Everything You Need To Know About Heart Surgery But Were Afraid To Ask

Open heart surgery is a new experience; for some it may be frightening.  With the information in this booklet you can understand how the heart works, how disease affects it, and what to expect during your hospitalization and recovery. This knowledge can play a vital role in helping you prepare for surgery and making you feel more confident about resuming your normal activities. If you have questions not answered in the booklet, please write them down on the blank pages at the end so that one of the members of the heart team can answer them for you

Anatomy of the Heart
It is important to know how the heart works in order to understand what happens in heart disease.   The heart works as a pump, squeezing and forcing blood into the right atrium. From there blood goes throughout the body to other vital organs, such as the brain, liver and kidneys. Blood from the body enters the right side of the heart and passes enters the right ventricle and is pumped under relatively low pressure into the lungs where it becomes oxygenated.  From the lungs the blood enters the left atrium, and then flows into the left ventricle.   From the left ventricle the blood, under relatively high pressure, is pumped out of the aorta to the rest of the body. There are four valves in the heart.   These open and shut in timed sequence to keep the blood moving in one direction.

Artery Disease
Coronary Artery disease causes a narrowing of the coronary arteries that restricts the flow of blood through these vessels.  It is a result of the process called atherosclerosis.  Atherosclerosis, or hardening of the arteries, is a buildup of fatty deposits within the walls of the arteries. The lining of the arteries becomes thickened and roughened by these fatty substances.  When the coronary artery becomes narrowed or blocked, the heart muscle does not receive enough blood which can lead to angina or heart muscle damage (a myocardial infarction or “heart attack”). Angina, or angina pectoris, occurs if an area of the heart muscle is not receiving enough blood because of blockages in the coronary arteries.  Angina, or chest pain, is a temporary pain.  It is a warning that the heart muscle is not receiving enough oxygen.  It does not mean a heart attack has occurred. Angina pain can occur during physical exertion, emotional upsets, exposure to cold weather, heavy meals, or exertion after eating.   Physical demands on the heart must be reduced when angina occurs. The best way to do this is to stop what you are doing, rest and take nitroglycerine. Angina pain may be described as heaviness, tightness, burning, pressure, and/or squeezing.   It is usually felt behind the breastbone and sometimes radiates to the shoulder, neck, arm, hand, jaw, or back.

Risk Factors For Coronary Artery Disease
Risk factors for heart disease are those habits and characteristics that make you more prone to coronary artery disease and heart attacks.   It is important to realize how your lifestyle may contribute to heart disease.    It is important to control and reduce those risk factors that. What is Coronary Artery Disease? Coronary Disease (CAD) is when the coronary arteries, the blood vessels that bring oxygen to the heart, become narrowed by a build up of fatty layers, called plaque, in the walls of the artery. 

The general term for this process is known as atherosclerosis.  As a result of the blockage, blood is not as able to flow through the arteries, and the amount of blood reaching the heart muscle is decreased.

What happens with Coronary Artery Disease?
The heart muscle needs oxygen to live and work properly.   When the coronary arteries are narrowed, not enough oxygen carrying blood goes to the heart muscle.   Chest pain, angina or shortness of breath may be experienced.  Many people are not aware they have coronary artery disease until tests are performed.

Who is at risk for Coronary Artery Disease?
Certain conditions are known to increase your risk of developing coronary artery disease.   These risk factors fall into two basic categories: those that can be controlled and those that cannot be controlled. The table below lists some of these factors:

Can Control

• Diet
• Smoking
• Obesity
• High blood pressure
• Physical Inactivity
• Diabetes
• Depression and Anger

Cannot Control

• Heredity (Family History)
• Aging

How are the risks of Coronary Artery Disease managed?
Many factors can be controlled by medical guidance and patient cooperation.  Some examples include the following:

• Diet: eliminate saturated fat, and controlled calories
• Stop smoking
• Reduce weight
• Control high blood pressure
• Reduce cholesterol levels
• Become physically active (start slowly while walking)
• Monitor and keep your diabetes in best possible control
• Reduce depression and anger

What might a doctor prescribe for Coronary Artery Disease?
Recommendations for diagnostic tests or treatment depend on the doctor’s evaluation of the severity of the condition. 
Preventive Measures include: medications when necessary, are exceedingly important.  If the condition is more
advanced, tests such as cardiac catheterization or treatment to improve the coronary blood supply may be required.

