17525 Heart Surgery

Overview

Heart surgery is an operation on the heart or the blood vessels around it. Doctors recommend it when other treatments can't do enough to keep your heart working well. There are many types. The most common is a coronary artery bypass, where a healthy blood vessel from another part of the body is used to make a new route around a blocked artery. Others include valve repair or replacement, fixing a hole or other problem you were born with, placing a device such as a pacemaker, or, rarely, a heart transplant. 'Cardiac' simply means 'to do with the heart', and 'surgery' means an operation.

Yes. Heart surgery is one of the most common types of major operation worldwide, and techniques and safety have improved a great deal over the past few decades.

It affects adults of all ages, most often people over 60 who have narrowed heart arteries or a damaged valve. It is also used in babies and children born with heart defects, and sometimes in younger adults with inherited heart conditions or valve problems.

Symptoms

Common symptoms

• Chest pain or tightness, especially with effort (doctors call this angina)
• Breathlessness when walking, climbing stairs or lying flat
• Unusual tiredness or low energy during normal activities
• Swelling in the ankles, legs or belly
• Palpitations — a feeling of a racing, fluttering or pounding heartbeat
• Feeling dizzy or lightheaded, sometimes fainting
• A heart murmur heard by a doctor through a stethoscope

Symptoms in children

• Fast breathing or difficulty feeding and poor weight gain in babies
• Blue-ish lips or fingertips (doctors call this cyanosis)
• Tiring quickly during play or falling behind in growth
• Frequent chest infections
• Sweating around the head during feeds

Symptoms in older adults

• Breathlessness doing everyday tasks such as dressing or making a cup of tea
• Dizziness or falls, sometimes linked to a slow or irregular heartbeat
• Swollen legs and ankles, or waking at night short of breath
• Confusion or unusual tiredness, which can be a sign the heart is struggling
• Symptoms that build up slowly and are mistaken for 'just getting older'

Causes

Main causes

• Coronary artery disease — fatty deposits (plaque) narrowing the arteries that feed the heart muscle
• Heart valve disease — a valve that is too narrow or doesn't close properly
• Congenital heart defects — problems with the heart's structure present from birth
• Heart rhythm problems that devices or surgery can help control
• Heart failure or an enlarged heart muscle that no longer pumps well
• A balloon-like swelling (aneurysm) or tear in the aorta, the body's main artery
• Damage to the heart after an infection or a heart attack

Risk factors

• Smoking
• High blood pressure
• High cholesterol
• Diabetes
• Being overweight
• Not being physically active
• A diet high in salt, saturated fat and processed foods
• Drinking too much alcohol
• A family history of early heart disease
• Increasing age
• Some conditions you are born with, or past infections such as rheumatic fever

When to see a doctor

See a doctor urgently if:

• Chest pain that is new, getting worse, or happening at rest
• Breathlessness that has become much worse over hours or days
• Fainting, or near-fainting with palpitations
• Rapid weight gain of a few kilograms over a few days with swelling
• After surgery: fever, wound redness or discharge, or bleeding that won't stop

Book a routine appointment if:

• Chest tightness or breathlessness that comes on with effort and eases with rest
• Being more tired than usual during everyday activities
• Swollen ankles that don't settle overnight
• A heartbeat you can feel fluttering or pounding
• A doctor has told you that you have a heart murmur
• You are recovering from heart surgery and want to check your progress or your medicines

Diagnosis

Your doctor starts by asking about your symptoms, your past health and your family history, then listens to your heart and checks your blood pressure, pulse and legs. Simple tests come next, and if they suggest a heart problem, you will usually be referred to a cardiologist (a heart specialist). The cardiologist combines several tests to see how your heart is built, how well it pumps, and whether its blood supply is blocked. Only then is surgery considered.

Tests that may be done

• Blood tests, including one that shows whether the heart muscle is under strain
• An ECG (electrocardiogram) — painless sticky patches that record the heart's electrical rhythm
• An echocardiogram — an ultrasound scan that shows the heart's chambers, valves and pumping strength
• A chest X-ray to look at the heart's size and the lungs
• A stress test, where your heart is monitored while you walk on a treadmill or after a medicine is given
• A coronary angiogram — a thin tube passed through a blood vessel in the wrist or groin, with dye used to show any narrowings
• A CT or MRI scan to get detailed pictures of the heart and blood vessels
• A 24-hour heart monitor if your heartbeat is irregular

What to expect at your appointment

Most heart tests are quick and painless. An angiogram is a day-case procedure; you will be awake but the area is numbed, and you rest for a few hours afterwards. When the results are ready, your team will sit down with you and explain what they found, what the options are, and what each option involves. Take someone with you if you can, and write down your questions beforehand — it is completely fine to ask for more time or a second conversation before deciding.

Treatment

Treatment aims to relieve symptoms, protect the heart muscle and lower the risk of future problems. It usually combines three things: heart-healthy living, medicines, and — for some people — a procedure or operation. Your team will tailor the plan to your heart problem, your age, your other health conditions and what matters most to you.

