Rehabilitation after heart bypass surgery. After coronary artery bypass surgery

Coronary artery bypass grafting is one of the “popular” operations that is used to treat coronary heart disease, incl. and myocardial infarction.

The essence of this operation is to create a bypass path - a shunt - for the blood that feeds the heart. That is, the blood along the newly created path bypasses the narrowed or completely closed section of the coronary artery.

To perform coronary artery bypass grafting, either the saphenous vein is taken from the leg (provided there is no venous pathology in the patient), or an artery is taken, usually the thoracic artery.

Coronary artery bypass surgery is performed under general anesthesia. The operation is open, that is, a classic incision is made to access the heart. The surgeon uses angiography to identify a narrowed or blocked area of ​​the coronary artery by plaque, and stitches a shunt above and below this place. As a result, blood flow in the heart muscle is restored.

In some cases, the operation can be performed, as indicated above, on a beating heart, without the use of a heart-lung machine. The advantages of this method are:

The operation lasts on average about 3 – 4 hours. After the operation, the patient is transferred to the intensive care unit, where he remains until consciousness is restored - on average one day. After which he is transferred to a regular ward of the cardiac surgery department.

Rehabilitation after coronary artery bypass surgery

Rehabilitation after coronary artery bypass surgery is basically the same as for other heart diseases. The goal of rehabilitation in this case is to restore the performance of the heart and the whole body, as well as to prevent new episodes of coronary artery disease.

So, the main thing in rehabilitation after coronary artery bypass surgery is measured physical activity. It is carried out with the help of individually selected physical exercise programs, with or without the help of simulators.

The main types of physical exercise are walking, health path, light running, various exercise machines, swimming, etc. All these types of physical activity in one way or another put stress on both the heart muscle and the entire body. If you remember, the heart is mostly a muscle, which, of course, can be trained in the same way as other muscles. But the training here is unique. Patients who have had heart disease should not exercise as much as healthy people or athletes.

During all physical exercises, mandatory monitoring of important parameters of the cardiovascular system, such as heart rate, blood pressure, and ECG data is carried out.

Physical therapy is the basis of cardiac rehabilitation. It is also worth noting the fact that physical activity helps relieve emotional stress and fight depression and stress. After therapeutic exercises, as a rule, anxiety and restlessness disappear. And with regular exercises, insomnia and irritability disappear. And, as you know, the emotional component in IHD is an equally important factor. After all, according to experts, one of the reasons for the development of diseases of the cardiovascular system is neuro-emotional overload. And therapeutic exercises will help to cope with them.

In addition to physical exercise, psychotherapy also plays an important role. Our specialists will help you cope with stress and depression. And, as you know, these two phenomena can directly affect the condition of the heart. For this purpose, our sanatorium has excellent psychologists who will work with you either individually or in a group. Psychological rehabilitation is also an important part of the entire cardiac rehabilitation.

It is also very important to control your blood pressure. It should not be allowed to increase due to physical activity. Therefore, you need to constantly monitor it and take the necessary medications prescribed by your doctor.

Depending on the condition of the body, in addition to therapeutic exercises and walking, other types of physical activity can be used, for example, running, vigorous walking, cycling or cycling, swimming, dancing, skating or skiing. But such types of exercise as tennis, volleyball, basketball, training on exercise machines are not suitable for the treatment and prevention of cardiovascular diseases; on the contrary, they are contraindicated, since long-term static loads cause increased blood pressure and heart pain.

For rehabilitation after coronary artery bypass surgery, methods such as aromatherapy and herbal medicine are also used.

Another important aspect of rehabilitation is teaching the correct lifestyle. If after our sanatorium you give up physical therapy and continue to lead a sedentary lifestyle, then it is hardly possible to guarantee that the disease will not worsen or worsen. Remember, a lot does not depend on pills!

It seems to us that the correct development of a diet is very important. After all, it is from cholesterol, which enters your body with food, that atheromatous plaques are formed, narrowing the blood vessel. And a shunt after surgery is the same vessel as the coronary arteries, and it is also susceptible to the formation of plaques on its wall. That is why it is so important to understand that the whole matter does not end with just one operation, and proper rehabilitation is important.

You probably already know what is important in the diet of a patient with heart disease - eat less fat, table salt, and more fresh vegetables and fruits, herbs and grains, as well as vegetable oils.

Our specialists will also have a conversation with you aimed at helping you get rid of bad habits, especially smoking, which is one of the important risk factors for IHD.

Cardiac rehabilitation also involves eliminating all, if possible, risk factors for coronary artery disease. This is not only smoking, but also alcohol, fatty foods, obesity, diabetes, hypertension, etc.

Rehabilitation after CABG

Rehabilitation after CABG, as after any other abdominal surgery, is aimed at the speedy recovery of the patient’s body. Recovery after CABG surgery begins with the removal of sutures, including sutures from the areas from which veins were taken for bypass surgery (usually the saphenous veins of the legs). Immediately after surgery, from the first day and for five to six weeks (before and after removal of sutures), patients must wear special support stockings. Their task is to help restore blood circulation in the legs and maintain body temperature. Since after the operation the blood flow is distributed through the small veins of the leg, temporary swelling and swelling may be observed, which disappear within the first month and a half.

Recovery after CABG

As the main means for the recovery of patients after CABG, physical activity is used from the first day after surgery. On the first day you can already sit up in bed, reach for a chair, making several attempts. On the second day, you can already get out of bed and, with the help of a nurse, move around the ward, and also begin performing simple physical therapy exercises for your arms and legs.

After the suture on the sternum has healed, the patient is allowed to move on to more complex exercises (usually after five to six weeks). The main recommendation is dosing physical activity and limiting weight lifting. The main types of exercise during this period include walking, light running, various exercise equipment, and swimming. During physical exercise, starting from the first day after surgery and as the patient recovers, the most important indicators of the cardiovascular system are monitored - blood pressure, pulse rate, ECG.

The rehabilitation program is prescribed by a specialist in rehabilitation therapy - a cardiologist. In the conditions of city hospital No. 40, it is carried out on the basis of the department of medical rehabilitation of patients with somatic diseases, located on the 3rd floor of the hospital’s therapeutic building.

Rehabilitation of coronary artery bypass surgery

Myocardial infarction is one of the most common diseases not only in the elderly, but also in middle age. The mortality rate for this disease is quite high, almost 50%.

Cause

The main cause of occurrence is cardiac ischemia, which develops due to narrowing or complete blockage of the coronary vessels, those that feed the heart. The heart, although it is an organ that passes large volumes (flows) of blood through itself, receives nutrition not from the inside, but from the outside, through the system of coronary vessels. And of course, if they are amazed, then this is immediately reflected in his work.

Coronary artery bypass surgery

At an advanced stage of coronary heart disease, when the risk of myocardial infarction is significant, coronary artery bypass surgery is resorted to. Using part of the saphenous vein of the lower limb or the thoracic artery, an additional path for blood is created, bypassing the coronary vessel affected by atherosclerosis.

They operate on an open heart, with an opening of the sternum, therefore, after discharge from the hospital, rehabilitation measures are aimed not only at restoring heart function and preventing repeated episodes of ischemia, but also at speedy healing of the sternum. To do this, heavy physical exertion is excluded, and patients are warned not to drive, due to the risk of injury to the sternum.

Rehabilitation

In addition, if a vein of the lower limb was used for the operation, then due to swelling that persists for some time, there are a number of restorative measures for it: wearing elastic stockings and keeping the leg elevated in a sitting position.