Major Risk Factors

• Family history of coronary artery disease
• Cigarette smoking
• High blood pressure
• Increased amount of cholesterol in the blood

Other Risk Factors

• Sex (males are more prone to heart disease than females)
• Obesity
• Age
• Diabetes
• High triglycerides (increased  fats) in the blood]
• Lack of regular exercise
• Stress/Tension

Coronary Artery Bypass Surgery

Saphenous Vein Bypass
Coronary artery bypass surgery, which began in the late 1960's is one method used for treating coronary artery disease.  Its purpose is to increase the circulation and nourishment to the heart muscle.  A large vein, called the saphenous vein is removed from the leg. One end of the vein is attached to the aorta and the other end is connected to the coronary artery below the blockage, by passing the obstructed area. The coronary artery bypass supplies blood to an area of the heart deficient in blood, thereby relieving chest pain.  Persons who were formerly unable to perform any activity due to angina can be relieved of pain with the bypass.  In addition to the bypass surgery, risk factors must be modified in order to slow further development of coronary artery disease.

Internal Mammary Artery Bypass In some cases the surgeon may elect to use either one or both of the internal mammary arteries, which are the arteries behind the breastbone, to bypass the obstructed coronary arteries.  The internal mammary arteries have been used as bypass grafts since the 1970s.  The left internal mammary artery is particularly suitable for grafting the left anterior descending coronary artery because of its size and location.

Saphenous Vein
The saphenous vein in the leg is used to bypass the blocked coronary arteries.   This vein is removed from either one or both of the legs depending on the number of bypasses that need to be done.  The saphenous vein is a superficial vein that the leg does not need.  Even though the vein is removed, the deep venous system remains intact and provides adequate venous drainage for the leg.   Temporarily, there may be some swelling and oozing from the leg where the vein was removed.

Coronary Angioplasty
Percutaneous transluminal coronary angioplasty (PTCA) is another approach to the treatment of coronary artery disease.  The first coronary angioplasty was done in September 1977 by Dr.Andreas Gruntzig in Zurich, Switzerland.   A specially designed balloon tipped catheter is introduced into the coronary artery to open the narrowed portion of the coronary artery.   The catheter is passed through an artery in the leg into the aorta and then into the coronary artery where the balloon is inflated.    The opening for blood flow is enlarged, thus increasing the flow of blood through the artery.  About 90% of the cases are successful.    About 3-5% of the patients undergo urgent coronary bypass surgery. Restenosis (recurrence of the narrowing of the coronary artery) occurs in approximately 20-30% of the individuals in the first year.  Restenosis can be treated by angioplasty again or by surgery.  After the first year restenosis is unusual. Usually PTCA is performed on patients who have a single narrowed segment in one coronary artery.  Recently, for a select, small group of patients, angioplasty is being used to treat multiple narrowed segments in one or more coronary arteries (multivessel angioplasty).   The initial success rate is 85-90%, but the restenosis rate is higher than in PTCA, for a single narrowed segment (up to 40%).

Valvular Surgery
Valves are smooth structures that allow the blood to flow through the chambers of the heart in one direction.  Each heart has four valves:

• Tricuspid Valve - Enables blood to flow from the right atrium to the right ventricle.
• Pulmonic Valve - Allows blood to flow from the right ventricle to the pulmonary artery.
• MitralValve - Enables blood to flow from the left atrium to the left ventricle.
• AorticValve -Allows blood to flow from the left ventricle to the rest of the body.

These valves open to let blood through and close tightly to prevent any blood from flowing backwards.  Many times these valves become scarred and thickened due to birth defects, old age, or infections such as rheumatic fever.  When the opening of the Different Types of Artificial Valves

• Tissue Valve
• Tissue valves made from pig heart tissue.
• Mechanical Disc valve
• Man-made artificial valve

Bacterial Endocarditis
People who have had valve surgery are more prone  to  a  condition  called  bacterial endocarditis.  This is an infection  or inflammation of the heart valves.   Endocarditis occurs when bacteria enter into the blood stream and become lodged on the abnormal or damaged structure in the heart. Certain types of people seem to be at higher risk to develop bacterial endocarditis.   These people have one of the following:

• Abnormal or damaged heart valves
• Artificial heart valves
• Congenital heart defects
• Patch graft used to repair certain heart defects

Some of the symptoms of endocarditis are:

• Chills
• Profuse sweating
• Joint pain
• Poor appetite and weight loss
• Fatigue and weakness
• Temperature greater than 100°F

If you develop any of these symptoms, call your doctor immediately.  Early diagnosis and prompt
treatment will decrease the chance of heart damage.

