

If you had bypass surgery, you may have more pain in your legs than around your chest incision if saphenous vein grafts were used. Walking, daily activities, and time will help to lessen leg discomfort and stiffness.

Call your doctor if your sternum feels like it moves, or it pops or cracks with movement.

7.3Swelling - for those with vein grafts taken from their legs

You may return home with some swelling in your legs and feet, especially if you had vein graphs taken from your legs. If you notice swelling:

Place your feet up higher than your heart level when resting. One way to do this is to lie on your bed or couch and put several pillows under your legs. Or, you may lie on the floor and place your feet on the couch. Try this three times a day for one hour to relieve swelling. (Note- recliners do not adequately elevate your feet).

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  Do not cross your legs
  
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  Walk daily even if your legs are swollen
  
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  Hospital support hose may be suggested
  
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  Call your doctor if swelling in your leg(s) become worse or painful and/or associated with increased fatigue and/or shortness of breath.
  

7.4Medications

You may need medications after surgery. Your doctor will tell you if you need these medications until you recover from heart surgery or lifelong. Make sure you understand the names of your medications, what they are for, and what times to take them. Only take the medications that are prescribed when you are discharged from the hospital. If you want to take medications you were previously on for other conditions, discuss this with your doctor first.

7.5Driving

Your doctor will tell you when you may resume driving. This usually occurs about six to eight weeks after surgery, however, time may be shorter if you had minimally invasive surgery. During this time, you may be a passenger as often as you like.

7.6Activity

For the first six to eight weeks:

Gradually increase your activity. You may do light household chores, but do not stand in one place longer than 15 minutes.

Do not lift objects greater than 20 pounds (your doctor may give you a different number if appropriate). Also, do not push or pull heavy objects.

It is OK to perform activities above shoulder level, such as reaching for an object or brushing your hair. But, do not hold your arms above shoulder level for a longer period of time.

You may climb steps unless they have been restricted by your doctor. You may need to rest part of the way if you become tired. Do not climb up and down stairs several times during the day, especially when you first arrive home. It is better to plan activities to go downstairs in the morning and back upstairs when it is time for bed.

Pace yourself - spread your activities throughout the day. If you become tired, rest and schedule unfinished activities for another time.

Walk daily. Your doctor or cardiac rehabilitation specialist will give you guidelines for walking when you return home.

Check with your doctor to confirm activity guidelines.

7.7Diet

You should eat a healthy diet to help you heal. Your doctor will tell you if you should follow any special diet instructions. It is common after surgery to have a poor appetite at first. If this is the case, try to eat smaller, more frequent meals. Your appetite should return within the first few weeks. If it does not, contact your doctor.

7.8Sleep

It is important to get enough rest or you may feel overtired and irritable. Unfortunately, many people complain of having trouble sleeping for some time after surgery. Normal sleep pattern`s should return within a few months. Call your doctor if lack of sleep begins causing changes in behavior or if normal sleep patterns do not return.

7.9Work

You will need to take time to recover; usually about six to eight weeks (may be earlier with minimally invasive surgery). Your doctor will tell you when you can return to work. If you have the flexibility at your job, ease back to your work schedule. If possible, start back at half-time and gradually increase back to your normal routine.

8Drug Therapy

Improvements in long-term survival after valve surgery will most likely be achieved through the earlier recognition and correction of significant valve lesions, pacemaker implantation and controlled multiple drug therapy.

8.1Anticoagulation Therapy - Warfarin

8.1.1Drugs Potentiating the Effect of Warfarin

Antibiotics drugs:

There is highly probable evidence for; cotrimoxazole, erythromycin, isoniazid, fluconazole, miconazole, and metronidazole. There is some evidence for; ciprofloxacin, itraconazole, and tetracycline.

Cardiac drugs:

There is highly probable evidence for; amiodarone, clofibrate, propafenone, propranolol, and sulfinpyrazone. Sulfinpyrazone's effect was biphasic, which means that an initial potentiation of effect was noted, followed by inhibition of the effect. There is some evidence for; Quinidine, simvastatin, fluvastatin, and acetylsalicylic acid.

Anti-inflammatory or analgesic drugs:

There is highly probable evidence for; phenylbutazone, piroxicam, acetylsalicylic acid, acetaminophen, and dextropropoxyphene.

Other medications with highly probable or probable evidence were cimetidine, omeprazole, alcohol (only if concomitant liver disease was present), chloral hydrate, disulfiram, phenytoin (late effect of inhibition), tamoxifen, anabolic steroids, and influenza vaccines.
It is possible that diltiazem, tobacco, and vancomycin do interact with warfarin because the evidence for no interaction was doubtful.

8.1.2Drugs Inhibiting the Effect of Warfarin

Few drugs inhibited the effect of warfarin, but there are a proportion with good evidence. There is highly probable evidence for nafcillin, rifampin, griseofulvin, cholestyramine, barbiturates, carbamazepine, chlordiazepoxide, sucralfate, high vitamin K content in enteral feeds or in the diet, and large amounts of avocado. There is probable evidence for dicloxacillin. Reported interactions for four other drugs in addition to the consumption of large amounts of broccoli were considered possible evidence.

8.1.3Drugs with No Effect on Warfarin

It is highly probable that several cardiac and gastrointestinal drugs do not interact with warfarin. These drugs included atenolol, bumetanide, felodipine, metoprolol, moricizine, antacids, famotidine, nizatidine, psyllium, and ranitidine. Seven other drugs also have highly probable evidence: enoxacin, diflunisal, ketorolac, naproxen, alcohol (when not taken to levels inhibiting normal liver function), nitrazepam, and fluoxetine. In addition there is probable evidence for ketoconazole, ibuprofen, and ketoprofen.