Many patients, after undergoing surgery, are overly protective of themselves and move less, which in no case should be done. The heart is a muscle, and therefore it must be constantly trained. Physical activity is necessary, but it must be gentle and dosed.

Walking, running, swimming, exercise bikes are suitable. However, not all sports should be preferred. For example, team sports that involve long-term static loads, such as volleyball, basketball, tennis, are contraindicated. They contribute to an increase in blood pressure, and this should not be allowed, because... unwanted stress on the heart increases.

Blood pressure monitoring should be mandatory, especially after exercise.

In addition to strengthening the heart muscle and the body as a whole, physical exercise allows you to relieve emotional stress, which is one of the factors in the development of coronary artery disease.

Diet for coronary artery bypass surgery

During rehabilitation after coronary artery bypass surgery, adherence to diet is not unimportant. It is necessary to exclude fatty and salty foods, and include more greens, vegetables, and fruits in your diet. You should radically change your lifestyle by giving up bad habits: smoking, drinking alcohol, overeating.

Only in combination with physical exercise, proper nutrition and healthy lifestyle, can the risk of re-developing coronary artery disease be reduced to zero.

It is worth getting another doctor's opinion on recovery after heart bypass surgery.

Life after coronary artery bypass surgery. Physical activity, nutrition

In February of this year, I came across the article “Shunts do not last forever.” A correspondent for the Evening Moscow newspaper talked with the head of the laboratory of X-ray endovascular methods of the Cardiology Research Center, Doctor of Medical Sciences A.N. Samko. The discussion was about the effectiveness of coronary artery bypass grafting (CABG) operations. Dr. Samko painted a bleak picture: after a year, 20% of shunts close, and after 10 years, as a rule, all of them! In his opinion, repeat bypass surgery is risky and extremely difficult. This means that life is guaranteed to be extended by only 10 years.

My experience as a long-time cardiac surgical patient who has undergone two coronary artery bypass operations suggests that these periods can be increased, primarily through regular physical activity.

I view my illness and operations as a challenge from fate that must be actively and courageously resisted. Unfortunately, physical activity after CABG is mentioned only in passing, by the way. Moreover, there is an opinion that some patients after heart surgery live safely and for a long time without making any effort. I have never met such people. What I want to talk about is not a miracle, not luck or a fortunate coincidence, but a combination of the high professionalism of the doctors of the Russian Scientific Center for Surgery and my perseverance in implementing my own program of restrictions and loads (RON).

My story is this. Born in 1935. In his youth he suffered from malaria for many years, and during the war from typhus. Mother - a heart patient, died at 64 years old.

In October 1993, I suffered an extensive transmural posterolateral myocardial infarction of the left ventricle, and in March 1995 I underwent coronary artery bypass grafting - 4 shunts were sewn in. Thirteen years later, in April 2008, angioplasty of one shunt was performed. The other three were functioning normally. And after 14 years and 3 months, I suddenly started having angina attacks, which I had never had before. I went to the hospital, then to the Scientific Cardiology Center. I underwent further examination at the Russian Scientific Center for Surgery. The results showed that only two of the four shunts were functioning normally, and on September 15, 2009, Professor B.V. Shabalkin performed a repeat coronary artery bypass surgery on me.

As you can see, I have been able to significantly extend the average life expectancy with shunts, and I am convinced that I owe this to my RON program.

Doctors still consider my post-operative physical activity too high and advise me to rest more and take medication constantly. I can't agree with this. I want to make a reservation right away - there is a risk, but it is a justified risk. Understanding the seriousness of my situation, from the very beginning I introduced certain restrictions into my system: I excluded jogging, exercises with dumbbells, on the horizontal bar, hand push-ups and other strength exercises.

Typically, clinic doctors classify CABG surgery as an aggravating factor and believe that the person undergoing surgery has only one destiny: to live out his life quietly and calmly and constantly take medications. But bypass surgery ensures normal blood supply to the heart and the body as a whole! And how much work has been invested, effort and money spent to save the patient from death and give him the opportunity to live on!

I am convinced that even after such a difficult operation, life can be fulfilling. And I can’t come to terms with the categorical statements of some doctors that my workload is excessive. They are feasible for me. But I know that if atrial fibrillation appears, severe pain in the heart area, or the lower limit of blood pressure exceeds 110 mm Hg, you must immediately call an ambulance doctor. Unfortunately, no one is immune from this.

My RON program includes five points:

1. Physical training, constant and gradually increasing to a certain limit.

2. Dietary restrictions (mainly anti-cholesterol).

3. Gradually reduce your medications until you stop taking them completely (I only take them in emergencies).

4. Prevention of stressful conditions.

5. Constantly being busy with interesting things, leaving no free time.

Gaining experience, I gradually increased physical activity, included new exercises, but at the same time strictly controlled my condition: blood pressure, heart rate, did an orthostatic test, a test for heart fitness.

My daily physical activity consisted of measured walking (3-3.5 hours at a pace of steps per minute) and gymnastics (2.5 hours, 145 exercises, 5000 movements). This load (metered walking and gymnastics) was performed in two doses - in the morning and in the afternoon.

Seasonal loads were added to the daily loads: skiing with stops every 2.5 km to measure heart rate (total 21 km in 2 hours 15 minutes at a speed of 9.5 km per hour) and swimming, one-time or fractional - pom (800 m in 30 minutes).

In the 15 years since my first CABG operation, I have walked 80 thousand kilometers, covering a distance equal in length to two equators of the earth. And until June 2009, I didn’t know what angina attacks or shortness of breath were.

I did this not out of a desire to demonstrate my exclusivity, but because of the conviction that blood vessels, natural and artificial (shunts), fail (clog) not from physical exertion, especially strenuous ones, but due to progressive atherosclerosis. Physical activity inhibits the development of atherosclerosis, improves lipid metabolism, increasing the content of high-density cholesterol (good) in the blood and reducing the content of low-density cholesterol (bad) - thereby reducing the risk of blood clots. This is very important for me, since my total cholesterol levels fluctuate at the upper limit. The only thing that helps is that the ratio of high and low density cholesterol, the content of triglycerides and the cholesterol coefficient of atherogenicity never exceed the established standards.

Physical exercises, gradually increasing and giving an aerobic effect, strengthen muscles, help maintain joint mobility, increase minute blood output, reduce body weight, have a beneficial effect on intestinal function, improve sleep, increase tone and mood. In addition, they help in the prevention and treatment of other age-related diseases - prostatitis, hemorrhoids. A reliable indicator that the load is not excessive is nasal breathing, so I breathe only through my nose.

Everyone is sufficiently informed about measured walking. But I would still like to cite the opinion of a famous surgeon, who himself was not involved in sports, but was fond of hunting, to confirm its usefulness and effectiveness. And hunting means walking for many hours. We will talk about Academician A.V. Vishnevsky. Since his student years, fascinated by anatomy and having perfectly mastered the art of dissecting, he loved to tell his acquaintances all sorts of interesting details. For example, there are 25 joints in each human limb. With each step, 50 articulated sections are thus set in motion. The 48 joints of the sternum and ribs and the 46 bony surfaces of the spinal column do not remain at rest. Their movements are barely noticeable, but they are repeated with every step, with every inhalation and exhalation. Considering that there are 230 joints in the human body, how much lubricant do they need and where does this lubricant come from? Having asked this question, Vishnevsky answered it himself. It turns out that the lubricant is supplied by a pearly-white cartilaginous plate that protects the bones from friction. There is not a single blood vessel in it, and yet the cartilage receives nutrition from the blood. In its three layers there is an army of “builder” cells. The upper layer, which wears out due to friction of the joints, is replaced by the lower ones. This is similar to what happens in the skin: with each movement, the clothing erases dead cells from the surface layer, and they are replaced by underlying ones. But the cartilage-former does not die ingloriously, like a skin cell. Death transforms him. It becomes soft and slippery, turning into a lubricant. This way, a uniform layer of “ointment” is formed on the rubbing surface. The more intense the load, the more “builders” die and the faster the lubricant is formed. Isn't this a walking hymn!