Precautions:
If you are one of these high-risk patients you will need to take precautions for the rest of your life to prevent bacterial endocarditis. It is important that you maintain good oral hygiene because improper care of your teeth and gums can cause bacteria to enter your blood stream.  Dental floss can be used gently, but never use toothpicks or a waterpik. 
Clean your teeth with a soft bristle toothbrush. Your doctor and dentist should be informed that you are prone to bacterial endocarditis; antibiotics may need to be given before and after the following:

Atrial Septal Defect
Atrial septal defect is one of the most common forms of congenital heart disease in adults.   It occurs more frequently in females than in males. The wall that divides the two upper chambers of the heart (atria) is known as the atrial septum.  An atrial septal defect is an opening in the wall separating the two upper chambers that failed to close during the early development of the heart. The common symptoms are shortness of breath with exercise, fatigue, and irregular heartbeats.  Surgery may be recommended to correct the defect.   To correct the atrial septal defect, the opening can be covered with a patch graft made of a synthetic material, or the opening can be sewn together.

Before Surgery
You may be admitted to the hospital one or two days before your operation.  Sometimes surgery can be performed the same day you come to the hospital.   In either cases, blood and urine specimens will be analyzed to be certain that everything is in proper balance and to ascertain baseline values.    An x-ray of your chest and an electrocardiogram will be taken as part of the preoperative preparations. If you are a smoker, it is strongly advised that you stop smoking.  It is extremely important that you do not resume smoking after the operation.  

Smoking irritates your lungs and increases the amount of mucus. The increased mucus will be a significant factor in you recovery since you will need to cough more in order to keep your lungs clear after the operation.  Smoking is also harmful because of the carbon monoxide gas. If you smoke, carbon monoxide, which is a poisonous gas, replaces the oxygen molecule in your red blood cells. Instead of transporting oxygenated blood to your vital organs, blood with the poisonous gas will be delivered to the body's tissue.  To resume smoking after the surgery may cause the new bypasses to close off and fail.  Smoking increases the heartbeat, narrows the blood vessels, and raises the blood pressure.   If you have been a smoker it will be difficult to stop smoking, but it is very??

• Dental procedures, including routine cleaning, filling  of  cavities, root canals or other dental surgery.
• Diagnostic procedures which involve examination of bladder, colon, lungs, rectum, and Pap smears.
• Infections, skin ulcers, or abscesses other than minor cuts.
• Any type of surgical procedure.

Medical Identification:
If you are prone to bacterial endocarditis or have a heart condition, it is important that you carry A member of the heart surgery team, usually a nurse, will meet with you and your family to explain what will happen in the Intensive Care Unit (ICU) when you awaken after the surgery.  If you and your family wish to visit the ICU to see the unit and equipment before your operation, this will be arranged by the nurse.  You are strongly encouraged to visit the ICU.  In the majority of patients this helps to reduce the fear of the unknown. The anesthesiologist will see you before surgery and will order your pre-operative medications for the day of the surgery.   This medication will make you sleepy and groggy.   You will not be completely sedated at this time.

 Explanation of the Day of Surgery
An antibiotic is given to prevent infection. About an hour before you are taken to the operating room, you will receive a preoperative injection. This will relax you and make you drowsy.  Once you have been taken to the operating room you will not be put to sleep for about an hour.  The anesthesiologist will prepare you by putting in several intravenous (IV) lines.   You may feel some slight discomfort as the IV lines are inserted.  One or two IV's are inserted in each arm.  An arterial line is inserted into the artery of your wrist to monitor your blood pressure. Another line, called a Swan Ganz catheter, will be inserted into the large vein in your neck.  This line monitors your heart pressures during the operation.   Once all these lines are inserted, you will be put to sleep with medication given through the IV. After you are asleep, a breathing tube is inserted through your mouth or nose, and the operation begins.