Self-care at home

• Stop smoking — this is the single biggest thing you can do for your heart, and free support is available
• Keep active within the limits your care team set, and build up gradually
• Eat a heart-healthy diet: plenty of vegetables, fruit, whole grains, beans, nuts, oily fish, and less salt and processed food
• Keep to a healthy weight and watch your waist measurement
• Limit alcohol and avoid binge drinking
• Take your medicines exactly as prescribed and use a pill organiser or phone reminder if it helps
• Attend your follow-up appointments and cardiac rehabilitation sessions
• Look after your mood and sleep, and tell someone if you feel low or anxious
• Know your numbers — blood pressure, cholesterol and blood sugar — and keep a record

Medical treatments

Medicines are used to lower blood pressure, reduce cholesterol, protect the heart muscle, slow a fast heartbeat, relieve fluid build-up, prevent clots, or ease chest pain. Your doctor will choose what suits you and adjust it over time; never stop or change a heart medicine on your own. Some problems can be treated without open surgery, using a thin tube (catheter) passed through a blood vessel — for example, stretching a narrowed artery with a small balloon and holding it open with a tiny mesh tube, or replacing a valve through a small cut in the groin or chest. Others are managed with a device such as a pacemaker. Cardiac rehabilitation — a structured programme of supervised exercise, education and emotional support — is proven to help people recover better and feel more confident.

When is surgery considered?

Surgery is usually considered when narrowed arteries, a damaged valve, a structural defect or an abnormal rhythm are causing symptoms that medicines can't control, or when the heart is at risk of lasting damage. Your team will weigh the benefit against the risks of the operation and discuss less invasive alternatives with you. Emergency surgery may be needed for a tear in the aorta or after a severe heart attack complication. If surgery is planned, you will have a pre-operative assessment, clear instructions about eating, drinking and medicines beforehand, and time to ask questions.

Living with this condition

In the first few weeks after surgery you will tire easily, and your chest or leg wounds will feel sore and tender. This is normal. Most people need help at home for the first two to four weeks. You will be given advice about lifting, driving, bathing and wound care. Build activity back slowly — short walks that get a little longer each day work well. Many people return to desk-based work in six to eight weeks, and to heavier work later. Recovery is a slope with good days and flat days, not a straight line.

Lifestyle tips

• Follow your cardiac rehabilitation programme — it lowers your risk of further problems and helps you feel like yourself again
• Keep your wound areas clean and dry, and check them daily for redness, swelling or discharge
• Avoid heavy lifting, pushing or pulling until your care team says it is safe
• Pace yourself: rest between activities and put off big tasks
• Keep up your social contact — a short visit or phone call does a lot of good
• Ask about when you can drive, fly and have sex — there are clear, practical answers and no embarrassing questions
• Keep a symptom diary for your follow-up visits

Diet and exercise

Eat regular, balanced meals built around vegetables, fruit, whole grains, beans, lentils, nuts and oily fish, with less salt, sugar and processed meat. Swap butter for olive or rapeseed oil and read labels for hidden salt. Walking is the best starting exercise for most people — begin with a few minutes several times a day and add a little each week. Once you are recovering well, aim for around 150 minutes of moderate activity a week, spread over most days, plus some gentle strength work. Always warm up, stop if you get chest pain, dizziness or unusual breathlessness, and follow the specific advice your team gives you.

Mental health and emotional wellbeing

It is very common to feel frightened, low, tearful or frustrated after heart surgery. Some people feel anxious about every twinge or worry constantly about their heart. Others feel a strange sense of grief for their old self. These feelings usually ease over weeks, but they are real and worth talking about. Tell your GP, your cardiac nurse or your rehabilitation team how you are feeling — support such as talking therapies is effective and available. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line straight away.

Prevention

You can't control everything, but most of the heart problems that lead to surgery are strongly linked to things you can change. Not smoking, keeping blood pressure and cholesterol in a healthy range, staying active, eating well and limiting alcohol can greatly lower your risk. If you already have a heart condition, the same steps help protect your heart and may delay or prevent the need for an operation.

Vaccines

Ask your doctor or pharmacist about recommended vaccinations, such as flu and pneumonia jabs, which are offered to many people with heart conditions because infections can put extra strain on the heart.

Screening programmes

If you are over 40 or have a family history of early heart disease, ask about a heart health check, which usually includes blood pressure, cholesterol and a diabetes risk assessment. If you have symptoms such as chest pain or breathlessness, don't wait for a screening — see your doctor.

Complications

If left untreated

• Worsening chest pain and breathlessness that limit everyday life
• Heart muscle damage or heart failure, where the heart struggles to pump
• Dangerous heart rhythm problems
• Sudden cardiac arrest in some conditions
• A tear or rupture of the aorta, which is life-threatening
• Stroke, when a clot or narrowing affects the brain
• Kidney and other organ problems from poor circulation

Long-term outlook

Most people who have heart surgery feel better and live longer, more active lives. Many notice less breathlessness and chest pain within a few weeks, and are back to everyday activities within a couple of months. Recovery takes time and needs patience, and some people need medicines long term or further procedures later. Your team will be honest with you about what to expect, and will keep supporting you long after you leave hospital. Whatever your situation, there is almost always something that can be done to help you feel better — talk to your care team about your goals.

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