After the first CABG operation, my weight remained within kg (with a height of 165 cm), I took medications only in emergency cases: with increased blood pressure, temperature, heart rate, headaches, and arrhythmia. The main difficulty for me was my easily excitable nervous system, which I practically could not cope with, and this affected the results of the examinations. A sharp increase in blood pressure and heart rate due to anxiety misled doctors about my actual physical capabilities.

After analyzing statistical data from long-term physical training, I determined the optimal heart rate for my operated heart, guaranteeing the safety and aerobic effect of physical exercise. My optimal heart rate is not unambiguous, like Cooper’s; it has a wider aerobic range of values, depending on the type of physical activity. For gymnastic exercises - 94 beats/min; for measured walking - 108 beats/min; for swimming and skiing - 126 beats/min. I rarely reached the upper limits of my heart rate. The main criterion was that the restoration of the pulse to its original value was, as a rule, rapid. I want to warn you: the optimal pulse recommended by Cooper for a 70-year-old man - 136 beats / min - after myocardial infarction and CABG surgery is unacceptable and dangerous! The results of long-term physical training confirmed every year that I was on the right path, and the conclusions made after the first CABG operation were correct.

Their essence is as follows:

The main thing for the operator is a deeply conscious understanding of the significance of the CABG operation, which saves the patient by restoring normal blood supply to the heart muscle and gives him a chance for the future, but does not eliminate the cause of the disease - vascular atherosclerosis;

The operated heart (CABG) has great potential, which manifests itself with a properly selected lifestyle and physical training, which should be done constantly;

The heart, like any machine, needs to be trained, especially after a myocardial infarction, when more than 25% of the heart muscle has turned into scar, and the need for normal blood supply remains the same.

Only thanks to my lifestyle and physical training system I managed to maintain good physical shape and undergo repeat CABG surgery. Therefore, in any conditions, even in the hospital, I always tried not to stop physical training, albeit in a reduced volume (gymnastics - minutes, walking around the ward and corridors). While in the hospital, and then in the Cardiology Research Center and the Russian Research Center for Surgery, I walked a total of 490 km before the repeat CABG operation.

Two of my four shunts, installed in March 1985, survived for 14.5 years with the help of physical training. This is a lot compared to the data in the article “Shunts are not forever” (10 years) and the statistics of the Russian Scientific Center for Surgery (7-10 years). So the effectiveness of controlled physical activity for myocardial infarction and coronary artery bypass surgery seems to me to be proven. Age is not a barrier. The need and volume of physical activity should be determined by the general condition of the operated patient and the presence of other diseases that limit his physical activity. The approach must be strictly individual. I was very lucky in that I always had an intelligent, sensitive and attentive doctor next to me - my wife. She not only observed me, but also helped me overcome both medical illiteracy and fear of a possible negative reaction of the cardiovascular system to constantly increasing physical activity.

Experts say that repeat operations pose a particular challenge for surgeons around the world. After my second operation, my rehabilitation did not proceed as smoothly as the first time. Two months later, some signs of angina appeared with this type of exercise, such as measured walking. And although they were easily removed by taking one tablet of nitroglycerin, this really puzzled me. Did I understand? that it is impossible to draw hasty conclusions - too little time has passed since the operation. And rehabilitation began in the sanatorium already on the 16th day (after the first operation, I began more or less active actions 2.5 months later). In addition, it was impossible not to take into account that I had become 15 years older! All this is true, but if a person, thanks to his system, achieves certain positive results, he is inspired and confident. And when fate throws him back overnight, making him vulnerable and helpless, this is a tragedy associated with very strong emotions.

Having pulled myself together, I began to work out a new program of life and physical training and quickly became convinced that my work was not in vain, since the main approaches remained the same, but the volume and intensity of the loads would have to be increased more slowly, taking into account my new condition and in conditions of strict control over it. Starting with slow walks and 5-10-minute gymnastic warm-ups (head massage, rotational movements of the pelvis and head, inflating the ball 5-10 times), 5 months after the operation I increased physical activity to 50% of the previous: gymnastics for 1 hour 30 minutes (72 exercises, 2300 movements) and dosed walking for 1 hour 30 minutes at a pace of steps per minute. I perform them only once in the first half of the day, and not twice, as before. In 5 months after repeated bypass surgery, I walked 867 km. At the same time, I conduct auto-training sessions twice a day, which help me relax, relieve tension and restore performance. My gym equipment so far includes a chair, two gymnastic sticks, a ribbed roller, a roller massager and an inflatable ball. I stopped at these loads until the causes of angina manifestations were fully clarified.

Of course, the CABG operation itself, not to mention a repeat operation, its unpredictable consequences, possible postoperative complications create great difficulties for the operated person, especially in organizing physical training. He needs help, and not just medication. He needs a minimum of information about his disease in order to competently build his future life and avoid undesirable consequences. I hardly came across the information I needed. Even in M. DeBakey’s book with the intriguing title “A New Life of the Heart,” the chapter “Healthy Lifestyle” talks mainly about eliminating risk factors and improving lifestyle (diet, weight loss, limiting salt intake, quitting smoking). Although the author pays tribute to physical exercise, he warns that excessive stress and sudden overload can end tragically. But nothing is said about what excessive loads are, how they are characterized and how to live with a “new heart”.

Articles by N.M. helped me develop a competent approach to organizing physical training. Amosova and D.M. Aronov, as well as K. Cooper and R. Gibbs, although all of them were devoted to the prevention of heart attack using jogging and did not affect CABG operations.

The main thing that I managed to do was maintain mental activity and creative activity, maintain a spirit of cheerfulness and optimism, and all this, in turn, helped me gain the meaning of life, faith in myself, in my ability to improve and self-discipline, in the ability to take responsibility for your life in your own hands. I believe that there is no other way and I will continue to continue my observations and experiments, which help me overcome emerging health difficulties.

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Physical activity after surgery

Coronary heart disease (CHD) is one of the main causes of mortality in developed countries. According to summary data, as a result of coronary heart disease, every year humanity loses more than 2.5 million people, more than one third of which are people of working age

Coronary artery bypass surgery (CABG) is currently the most effective method of treating coronary artery disease, improving the quality and life expectancy of patients and reducing the risk of developing possible complications of the disease. Restoring normal lumen in the most damaged vessels will relieve patients from debilitating angina pain, from the need for constant use of nitroglycerin and other drugs, but no matter how radical the surgeons are, they are not able to either restore the normal structure of the vascular wall or stop the progression of the underlying disease - coronary artery disease atherosclerosis. But to a certain extent, this is within the power of the patients themselves if they follow the appropriate recommendations: a healthy lifestyle, combating risk factors that contribute to the progression of coronary heart disease (smoking, hypercholesterolemia, arterial hypertension, as well as excess body weight, physical inactivity, etc.).