After Surgery:
In the cardiovascular recovery room, you will be brought directly from the operating room to the cardiovascular recovery room.   The first two to four hours you will still be under the effects of anesthesia.  Your breathing will be mechanically assisted by a respirator with oxygen through the breathing tube.   When fully awake, you will be
gradually weaned from the respirator.   This process can begin the evening of surgery or the morning after. Normally your family can visit you in the Cardiovascular Recovery Room one to two hours after the operation.

• A nasogastric tube (stomach tube) will be put in the nose, going down the esophagus and into the stomach.   The purpose of this tube is to prevent gastric distention and nausea.  There is no pain from the tube, but it may cause some post-natal drip. The tube will be removed the following morning.
• The breathing tube (endotracheal or ET tube) is connected to a respirator breathing machine.   The purpose is to ensure deep breaths and make it easier for you to breathe.  When you awaken you will not be able to talk because the breathing tube goes down between the vocal cords.   You will be able to communicate by writing notes or nodding your head.  Your hands may be gently restrained to remind you not to pull the tube out.  Suctioning of the breathing tube to remove secretions and prevent pulmonary problems will be done as needed.  You may experience a coughing sensation when the breathing tube is suctioned.  The tube will be removed as soon as you are awake and breathing adequately on your own. Once the tube is removed, your throat may be sore and you may be hoarse.  When you cough out the sputum, it may be blood tinged due to irritation from the tube.   All of these conditions are temporary.
• A Foley catheter will be inserted into your bladder while you are asleep.   The purpose of the catheter is to accurately measure and record urine output.  You may still feel the urge to urinate even with the catheter.  It will be removed on the first postoperative day for men and the second postoperative day for women.  There may be a burning sensation the first time you urinate after the Foley catheter is removed.
• One or two tubes will be inserted in your chest at the end of the operation.  The purpose of the chest tube(s) is to prevent the accumulation of fluid in the chest cavity.  The chest tube(s) will be gently squeezed or milked to ensure adequate drainage.  When the family comes in to visit they
• An arterial line is a plastic needle that is inserted into the radial artery in the wrist to monitor the blood pressure.  For the first 24 hours any blood samples that are necessary for tests can be drawn from the arterial line.  It is usually removed on the first postoperative day.
• IV lines will give you fluid, medications, and blood when needed. The IVs are removed the morning after surgery.

First Day After Surgery

• Once you are fully awake, you will be taken off the respirator and allowed to breathe on your own. The breathing tube, which supplies humidified oxygen, will still be in place in your mouth.
• Blood will be drawn to determine if your body has enough oxygen.  If the supply of oxygen is adequate, the breathing tube will be removed and you will be given oxygen through a nasal cannula or high humidity face mask.
• The nasogastric tube will be removed.
• You will be taught how to perform coughing and deep breathing exercises.  It will be uncomfortable to do these exercises, but they will cause no damage to the heart, grafts or incisions.
• You will be turned from side to side at least every four hours to relieve pressure areas.
• You will be given clear liquids several hours after the breathing tube has been removed and then progress to a regular diet.
• If your condition is stable, many of your monitoring lines will be removed. The only line left will be an IV or heparin lock.
• The chest tube(s) remains in place for one to two days.
• You may be transferred out of the Cardiovascular Recovery Room to Intensive Care Unit.  In ICU your heart will be monitored for 2-3 days.

Once your appetite has returned, you can begin to eat regular food, but your fluid will be limited to 6 cups (48oz.) to 8 cups (64 oz.) in 24 hours. Your IV will be removed and a heparin lock will be inserted. A heparin lock is a needle which unlike the IV, does not always needs to be connected to fluid.  It may be used if it is necessary to give medication or blood.

• Your Foley catheter will be removed, if it was not removed on the first day after surgery.
• Chest physical therapy will begin at this time if indicated.
• After your chest tube(s) has been removed, you will be assisted out of bed and into a      chair.
• You will find that you are very tired from your stay in the ICU. You may be very sore and uncomfortable.    It is important that you let your nurse know so she/he can give you your pain medication. If  you  are comfortable you will find it easier to do your deep Postoperative Discomfort and Expected Minor Complications

PAIN
Pain is a primary concern of patients about to undergo surgery.   It is natural to have aches and pains after the surgery.   Your physician will prescribe pain medication, which should be taken when needed.   The nurses will ask you if you have pain in either the chest or leg incision, but it is your responsibility to ask the nurse for pain medication.  A good time to request the pain medication is 15-20 minutes before beginning your breathing exercises.

