3. What medications will I be taking?
Listed below are common medications that will be individually prescribed upon discharge, depending on the nature of your heart disease.

Enteric aspirin: 81 or 325 mg
Results: Gently thins the blood to avoid clot formation
Duration: Indefinitely

HMG-CoA Reductase Inhibitor: For coronary heart disease
Results: Lipid (blood fat) lowering agent. These drugs are commonly known as "Statins." Statins inhibit an enzyme, HMG-CoA reductase, that controls the rate of cholesterol production in the body, and increase the liver's ability to remove the LDL-cholesterol already in the blood. Examples of statins include:
• Simvastatin (Zocor)
  
• Pravastatin (Pravachol)
  
• Atorvastatin (Lipitor)
Duration: Indefinitely

Beta blocker: Considered for patients with coronary heart disease
Results: Scientific studies have demonstrated that this medication reduces the risk of heart attack (myocardial infarction), makes it more likely that a patient will survive an infarction, and reduces the risk of developing heart failure.
Duration: Your cardiologist will determine

Ace inhibitor:
Results: Reverses blood-vessel-lining dysfunction, and lowers the risk of atherosclerosis progression through potent vascular and cardiac protection. Patients with coronary heart disease after myocardial infarction have improved survival and less heart failure.
Duration: Your cardiologist will determine

Estrogen: Considered for postmenopausal females with coronary heart disease
Results: Hormone replacement therapy can play a role in improving LDL and HDL-cholesterol levels.
Duration: Your gynecologist will determine

Calcium channel blocker: For patients who have a radial artery graft (from forearm)
Results: Prevents spasm
Duration: Approximately 3 months

Anti-ulcer medication:
Results: Reduces acid in the stomach. Surgery can cause stress, and stomach irritation can result from pain medications, antibiotics and anti-inflammatories.
Duration: 2 weeks

Anti-inflammatory:
Results: Reduces inflammation and pain
Duration: 7-10 days

Stool softner:
Results: Softens stools; inactivity and pain medications can cause constipation.
Duration: Generally 1-2 weeks

4. What rehabilitation programs are available?

Cardiac Rehabilitation: This program is designed to help patients with heart disease begin an exercise program. Patients who attend the program are monitored at exercise work stations. The goal is to slowly and gradually work up to a level of exercise that will help maintain a healthy lifestyle. The program is usually for 1 hour--3 times a week--for a total of 6 weeks. Classes are under the direction of specially trained cardiac rehabilitation nurses and a cardiologist. Most insurance companies pay 80% of the total cost.

Freedom from Tobacco Network: This class is open to all who want to stop using tobacco forever. Medical support for smoking cessation is provided at this class, offered every Thursday 7:00-8:00pm. No pre-registration is necessary, and no fee is required.

Heart Healthy Class Series: This four-session course is directed by dieticians at St. Joseph Hospital. Classes demonstrate how to live healthier through a nutritious, low-fat eating plan.

Stress Reduction: "Bless Your Heart" Class Learn an easy and effective technique to handle stress. Offered once a week; no fee is required.

5. What type of care will I need when I go home from the hospital?
Ideally, you will need 2 weeks of around-the-clock support. Issues to consider include:

• who will be able to stay with you at home after discharge
• who will provide transportation for you to your doctor appointments
• who will be able to help with groceries and meals
• how will you get your prescriptions from the pharmacy
• would you benefit from home health services or require special assist devices

6. When should I call the doctor?
You should call the doctor when you notice any of the following symptoms:

• Temperature of 101° or greater, or a persistent temperature over 100°
• Weight gain of greater than four pounds within one or two days
• Heart rate less than 50 beats per minute, or greater than 120 while you are at rest
• Increasing shortness of breath or cough
• Angina or other chest pain that is getting worse rather than better
• Excessive fatigue, weakness, dizziness, or fainting
• Signs of incisional infection: redness, swelling, drainage, or excessive tenderness
• Persistent nausea, vomiting, diarrhea, or constipation

7. Should I have a living will?
Advanced care directives are very important in the event you become unable to make your own decisions about your medical care during your hospitalization. Two types of advanced care directives are the "living will" and "durable power of attorney." Whether or not you have advanced directives will never affect the quality of care you receive. We will continue to provide for your physical, emotional and spiritual comfort with the assistance of hospital staff. It is also very important to assign a family spokesperson for the health care team to communicate with during your hospitalization.

Living will: A simple written form that lets you express your wishes about life-prolonging measures in case of a terminal illness. It is used only when you are no longer able to fully participate in your health care decisions. Even then, two physicians must certify that a disease is incurable before any treatment will be withheld.