It is obvious that the positive results of the operation will last for many years only if the necessary amendments are made to the lifestyle, giving up bad habits, and the active participation of patients in preventive measures aimed at maintaining health. Carrying out complex rehabilitation measures helps to optimize the results of CABG, more complete and rapid improvement of the quality indicators of the cardiovascular and respiratory systems and restoration of working capacity. Physical training is mandatory for all patients who have undergone CABG. However, the timing of the start of physical rehabilitation, its intensity and nature are determined strictly individually.

After discharge from the hospital, the patient is observed by a cardiologist at his place of residence or transferred to a sanatorium. At the dispensary stage of rehabilitation, treatment and preventive measures and physical rehabilitation continue based on selected recommendations in the cardiac surgery hospital and sanatorium. Physical rehabilitation should be built depending on the group of physical activity of patients and includes: morning hygienic exercises, therapeutic exercises, measured walking, measured climbing stairs.

Morning hygienic gymnastics (UGG).

The main task of UGG is to activate peripheral blood circulation and gradually engage all muscles and joints, starting with the feet and hands. All exercises of a training nature, exercises with weights (bending over, squats, push-ups, dumbbells, etc.) are excluded from UGG, since this is the task of therapeutic gymnastics.

Starting position - lying on the bed, sitting on a chair, standing against a support, standing - depending on the patient’s well-being. The pace is slow. The number of repetitions of each exercise is times. UGG time is from 10 to 20 minutes, carried out daily before breakfast.

Therapeutic gymnastics (LG).

One of the most important tasks of LH is to train extracardiac circulatory factors to reduce the load on the myocardium.

Dosed physical activity causes the development of the vascular network in the heart and reduces cholesterol levels in the blood. Thus, the risk of thrombosis is reduced. Physical activity must be strictly dosed and regular.

Therapeutic exercises are performed daily and cannot be replaced by other types of physical activity. If, when performing exercises, discomfort occurs behind the sternum, in the heart area, or shortness of breath appears, it is necessary to reduce the load. However, to achieve a training effect, if the complex is performed easily, the load is gradually increased. Only a gradually increasing load ensures the body is trained, helps improve its functions, and prevents exacerbation of the disease. A correct gradual increase in physical activity contributes to faster adaptation of the heart and lungs to new circulatory conditions after CABG. The recommended set of physical exercises is performed minutes before meals or 1-1.5 hours after meals, but no later than 1 hour before bedtime. Exercises must be performed at the recommended pace and number of repetitions.

We recommend indicative complexes of therapeutic exercises at home of varying degrees of complexity: I - for the first three months after discharge from the hospital; II - for 4-6 months. and III- for 7-12 months after discharge from the hospital.

The LH procedure begins in the water part with breathing exercises. Thanks to the work of the respiratory muscles, the diaphragm, and changes in intrathoracic pressure, blood flow to the heart and lungs increases. This improves gas exchange, redox processes, and prepares the cardiovascular and respiratory systems for increased load. One of the main breathing exercises is diaphragmatic breathing, which should be done at least 4-5 times a day. How to perform it correctly: starting position lying on a bed or sitting on a chair, relax, put one hand on your stomach, the other on your chest; take a calm breath through the nose, inflating the stomach, while the hand lying on the stomach is raised, and the second one, on the chest, should remain motionless. Inhalation duration is 2-3 seconds. When you exhale through a half-open mouth, the stomach releases. The duration of exhalation is 4-5 seconds. After exhaling, there is no need to rush to inhale again, but should pause for about 3 seconds until the first desire to inhale appears. In the main part of the LH procedure, it is necessary to observe the correct order of inclusion of various muscle groups (small, medium, large). A gradual increase in load helps to strengthen central, peripheral blood circulation, lymph circulation and more rapid recovery of strength, increases the body's resistance. The LH procedure should be completed with complete muscle relaxation and calm breathing.

Monitoring the effectiveness of the procedure is carried out according to the pulse count, the nature of its filling, the time of return to the original values, and general well-being.

When performing 1 LH complex, it is allowed to increase the pulse rate to 15-20% of the initial value; II - up to 20-30% and III - up to 40-50% of the original value. Restoring the pulse to its original values ​​within 3-5 minutes indicates an adequate response.

The pace of the exercises is slow, medium.

Particular attention is paid to proper breathing: inhale - while straightening the torso, abducting the arms and legs; exhale - when bending; adduction of arms and legs. Avoid holding your breath, avoid straining.

Approximate complex of therapeutic exercises N 1

for home exercises (1-3 months after coronary artery bypass surgery)

Starting position (I.p.)

Sitting, hands on knees, legs slightly apart

Raising your arms to the sides (inhale), returning to the starting position (exhale)

Inhale for 1-2, exhale

Sitting, arms bent at elbows at right ANGLES

Circular movements with the brushes in both directions

5-7 times each way

After the exercise, shake your hands

Sitting, hands on knees, legs slightly apart

Simultaneously raising both feet on the toes, then lowering them onto the heels while lifting

Abduction of the right arm to the side with a slight rotation of the body and head (inhale), return to the p. (exhale)

24 times each way

Don't strain your muscles

Spreading your legs to the sides by stepping from heels to toes and returning to i. in the same way

Don't strain your muscles

Sitting on the edge of a chair, leaning against the back, left hand on your stomach, right hand on your chest

When you inhale, the abdominal wall protrudes, when you exhale, it retracts.

Sitting, hands at shoulder joints

Circular movements at the shoulder joints

Sitting on the edge of a chair, leaning against the back, holding the seat of the chair with your hands, one leg straightened, the other bent and placed on the toe under the chair

3 i. p. - inhale, while exhaling, change the position of the legs several times

After the exercise, rest break

Sitting, hands on knees, legs shoulder-width apart

3 i. p. - inhale: while exhaling, bend over to your right leg, placing both hands on your knee, return to i. p. (inhale)

4-5 times each way

Straightening your torso. watch your back position

I. p. - sitting, arms down. legs slightly apart

Alternately pulling the knee to the stomach in combination with exhalation. return to i. p. - inhale

2-3 times with each leg

If there is difficulty, limit yourself to raising your knee high

Sitting, hands on waist, legs slightly apart

In and. p. - inhale, while exhaling stand up, then sit down

When standing up for the last time, remain in a standing position.

Standing behind the back of a chair

Raising your arms to the sides (inhale), lowering your arms onto the seat of a chair and leaning forward (exhale)

Relax while bending

Standing sideways to the back of a chair, holding onto it with your left hand

Freely swing the relaxed right leg back and forth. Turn around, do the same with your left foot

Pump your leg 4-6 times

Don't hold your breath

Standing behind the back of a chair, holding it with your hands

Alternate abduction of arms with a slight rotation of the torso in the same direction

2-3 times in each direction

When turning to the side - inhale, return to i. p. - exhale

"Roll" from heels to toes and back

A blurry swing of the leg to the side and a return to i. n. Then do the same with the other leg

2-4 times each way

Breathing freely

Standing, feet shoulder-width apart, arms down

In and p. - inhale: during exhalation, tilt the torso to the SIDE with sliding of the arms along the body (“pump”) and return to i. P.

3-4 times in each direction

Stay straight, don't lean forward

Standing behind the back of a chair, 11 holding it with your hands

Squats with hands supporting the back of a chair and returning to i. P.