PERICARDITIS
The pericardium is a thin lining (sac) around the heart that is opened during the surgery.    Normally there is a small amount of fluid in the pericardial sac, and the heart moves easily within it.  The sac may become inflamed and irritated as a result of the surgery, and this will cause discomfort in the chest, shoulders and neck.  The soreness can be mild to severe.   Sweating may occur especially at night.   The discomfort can increase with deep breathing,
coughing or lying down.  It can be treated with one of several anti-inflammatory drugs or steroids.  The discomfort subsides within a few days and the medication can be discontinued within a few weeks.

DYSRHYTHMIAS
Dysrhythmias or irregular heartbeats can occur after surgery.   You may feel your heart racing, palpitating or doing flip-flops.  Do not panic.  Notify your nurse.  An electrocardiogram may be done and if necessary, medication will be started.

DEPRESSION
It is common to become depressed after surgery.   Depression can occur several days, or even months, after the operation.  You do not get a lot of sleep in the ICU.  There are noises, people and activity in the ICU 24 hours a day.   You may feel tired, irritable, grumpy, and even depressed.  As you catch up on your sleep and as the time of discharge approaches, the depression usually lessens or disappears.

COUGHING
After surgery it will hurt to take deep breaths and to cough, but coughing is extremely important.   When you do not breathe deeply, secretions can build up in your lungs which could lead to a partial collapse of your lungs or even pneumonia.  By coughing and deep breathing, you bring up those secretions, thus keeping your lungs clear.

BLEEDING
Bleeding can occur after surgery.  The drainage from the test tube(s) is observed closely for any signs of excessive bleeding. The procedure takes about an hour.   The patient is returned to the ICU.   This procedure will not usually slow recovery. Atrial septal defect is one of the most common forms of congenital heart disease in adults.  It occurs more frequently in females than in males.

Remainder Of Hospital Stay
The day you are transferred to the regular unit you should walk in your room and sit in a chair two or three times.  The next day you should walk in the hallway; at first, walk with assistance until you are more steady on your feet.  For the remainder of your hospital stay you should start more and more in the hallway.  By the time you leave the hospital you may be able to walk up to one mile a day (not a 1 at one time). You will probably be ready to leave the hospital 6 to 10 days after your surgery. The remainder of your recovery will take you from four to six weeks at home.

Your Recovery at Home

Introduction
Now that your heart surgery is completed and you are in the process of healing.   It is time to prepare for your return home.  This section of the booklet will answer your questions and give you guidelines to follow in your recovery at home.   If you have any other questions, please ask your doctor or nurse about them. It is not usual to feel apprehensive or depressed about leaving the hospital. The hospital has provided you with a sense of security.   Just remember that you will not be discharged until the doctor feels you are ready. Once you are home, try to resume a normal routine.  It is important to arise at a reasonable hour, shower daily, and dress in street clothes. This will help greatly in your recovery.

The Psychological Impact of Leaving the Hospital After Surgery
Shortly after surgery, you and your family will breathe a welcome sigh of relief.    Some may experience a mild euphoria that accompanies this relief.  You may have been annoyed by some of the electronic monitoring leads and may not have particularly liked some of the alarms and buzzers that frequented the airwaves in and around your bed.   Some of the attention given to you by the nursing personnel and from the physician staff may have seemed aggressive in that they wanted you up and about quickly, maybe even more quickly than you would have wanted.  But before you know it, you and your family are anticipating discharge.  It is common for you and your family to feel mixed emotions about leaving the hospital.  The monitoring and careful attention given to you gave some comfort and let you not worry about your health.  You and your family will most likely wonder what it will be like without such care.  Oftentimes, your imagination may get the best of you and some of your fantasies may frighten even the most stoic.   This reaction should be considered within the range of normal.  Books such as this will provide some concrete information to help you ease your mind.  

