Each year, more than two million people around the world undergo coronary artery bypass graft surgery or another form of open-heart surgery. These life-saving operations typically take just hours to complete, but they are followed by three to five days, on average, in a hospital plus a period of convalescence at home lasting months. In some cases, the recovery process is not only lengthy but also a bit rocky.
Not surprisingly, fatigue and pain are just two of several unsettling physical and emotional issues that can crop up in the wake of open-heart surgery, says heart specialist C. Noel Bairey Merz, MD. The procedure itself requires surgeons to saw through the patient’s breastbone to reach the heart and repair a blocked artery or aortic aneurysm or to replace a leaky valve. Even with acetaminophen and/or other over-the-counter and prescription painkillers, some post-surgical chest discomfort will occur because injuries to the bone tend to be more painful than muscle or joint injuries.
Here are nine other possible complications patients should be aware of…
Blurry vision. In the first few weeks after surgery, some patients discover that their vision isn’t quite as sharp as it had been before surgery. Post-surgical blurry vision typically results from transient swelling in the eyes. The problem usually resolves within six weeks. Unless there’s a sudden, dramatic change in eyesight, there’s typically no need to rush to the eye doctor.
Brain fog. Memory, focus and other mental functions can be disrupted for weeks or even months after surgery—and, in some cases, the changes can be permanent. Partly to blame may be the powerful anesthetics and the heart-lung machine that pumps oxygen-rich blood throughout the body while the heart is temporarily stopped during surgery. Post-surgical brain fog also may be related to fatty plaques in the walls of blood vessels. These deposits, which can break off and disrupt the flow of oxygen to cells especially following heart surgery, are seen in people who have “hardening of the arteries,” or atherosclerosis—the same disease process that tends to necessitate heart surgery in the first place. In some cases, symptoms of dementia that had not been apparent before surgery become more noticeable following surgery.
Heart-rhythm disturbances. The cutting open of the pericardium membrane, the sac that holds the heart, causes inflammation that can trigger an erratic heartbeat in the weeks following surgery. The most common of these so-called cardiac arrhythmias is atrial fibrillation (Afib), in which the upper chambers of the heart, or atria, contract too rapidly and out of sync with the lower chambers. Afib can cause chest pain, lightheadedness and other symptoms, though it also can be asymptomatic. The condition itself typically is not life-threatening, but it can raise the risk that blood clots will form and travel from the heart to the brain and cause a stroke, so it’s important to alert the doctor to the problem right away. Afib is commonly treated with medication, electric shock treatment or an ablation procedure.
Infection. Because of improvements in surgical methods and sterile techniques, infections now are rare following heart surgery, but they do sometimes happen. Any patient who develops fever, especially in combination with red streaks on the arms or legs, should alert his/her doctor.
The most common infection is a bladder infection, which typically causes a painful burning sensation during urination. Bladder infections are commonly caused by bacteria that enter the body via the urinary catheters that patients get before surgery. Oral antibiotics generally can kill the infection-causing germs and eradicate the infection.
Rarely, patients can develop infections within the breastbone, or sternum. Sternal infections, typically marked by fever, persistent chest pain and wound drainage, can be difficult to eradicate even with months of antibiotic therapy. Any patient who develops suspicious symptoms should alert the doctor.
Mood swings. Temporary feelings of sadness and/or anxiety over the six to 12 weeks following surgery are common, and some patients even find that they burst into tears for no apparent reason. Unpleasant emotions shouldn’t come as a surprise, given the pain and uncertainty associated with this surgery. Physical exercises done as part of a cardiac rehabilitation program can go a long way toward easing negative emotions. Emotional problems that persist might necessitate the use of psychotherapy and/or a prescription antidepressant medication.
Reduced appetite. Pain, anxiety and depression can torpedo a heart patient’s appetite, but it tends to return as they start to feel better.
Shortness of breath. Many patients find that they are easily winded after heart surgery. Mild breathing problems of this sort generally are no cause for alarm and tend to get better over time. Good news: Consistent use of handheld spirometers—devices with balls that float on air as the patient exhales forcefully—can help restore lung function and thus reduce breathlessness.
Beware: A severe, acute breathing problem is a medical emergency. It can be symptomatic of pulmonary embolism, in which clots that form in blood vessels in the legs—a condition known as deep vein thrombosis—travel to the lungs. The risk for this potentially deadly condition can be lessened by not being too sedentary or spending too much time in bed in the weeks following surgery.
Sleep disturbances. Major operations, including open-heart surgery, interfere with the body’s circadian rhythms and can cause transient sleep disturbances. Some recovering patients feel excessively sleepy and require frequent catnaps during the day. Others have trouble sleeping. If sleep problems continue, consider seeing a cognitive behavioral psychologist before resorting to sleeping medications.
Swollen ankles. Following surgery, fluid sometimes accumulates in the ankles and lower legs and causes visible swelling. Mild swelling that occurs on both sides of the body typically is a harmless and transient consequence of fluid retention. But swelling on one side only could indicate the presence of a blood clot so it’s important to alert your doctor.