Keep your back straight

Standing, arms down

Raising your arms to the sides - - inhale: lowering the rue down with a slight tilt of the torso forward - exhale

Put your hands down and relax

Standing, arms down

Walking with gradual acceleration and subsequent deceleration

Inhale for 2 steps, exhale for 4 steps

Sitting leaning against the back of a chair

Calm inhalation and full exhalation

Lesson duration min.

Therapeutic gymnastics complex N 2

for home exercises 4-6 months after coronary artery bypass surgery

Starting position (I.p.)

Sitting, hands on knees, palms up

Clenching your fingers into fists while bending your feet

Sitting, hands on knees

Bend your arms to your shoulders, straighten them forward, bend your arms to your shoulders, spread them to the sides, return them to a

Sitting, hands on waist

Stepping your feet sideways in a herringbone pattern and back again

Sitting, left hand on the belt, right hand on the chest

Breathe deeply with the right lung, then, changing position, breathe with the left lung

Exhale for a long time

Sitting, hands on waist

Rotate the body first to the left, then to the right

Sitting, hands on waist, one leg under the chair, the other in front

Changing the position of your feet (you can slide your feet along the floor)

Sitting, one hand on the chest, the other on the stomach

Exhale for a long time

Sitting, hands to shoulders

Circular movements with bent arms

1 0 times forward and backward

When moving the route up, inhale, down, exhale.

Sitting hands on belt

Bicycle movements with one leg, then with the other leg

Alternately pulling the knee to the chest, followed by spreading the rue to the sides

When you spread your arms, inhale, when you pull up your knee, exhale.

Standing, lean your hands on the back of the chair

Rolling from toes to heels

Alternately moving your legs back

4-6 times with each leg

Keep your back straight

Standing, arms down

Raising your arms to the sides in combination with inhalation, returning to the starting position with exhalation

Keep your back straight

Standing, lean your hands on the back of the chair

Alternately moving the legs to the side

4-5 times with each leg

Keep your back straight, breathe freely

Hands on waist, feet shoulder-width apart

Torso rotation to the left, then to the right

5-6 times in each direction

Rotation of the torso to the side with abduction of the same arm

When turning to the side, inhale when returning to i. I - exhale

Standing, with a gymnastic stick in hands

Raise the stick up, inhale, lower the stick down - exhale

When lifting a stick, stretch upward

Standing, stick vertically

Leaning your hands on the pack, alternately rotate your straight leg (forward - to the side - back)

4-6 times with each leg

Standing, stick horizontally

Raise the stick up, lower it onto your shoulders behind your head, lift it up, lower it forward

When lifting the stick up, inhale; when lowering, inhale.

Stick behind head, feet shoulder-width apart

Turn the body to the left, then to the right

Inhale when turning

Standing, stick in front horizontally

Half squat with jackdaw raised forward

Exhale when squatting

Standing, jackdaw vertically

Alternately moving the arm to the side

Inhale when abducting your arm

Standing, stick vertically, one leg bent in front (lunge forward)

Spring squats on one leg, then, changing the position of the legs, squats on the other leg

4 times on each leg

Standing, hold the stick by the middle in one hand

Rotating the stick in your hand, then changing the position of your hands, rotating the pack in the other hand

Breathing is free. Hold the stick tightly without relaxing your fingers

Walking in place

Sitting. One hand on the chest, the other on the stomach

Sitting. Put one foot on top of the other

10 times with each leg

Raising the rue upward in combination with breathing

When raising your hands up - inhale, when lowering - exhale

Sitting, one foot on the toe, the other on the heel, hands on the belt

Changing leg position

Sitting, one hand on the chest, the other on the stomach

Lesson duration min.

therapeutic exercises for home exercises (7-12 months after coronary artery bypass surgery)

Starting position (I.p.)

Standing, arms down

Walking on toes, heels, feet with arms raised up, to the sides, down

Standing, arms down

Raising your arms to the sides - inhale, "coachman's" movements of the arms - exhale

As you exhale, press lightly on your chest

Standing. hands on the belt

Torso rotations with arms abducted to the sides) with tension

Keep your body straight

Standing, hands on belt

Squat, arms forward

Don't lean forward

Standing, hands on chest

Deep chest breathing

Don't hold your breath

Standing, arms down

Jogging with transition to walking with slowdowns

Standing, gymnastic pack on shoulder blades

Springy bends of the torso to the sides (while exhaling)

When straightening the body - inhale

Standing, gymnastic stick in hands

Alternately pulling the bent leg towards the stomach. On the exhale

Pressing the folder to encourage exhalation

Standing, gymnastic stick on shoulder blades

Bend the torso forward while exhaling

Don't lower your head

Standing, hold the gymnastic stick vertically in your hand by the middle

Alternate rotation of the brush 180°

Standing, arms down

Standing, hands on belt

Body rotation right and left

Standing, one hand on the chest, the other on the stomach

Chest and diaphragmatic breathing

Standing, stick horizontally in hands

Stepping over a stick

Standing, arms bent at the elbows, fingers clenched into fists

Standing, arms down

Shaking hands day muscle relaxation

Standing, arms down

Jogging with transition to slow walking

Don't hold your breath

Standing, hands behind heads

Springy side bends of the torso

Do not lean your torso forward

Standing, arms to the sides, hands in fists

Copying small, medium and large circles by hand

Standing, arms down

Alternately raising your arms up, inhaling

When you raise your hands, look at them

Abduction of the right arm and leg to the sides) and back. Same with left leg and hand

Standing, feet shoulder-width apart, holding the back of a chair

Don't hold your breath

Sitting, arms down

Rotational movements of the head

Avoid dizziness

Sitting, arms down

Alternating shaking of arms and legs

Sitting, arms down

Complete muscle relaxation

Strength, hands on knees

Lesson duration min.

Great importance is attached to both the inpatient and outpatient stages of rehabilitation to the use of such natural movement as walking. Dosed walking increases the vitality of the body, strengthens the heart muscle, improves blood circulation, breathing and leads to increased physical performance. When walking in doses, you must follow the following rules:

1. You can walk in any weather, but not below the air temperature of -20°C or. -15°C with wind.

2. The best walking time: from 11 to 13 hours and from 17 to 19 hours.

3. Clothes and shoes should be loose, comfortable, and light.

4. It is prohibited to talk or smoke while walking.

When doing measured walking, it is also necessary to keep a self-monitoring diary, where the pulse is recorded at rest, after exercise and after rest after 3-5 minutes, as well as general well-being. Method of measured walking:

1. Before walking, you need to rest for 5-7 minutes and count your pulse.

2. The pace of walking is determined by the patient’s well-being and heart performance. First, a slow walking pace is mastered - sh/min, with a gradual increase in distance, then an average walking pace - sh/min, also gradually increasing the distance, and then a fast pace - 100-110 sh/min. You can use the intersal type of walking, i.e. alternating walking with acceleration and deceleration.

3. After leaving home, it is first recommended to walk at least 100 meters at a slower pace, one minute slower than the walking pace that the patient is currently mastering, and then switch to the mastered pace. This is necessary in order to prepare the cardiovascular and respiratory systems for a more serious load. You should also finish walking at a slower pace.

Without mastering the previous motor mode, it is not recommended to move on to mastering a new one; load.

Equally important at all stages of rehabilitation is given to measured ascents to the steps of the stairs.

Almost all patients at home or due to their occupation are faced with the need to climb stairs.