Naturally, your surgical team, cardiologist or primary care physician will be most suited to provide any specific answers to you questions.   Knowing what's normal about your body post-
operatively will be comforting to you. Sometimes, your anxieties or those of family members may mount to such a point that you're just plain scared about returning home.   It is clearly in your best interest and in the interests of your doctors that you tell them of your fears. This will open the door to good communications and most likely will settle your anxieties.   You would at that time also set up a means where you could get further support after discharge.  This will usually consist of post-discharge visits to your surgeon's and physician's offices.  Of course, questions that may arise in between visits could be handled by phone.  Some anxieties experienced during the post-operative period may also be lessened by talking with or participating in self-help support groups such as the Mended Hearts.  Hearing about others experiences is frequently encouraging and coming. Other emotions can occur including depression and anger.  It is beyond the scope of this book to go into detail about these feelings but suffice it to say, that bringing these feelings to the attention of your physician is an excellent place to begin dealing with them.  After hearing about them in detail; he/she may suggest remedies on how to handle them satisfactorily thus not allowing them to interfere your recovery.

Modifying Risk Factors For Coronary Artery Disease
Your recovery period at home will last approximately six week.   During this time you will be building up your strength and starting to think about your lifestyle and the risk factors that contributed to your heart problem.  It is important to control and reduce those risk factors that contribute to the disease process.   Any one of the risk factors increases your chance for heart disease, and a combination of 2 or more factors multiplies the risk.  The major risk factors for heart disease are a family history of coronary artery disease, cigarette smoking, high blood pressure and an increased amount of cholesterol in the blood.    Other risk factors that contribute to developing heart disease are sex (males are more prone to heart diseases than females), obesity, diabetes,  lack of regular exercises and stress/tension.    Each of these risk factors will be discussed in detail.

Family History of Coronary Artery Disease (Heredity)
The tendency for heart disease is inherited.   This means that if your mother or father had heart disease, or especially a heart attack, prior to age 60, your risk of developing heart problem is increased.   Grandparents, as well as brothers and sisters who have had heart attacks or strokes should be included when considering heredity as a risk factor.  The greater the number of your family members who have heart problems, the greater your chances of developing similar problems. If heart disease runs in your family, pay special attention to reducing the other risks in your life such as smoking and high blood pressure.

Help your children or grandchildren become aware of the known risk factors for heart disease.  Teach them to choose a proper diet, maintain normal body weight and avoid smoking.   Early education may keep their risk of atherosclerosis, or hardening of the arteries, at a minimum.

Cigarette Smoking
Tobacco smoking is one of the three major risk factors that we can control.  Smoking more than a pack a day increases you risk of heart disease or heart attack, making it three to six times that of a non-smoker.   The non-smoker does outlive the smoker.   For those who have heart disease, there is less chance of a first or repeated heart attack if smoking is stopped.  Tobacco smoke contains nicotine.   Nicotine increases your heartbeat, narrows your blood vessels and raises your blood pressure.  Together these actions increase the heart's work load.   When the heart works harder it needs more oxygen.  However, smoking increases the amount of carbon monoxide in your lungs.   Instead of fresh oxygen, you are sending carbon monoxide, a poison, to your heart.  If you keep smoking after heart surgery, there is a chance your new bypasses will start closing off, just like the original arteries did.    It is a common misconception that because pipe and cigars are not inhaled that their smoke does not reach the lungs.   Switching from cigarettes to pipe or cigars does not alleviate the problem of smoke getting into the lungs. The first sign in quitting smoking is to decide to quit.   Then choose a method.   Methods to quit smoking are numerous, but probably the best method is to quit all at once.  Tips to help you quit smoking are: do not sit after eating, get adequate rest, especially the first five days after quitting, practice relaxation exercises, drink 6-8 glasses of water between meals, avoid alcohol at first if this increases your urge to smoke, get adequate exercise, and note the routine occasions when you are most apt to smoke and make conscious effort to eliminate cigarettes at those times.

High Blood Pressure
Blood pressure is the force that the moving blood puts on the artery walls. When blood pressure is high, there is added pressure on the artery walls.  This can result in damage to the artery, attracting cholesterol and other materials to form fatty plaques (atherosclerosis). This can happen in many arteries in the body and happens often in the small arteries.   Eventually high blood pressure can damage the brain, heart and kidneys, leading to strokes, heart and kidney failure.  The exact cause of high blood pressure cannot be determined for most people. However, blood pressure can be lowered by treatment to reduce the risks to the body organs.