Durable power of attorney: A legal document that identifies an individual with decision-making responsibility in the event you are unable to make decisions for yourself.

8. How much pain will I have after surgery?
You can expect variable and generalized discomfort from your incisions, for which your nurse will provide pain medications during your recovery. Although there is usually some discomfort along the incisions in the chest, leg, arm or between the shoulder blades, as your surgical wounds continue to heal, you should require less and less pain medication. You can decrease the number of pain tablets that you need when you go home, or increase the amount of time between doses as you feel it is appropriate. Remember to take your pain medication with meals or a snack to avoid an upset stomach. Being comfortable will help you rest, and will also help you increase your activity gradually. After a while, over-the-counter preparations, such as Acetaminophen or Ibuprofen, should sufficiently control your discomfort.

9. Will my diet change after surgery?
Weight reduction, low-fat diet, and close management of diabetes is important for patients with coronary artery disease. In combination with exercise and cholesterol-lowering medication, you can reduce your blood cholesterol levels. Information on outpatient dietary modification programs will be provided.

10. What should my cholesterol levels be?
Target lipid (blood fat) levels in patients with coronary disease are as follows:

Total Cholesterol: less than 200 mg
LDL (bad cholesterol): less than 100 mg
HDL (good cholesterol): greater than 35 mg
Triglyceride: less than 200 mg

You should ask your physician to recheck your "Lipid Profile" 6 weeks after your surgery and every year thereafter.

11. Why do I need a cholesterol lowering medication when following a low-cholesterol diet and exercising regularly?
Initiating or continuing a cholesterol-lowering medication in patients with coronary heart disease has been shown to stabilize plaques (fatty deposits) on the artery wall and reduce myocardial infarction (heart attack), unstable angina, and the need for revascularization when compared to patients treated through diet alone.

12. What can I do to reduce the risk of future heart problems?
It is important to learn as much as possible about your "risk factors." Listed below are modifiable "risk factors" for heart disease:

• high total cholesterol and high LDL-cholesterol
  
• low HDL-cholesterol
  
• cigarette smoking
  
• high blood pressure
  
• diabetes control
  
• obesity
  
• physical inactivity
  
• stress reduction
  

13. What is the likelihood of receiving blood transfusions?
In general, we don't order blood transfusions unless the benefit greatly exceeds the risk. Nevertheless, it is important to recognize that there are times when we have no realistic option but to order a blood transfusion. The blood bank screens blood for the AIDS antibody and other types of viral infections including Hepatitis. Although the risks are very low, they are not zero.

14. What are common risks of open heart surgery?
All operations carry risk. The presence of other medical conditions such as diabetes, lung disease, or kidney disease can increase the risk of complications in some patients. We take extensive precautions to prevent complications and diminish risk, and the survival rate for most patients is over 90-95%. Patients and their families should discuss the operation and its risks with their physicians prior to the procedure.
Possible complications:

• Stroke (less than 3%)
  
• Heart attack during or after surgery
  
• Closure of new bypass grafts
  
• Bleeding from the tissues inside the chest
  
• Infection at incision sites, newly placed artificial valves, or urinary bladder. Therefore, we use antibiotics before and after surgery.
  
• Irregularities of the heart beat
  
• Lung or kidney problems, especially if there is history of disease in these areas. These problems are usually temporary, but may require prolonged ventilator support, or the use of kidney dialysis. We will discuss such situations with patients and their families before starting "extraordinary" treatments, and will follow any "living will" guidelines.

15. What are some common tests that may be done prior to surgery?

Ultrasound of blood vessels:
Test that uses soundwaves to measure integrity or narrowing of blood vessels.


A. Carotid ultrasound "Duplex":
Used to evaluate the blood vessels of the neck leading to the brain. Sudden closure of these vessels could potentially cause a stroke. Most often used in the elderly or those with vascular disease.

B. Radial ultrasound/Palmar arch study
Used to evaluate the arterial blood vessels of the arm which could be used for bypass.

C. Lower extremity vein mapping:
Used to define possible veins in the legs that could be used for bypass. Most often used in patients with peripheral vascular disease.


Pulmonary function tests:
Helps define lung capacity in those patients with respiratory problems such as chronic obstructive pulmonary diseases, asthma, or ailments from smoking.

CT Scans:
Useful in evaluating/defining lung masses.

Chest X-ray:
Done to evaluate the lungs and determine heart size.

Blood tests:
Routinely done to check chemistries, blood count, and blood type.

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