Descending stairs counts as 30% of the ascent. The walking pace is slow, no faster than 60 steps per minute. You need to walk at least 3-4 times a day. Just like with any training load, patients keep a self-monitoring diary.

Social and labor aspect of rehabilitation.

One of the important indicators of the effectiveness of CABG surgery is the restoration of working capacity of operated patients.

After discharge from the hospital (during the first 3-4 months after surgery), patients are not recommended to: lift and carry weights of more than 5 kg, repair work, work involving bending, with fast and sudden movements. But you can’t exclude yourself from work, do everything according to how you feel and with rest. We must adhere to the golden mean: do not overload the heart muscle, but also do not leave it in a state of inactivity.

It should be borne in mind that for patients with coronary artery disease who have undergone CABG surgery, regardless of their condition, work associated with significant physical stress, even episodic, with constant moderate physical stress (long walking, night shift work) is contraindicated. Work at heights, under water, on a conveyor belt, work with exposure to toxic substances, acids, alkalis, etc., work in adverse weather conditions, work related to driving is contraindicated.

In addition to movements, positive emotions are also needed. If the patient cannot return to his job, then try to find a psychologically less stressful job or a job associated with less physical activity, or switch to part-time work, or try to find something to do at home.

And I would like to end with the words said by the director of the Human Reproduction Center A.S. Hakobyan: “Of course, medicine can do a lot. But we must not forget: a person’s life program is determined only 15% by the level of health care, 20% by genes, and the remaining 65% by lifestyle. No creature has such self-destructive tendencies as man. I think by adjusting your lifestyle, you can double your walk on Earth.” Lifestyle depends only on ourselves, changing a chaotic, idle lifestyle to a healthy one does not require material costs, it is enough to make a little effort on yourself, show will and patience.. In the regional clinical cardiology clinic, experienced, highly qualified specialists - cardiologists, surgeons, rehabilitation specialists together We are ready to develop an individual, comprehensive rehabilitation program with you, monitor its implementation and effectiveness, and also resolve issues of your ability to work and professional orientation.

If the coronary arteries and blood vessels are damaged, coronary artery bypass grafting is indicated. The postoperative period in this case requires the implementation of certain rules, which will guarantee the effectiveness of the treatment.

After surgery, there is a significant reduction in the symptoms of coronary artery disease. But this treatment method is not able to eliminate the cause of the disease. After surgery, other branches of the coronary arteries may become narrowed. In order to ensure the patient’s normal well-being, proper rehabilitation after bypass surgery must be carried out. By following all the rules, the risk of complications is eliminated.

Rehabilitation after coronary artery bypass surgery should be aimed at restoring normal heart function. With its help, stimulation of restoration processes in damaged areas is ensured. The recovery period should help consolidate the results of surgery. The goals of rehabilitation involve inhibiting the progression of diseases such as coronary artery disease, hypertension, and atherosclerosis. After completing the course, the patient must adapt to psychological and physiological stress. With its help, the formation of social, everyday and labor skills is ensured.

Recovery after coronary artery bypass surgery provides an opportunity to ensure a person’s full life and eliminate various complications.

First stage

Recovery after bypass surgery involves going through several stages. The duration of the first of them is from 10 to 14 days. During this period, the patient must remain in a hospital setting. This period is enough to normalize the performance of all organs and systems of the patient’s body.

After the patient is transferred from intensive care to a regular ward, it is necessary to normalize breathing and eliminate the possibility of congestion in the lungs. This is why patients are prescribed breathing exercises after bypass surgery. In this case, the patient needs to regularly inflate a rubber toy - a ball or ball. After surgery, the use of vibration massage is recommended. It is performed over the lung area using tapping movements.

In hospital settings, the patient is recommended to frequently change body position in bed. If the surgeon allows, the person can lie on his side. After bypass surgery, rehabilitation requires a gradual increase in physical activity. Initially, the patient must sit down on a chair and walk around the room or corridor. Performing certain actions should be carried out in accordance with the patient’s well-being. Before discharge, the person is advised to learn how to climb stairs themselves. During his stay in the hospital, walks in the fresh air are recommended.

Rehabilitation after coronary artery bypass surgery requires strictly following all the doctor’s recommendations, which will eliminate the possibility of complications.

Second phase

After the patient is discharged from the hospital, he is recommended to visit the doctor regularly. He examines the person and also provides his advice. In most cases, patients are recommended to visit a doctor within 1-3 months after discharge. In this case, the complexity of the surgical intervention and the presence of pathological processes that can lead to complications in the recovery period are taken into account. Regardless of the date of examination, the patient should contact the doctor if:

• Difficulty breathing;
• Increased body temperature;
• Severe pain in the sternum area;
• Increased body weight;
• Problems with heart function.

Rehabilitation after CABG at home should be aimed at normalizing blood circulation and metabolic processes. After surgery, patients are recommended to undergo drug therapy. With its help, the heart rate and blood pressure are normalized. After bypass surgery, medications reduce cholesterol levels in the blood and also eliminate the possibility of blood clots. Antiplatelet therapy requires taking:

• Cardiomagnyl;
• Aspirin cardio;
• Thrombo ACC.

The choice of medication should be made only by a doctor in accordance with the indications. After coronary artery bypass surgery, rehabilitation prohibits smoking and drinking alcoholic beverages. At this time, patients are advised to exercise. The best option in this case is walking. With its help, a gradual increase in the level of fitness of the body is ensured. In accordance with the patient's well-being, a regular increase in the pace and duration of walking is recommended. Patients are advised to take walks in the fresh air. During physical activity, it is recommended to control the heart rate, which should be from 100 to 110 beats per minute.

If the patient experiences swelling in the lower extremities, he is recommended to use compression stockings or elastic bandages on the shins. In some cases, the use of special therapeutic gymnastics complexes is recommended. After the sternum has completely healed, patients are allowed to run, swim, dance, and ride a bike. If heart bypass surgery has been performed, during the postoperative period it is prohibited to engage in tennis, basketball, push-ups, pull-ups and other sports that place stress on the chest.

Intimate life in the postoperative period is not prohibited. In most cases, sexual relations are resolved after the patient is discharged. In this case, it is necessary to choose poses in which the load on the chest will be minimal. Office workers and intellectual workers can return to work 1-1.5 months after surgery. If a person’s activity was associated with physical labor, then he is recommended to switch to easier conditions.

Rehabilitation after coronary bypass surgery requires the patient to give up bad habits, take appropriate medications and do as much physical activity as possible.

Diet

After heart bypass surgery, the patient must adhere to proper nutrition. This is explained by the fact that during a myocardial infarction, excess cholesterol in the blood can lead to complications. That is why it is recommended to exclude fats during the rehabilitation period. Patients are strictly prohibited from consuming:

• Pork;
• Ducklings;
• Lamb;
• Offal;
• Semi-finished products;
• Sausages.

The patient should also refuse fatty fermented milk products. It is not recommended to cook dishes from butter and margarine. A person’s diet should not consist of snacks, confectionery, fast foods, and fried foods.

The patient's diet should consist of fish dishes, vegetables and fruits, boiled lean meat. When consuming dairy products, it is recommended to ensure that they have a minimum level of fat content. Patients are recommended to give preference to vegetable oil from fats. Its daily dose should be no more than two tablespoons.