What you can do to control high blood pressure:

• Have your blood pressure checked as often as your doctor recommends
• Stop smoking, since smoking narrows the blood vessels; there may be a relationship between smoking and high blood pressure
• Take medications prescribed by your doctor
• Follow a low salt diet, if prescribed.
• Learn relaxation or exercise techniques to reduce tension and stress in your life
• Lose weight, if necessary; the heart pumps harder to supply blood and oxygen to an overweight body. Increased Amount of Cholesterol and Other Fats in the Blood High blood cholesterol occurs when there is too much cholesterol in your blood.  Cholesterol and other fats may be deposited more easily in the walls of your arteries when an excess of cholesterol and fat is circulating in the blood stream.  What you eat can raise or lower your blood cholesterol level. The best way to reduce your blood cholesterol level is to eat less dietary fat and cholesterol.

There are two major types of dietary fat saturated and unsaturated.   Unsaturated is further classified as either polyunsaturated or monounsaturated fats.   Together, saturated and unsaturated fats equal total fat.   All foods containing fat contain a mixture of these fats. One of the goals in your blood cholesterol lowering diet is to eat less total fat because this is an effective way to eat less saturated fat.   Saturated fat raises your blood cholesterol level more than anything else in your diet.   The best way to reduce your blood cholesterol level is to reduce the amount of saturated fat that you eat. Saturated fats are usually solid at room temperature and are found in animal and some vegetable foods.   Red meats such as beef, pork, and lamb, and whole milk dairy products such as butter, cheese, whole milk, ice cream and cream are high in saturated fat.

The four kinds of saturated vegetable fats are coconut oil, cocoa butter (found in chocolate), palm kernel oil and palm oil.  These vegetables fats are found in many commercially baked goods, such as cookies and crackers, and in nondairy substitutes, such as whipped toppings, coffee creamers, and cake mixes. They also can be found in some snack foods like chips and candy bars. Unsaturated fat actually helps to lower cholesterol levels when it is substituted for saturated fat; therefore, when you do eat fat, use polyunsaturated fats or monounsaturated fats.  These fats are liquid at room temperature and are found only from vegetable sources. Polyunsaturated fats are found in safflower, corn, soybean, cottonseed, sesame and sunflower oils.   Monounsaturated fats are found in olive and canola oils.  Cholesterol is a waxy, fat-like substance.   Although it is not the same as saturated fat,   dietary cholesterol can also raise your blood cholesterol.  Therefore, it is important to eat less food that is high in cholesterol.   While cholesterol is needed for normal body function, your liver makes enough for your body's needs so that you don't need to eat any cholesterol at all. Cholesterol is found only in foods that come from animals.  It is found in eggs, butter, milk, cheese, meat, poultry, fish and shellfish.   Egg yolks and organ meats are particularly high in cholesterol.  

Foods that come from plants like fruits, vegetables, grains, cereals, nuts and seeds contain no cholesterol. Since cholesterol is not a fat, you can find it in both high-fat and low-fat animal foods.  For example, eggs and liver are low in fat but high in cholesterol. Read the diet section under “Instructions For Recovery Period At Home” on page 38 for specific diet recommendations. But for now eat a well-balanced diet, let your body heal and become stronger.   Check with your cardiologist or internist in six weeks so that she/he can help you determine the dietary restrictions that you need.

Sex and age
Men under the age of 50 suffer five to ten times as many heart attacks as do women of the same age.  This is because women tend to be protected by nature from heart attacks up to the time of menopause.  After menopause the heart attack rate for women increases significantly.  By age 60, the heart attack rate for men and women is similar.  Bypass surgery is already being done on men in their 30s and 40s.  If women do not control their risk factors, especially smoking, they may have the symptoms of heart disease at an earlier age too before menopause.

Obesity
The heart pumps harder to supply an overweight body with blood.  As it works harder, the heart requires more oxygen. In addition, people with large amounts of body fat seem to have difficulty breathing.   Their lungs have less room in which to expand, taking in less than the usual amount of oxygen. Many people who are overweight also have high blood pressure; when the blood pressure is high and the body is overweight, the heart labors to pump the blood to all body tissue against the higher pressure.

What you can do to control obesity:

• Calculate your ideal weight
• Have your doctor recommend a diet
• Attend organized classes on weight reduction
• Plan realistic goals for weight loss of one to two pounds per week

Note:   This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.

For more information, please call:

CARDIOVASCULAR CENTER

Tel. No.: (632) 988-1000 / (632) 988-7000 ext. 6299

CENTER FOR PATIENT PARTNERSHIP

Tel. No.: (632) 988-1000 / (632) 988-7000 ext. 6444