After surgery, the patient is recommended to eat small meals. He should eat food five times a day, but in minimal portions. Cooking should be carried out by boiling, baking, stewing. Eating fried foods is strictly prohibited. Once a week, patients are recommended to perform unloading. After surgery, it is necessary to limit the amount of table salt consumed. Patients are advised to strictly adhere to the drinking regime. They should drink 1 to 1.2 liters of fluid per day. You should give up cocoa, coffee and strong tea. Drinking energy drinks after surgery is strictly prohibited by specialists.

The postoperative period after cardiac bypass surgery is quite important in treatment. That is why the patient must strictly adhere to the doctor’s recommendations and follow all the rules. Otherwise, negative consequences may develop.

Rehabilitation after coronary artery bypass surgery is necessary to quickly restore the patient’s physical and social activity and prevent complications.

Restorative measures include organizing proper nutrition, giving up bad habits, therapeutic exercises, psychological assistance, and drug therapy.

Rehabilitation of the patient is carried out both in the hospital and at home. In the postoperative period, sanatorium-resort treatment is practiced.

Rehabilitation objectives

The operation solves the problems created by coronary heart disease. However, the causes of the disease remain, the condition of the patient’s vessel walls and the level of atherogenic fats in the blood do not change. As a result of this state of affairs, there is a risk of a decrease in the lumen in other parts of the coronary arteries, which will lead to a return of old symptoms.

Rehabilitation is aimed at preventing negative scenarios and returning the operated patient to a full life.

More specific rehabilitation objectives:

1. Creating conditions to reduce the likelihood of complications.
2. Adaptation of the myocardium to changes in the nature of blood circulation.
3. Stimulation of restoration processes in damaged tissue areas.
4. Consolidation of the results of the operation.
5. Reducing the intensity of development of atherosclerosis, coronary heart disease, hypertension.
6. Adaptation of the patient to the external environment. Psychological help. Development of new social and everyday skills.
7. Restoring physical strength.

A rehabilitation program is considered successful if the patient managed to return to the lifestyle that healthy people lead.

Rehabilitation in the intensive care unit

After coronary artery bypass surgery, the patient is in the intensive care unit. Since the effect of anesthetics is prolonged, the patient still needs support for respiratory function for some time even after he comes to his senses. For this, the patient is connected to special equipment.

In the first days after surgery, it is important to prevent the consequences of the patient’s uncontrolled movements in order to prevent the sutures from coming apart or the catheters and drains attached to the body from being pulled out. The patient is fixed to the bed using special fastenings. In addition, electrodes are attached to the patient to monitor heart rate and rhythm.

On the first postoperative day, medical personnel perform the following actions with the patient:

1. Takes a blood test.
2. Conducts x-ray examination.
3. Performs an electrocardiogram.
4. Removes the breathing tube. The drains in the patient's chest and the gastric tube remain.

Note! It is extremely important at the first stage that the patient is warm. For this, the person is wrapped in a warm blanket. To avoid congestion in the legs, special underwear (stockings) is used.

On the first day, the patient is exclusively in a supine position. He is given antibiotics, painkillers and sedatives. There may be a slight increase in body temperature for several days. This reaction is normal and is a response to surgery. Another common postoperative symptom is profuse sweating.

Important! Prolonged stay of the patient in a supine position can lead not only to congestion in the legs, but also to pneumonia due to the accumulation of fluid in the lungs.

The level of physical activity is increased gradually, based on the health status of the individual patient. Initially, walking within the ward is allowed. Over time, physical loads increase, the patient begins to walk along the corridor.

Sutures from the lower limb are removed a week after surgery, and from the chest - right before discharge. The wound heals within 3 months.

Rehabilitation at home

The rehabilitation program is varied, but the main principle is gradualism. The return to active life occurs in stages so as not to cause harm to the body.

Drug therapy

In the postoperative period, patients take the following groups of drugs:

1. Antibiotics. After surgery, patients are at increased risk of infection: the most dangerous are skin and nasopharyngeal gram-positive strains, the activity of which leads to dangerous complications. Such complications include infection of the sternum or anterior mediastinitis. There is a risk of patient infection when receiving single-group blood transfusion. In the postoperative period, preference is given to antibiotics from the cephalosporin group, since they are the least toxic.
2. Antiplatelet agents. Designed to thin the blood and prevent the formation of blood clots. Patients with atherosclerosis and coronary heart disease are prescribed a lifelong course of antiplatelet agents.
3. Beta blockers. Drugs of this type reduce the load on the heart, normalize heart rate and blood pressure. Beta blockers are necessarily used for tachyarrhythmia, heart failure or arterial hypertension.
4. Statins. Used to reduce cholesterol levels in the patient's blood. Statins have an anti-inflammatory effect and a positive effect on the vascular endothelium. Therapy with statins can reduce the risk of developing coronary syndrome and the mortality rate by 30–40%.
5. Angiotensin-converting enzyme inhibitors (ACE inhibitors). Designed to treat heart failure and reduce blood pressure.

Note! The patient will have to take most of the drugs for a long time, and some drugs even throughout his life.

If necessary, diuretics, nitrates and other medications are used, depending on the patient’s condition and concomitant diseases.

Healthy eating

One of the foundations of successful rehabilitation is the organization of proper nutrition and diet. The patient needs to normalize weight and exclude from the menu foods that negatively affect the condition of blood vessels and other organs.

Products to avoid:

1. Most meat products (pork, lamb, any offal, duck, sausage, canned meat, semi-finished products, ready-made minced meat).
2. Some types of dairy products (fat sour cream, cheese and cottage cheese, cream).
3. Sauces, ketchups, adjikas, etc.
4. Fast food products, chips, snacks, etc.
5. Any fried foods.
6. Alcoholic drinks.

The patient should limit consumption of the following products:

1. Fats - both plant and animal origin. It is best to avoid animal oil altogether, replacing it with vegetable oil (preferably olive oil).
2. Carbonated and energy drinks, coffee, strong tea, cocoa.
3. Sweets, white bread and sweet products, puff pastry.
4. Salt. The restriction is the prohibition on adding salt when cooking. The daily salt intake is given to the patient and does not exceed 3–5 grams.

It is necessary to reduce the consumption of permitted meat products, fish and fats to a minimum. Preference should be given to red meat, poultry and turkey. It is recommended to consume lean meats.

The patient's diet should include as many fruits and vegetables as possible. It is advisable to choose dietary bread, the production of which does not use fats.

During the postoperative period, it is necessary to maintain the correct drinking regime. Water should be consumed moderately - 1 – 1.2 liters daily. The indicated volume does not include the water contained in the first courses.

The preferred methods of cooking are boiling in water, steaming, stewing, baking without oil.

The basic principle of nutrition is fractionalization. Food is taken in small portions. The number of meals is 5 – 6 times during the day. The menu is calculated based on 3 main meals and 2 - 3 snacks. Once a week the patient is recommended to have a fasting day.

Physical exercise

Physical rehabilitation is a set of exercises designed to adapt the patient's cardiovascular system to normal physical activity.

Physical recovery is carried out in parallel with psychological rehabilitation, since patients in the postoperative period have a fear of physical activity. Classes include both group and individual gymnastic training, walking, and swimming in the pool.

Physical activity should be given in doses, with a gradual increase in the effort expended. Already on the first day after surgery, the patient sits on the bed. On the second day you need to get out of bed, and on the third or fourth day it is recommended to walk along the corridor accompanied by medical staff. The patient performs breathing exercises (in particular, inflating balloons).

Early rehabilitation is necessary to prevent congestion and associated complications. Gradually the load is increased. The list of exercises includes walking in the fresh air, climbing stairs, riding an exercise bike, running on a treadmill and swimming.

The basic exercise is walking. This exercise allows you to dose the load by changing the duration and pace of training. Gradually the distances increase. It is important not to overdo it and monitor your general physical condition: if your pulse exceeds 100–110 beats, you should temporarily stop exercising.

Breathing training becomes more difficult. Exercises for training diaphragmatic breathing appear, the patient practices with a spirometer and exhales with resistance.

Physiotherapy is added to physical activity. The patient attends inhalation and massage procedures, takes medicinal baths.

Important! It is necessary to avoid sports where there is stress on the chest or the risk of injury to this part of the body. Undesirable sports include: basketball, football, tennis, weightlifting, exercises on gymnastic apparatus.

Psychosocial recovery

The postoperative condition is often accompanied by anxiety and depression. Caring for an anxious patient requires special efforts from medical staff and loved ones. A person's mood is subject to frequent changes.

Even if the operation went without problems, and rehabilitation progresses successfully, patients are prone to depression. The news of someone's death or the awareness of one's own inferiority (physical, sexual) puts a person in a depressed state.

For rehabilitation purposes, a three-month course of psychological assistance is conducted. The task of specialists is to reduce the patient’s depression, reduce his feelings of anxiety, hostility, and somatization (psychological “flight into illness”). The patient must socialize, feel an improvement in mood and an increase in the quality of his life.

Spa treatment

The best results in rehabilitation after surgery are achieved when treated in sanatoriums with cardiological specialization.

The advantage of spa treatment is the “single window” principle, when all services are provided in one place. The patient’s condition is monitored by specialists, providing all processes - from therapeutic exercises and physiotherapeutic procedures to monitoring the diet and psychological assistance.

Staying in a sanatorium encourages you to give up smoking, alcohol, and unhealthy diet. The patient adjusts to a new way of life, learning useful life skills.

Rehabilitation in sanatoriums lasts 1–2 months. It is recommended to visit sanatoriums on an annual basis.

The influence of smoking on rehabilitation

The contents of a cigarette have a complex effect on the body:

• blood clotting increases, which entails the risk of thrombosis;
• spasms of the coronary vessels occur;
• the ability of red blood cells to transport oxygen to tissues decreases;
• the conduction of electrical impulses in the heart muscle is disrupted, resulting in arrhythmia.

Even a small amount of cigarettes smoked has a detrimental effect on the health of a patient who has undergone coronary artery bypass surgery.

Successful rehabilitation and smoking are incompatible - a complete cessation of nicotine is necessary.

Traveling after coronary artery bypass surgery

The patient is prohibited from driving a car for a month after bypass surgery. The main reason for this, besides general weakness after surgery, is the need to prevent any risk of injury to the sternum. Even after 4 weeks, you can drive only if your health has consistently improved.

Any long-distance travel during rehabilitation, especially when it comes to air travel, must be coordinated with your doctor. The first long-distance trips are allowed no earlier than 8 to 12 weeks after bypass surgery.

Particular caution should be exercised when traveling to regions with dramatically different climates. During the first months, changing time zones and visiting high mountain areas is not recommended.

Note! Before going on a trip or business trip, it is advisable to be examined by a cardiologist.

Intimate life after bypass surgery

There are no direct contraindications to having sex during rehabilitation if the patient’s general health condition allows it.

However, for the first 1.5 - 2 weeks, intimate contact should be avoided or, at a minimum, intense exercise should be avoided, and positions should be chosen based on the rule - no compression of the chest.

After 10–12 weeks, the restrictions cease to apply, and the patient becomes free to realize his intimate desires.

Work after bypass surgery

In the first months after surgery, the patient's work capacity is limited.

Until the stitches on the chest heal (and this process takes 4 months), it is not allowed to lift loads that weigh more than 5 kilograms. Any jerk-type loads, sudden movements, or work involving bending and spreading the arms to the sides are contraindicated.

Throughout their lives, patients who have undergone coronary artery bypass surgery are prohibited from work associated with high physical exertion. Activities that require, albeit minor, regular physical activity are prohibited.

Disability and group design

To register a disability group, the patient must obtain the results of a medical examination from a cardiologist at his place of residence.

Based on the analysis of documents received from the patient and examination, the medical commission makes a conclusion about granting a disability group. Typically, patients are granted temporary disability for a year. Upon expiration of the period, the disability is extended or removed.

The first disability group is reserved for patients who are unable to cope without assistance due to regular attacks of angina or severe heart failure.

The second group is assigned for ischemic disease with constantly occurring attacks, with insufficient heart function of class 1 or 2. The second and third groups may allow going to work, but they regulate the permissible loads. The third group is prescribed if the heart damage is moderate and does not interfere with normal work activity.

Returning to a full life after coronary artery bypass surgery is certainly possible. However, this requires a lot of effort, following all the recommendations of doctors during the rehabilitation period.

The end result - a full healthy life - depends, first of all, on the patient himself, his perseverance and positive attitude.

Already for a long time The leading cause of mortality is occupied by cardiovascular diseases. Poor nutrition, sedentary lifestyle, bad habits - all this negatively affects the health of the heart and blood vessels. Cases of strokes and heart attacks have become not uncommon among young people; elevated cholesterol levels, and therefore atherosclerotic vascular damage, are found in almost every second person. In this regard, cardiac surgeons have a lot of work.

Perhaps the most common is coronary artery bypass surgery. Its essence is to restore blood supply to the heart muscle by bypassing the affected vessels, and the saphenous vein of the thigh or the arteries of the chest wall and shoulder are used for this purpose. Such an operation can significantly improve the patient’s well-being and significantly prolong his life.

Any operation, especially on the heart, has certain difficulties, both in the technique of execution and in the prevention and treatment of complications, and coronary artery bypass grafting is no exception. The operation, although it has been carried out for a long time and on a large scale, is quite difficult and complications after it, unfortunately, are not such a rare occurrence.

The highest percentage of complications occurs in elderly patients with multiple concomitant pathologies. They can be divided into early ones, which arose during the perioperative period (immediately during or within a few days after surgery) and late ones, which appeared during the rehabilitation period. Postoperative complications can be divided into two categories: from the heart and blood vessels and from the surgical wound.

Complications of the heart and blood vessels

Myocardial infarction in the perioperative period - a serious complication, which often causes death. Women are more often affected. This is due to the fact that representatives of the fair sex come to the surgeon’s table with cardiac pathology approximately 10 years later than men, due to hormonal characteristics, and the age factor plays an important role here.

Stroke occurs due to microthrombosis of blood vessels during surgery.

Atrial fibrillation is a fairly common complication. This is a condition when the full contraction of the ventricles is replaced by their frequent fluttering movements, as a result of which hemodynamics are sharply disrupted, which increases the risk of thrombosis. To prevent this condition, patients are prescribed b-blockers, both in the preoperative and postoperative periods.

Pericarditis- inflammation of the serous membrane of the heart. Occurs due to the addition of a secondary infection, more often in elderly, weakened patients.

Bleeding due to a blood clotting disorder. From 2-5% of patients who have undergone coronary artery bypass surgery undergo re-operation due to bleeding.

Read about the consequences of cardiac bypass surgery of a specific and nonspecific nature in the corresponding publication.

Complications from the postoperative suture

Mediastinitis and suture failure occur for the same reason as pericarditis, in approximately 1% of those operated on. More often, such complications occur in people suffering from diabetes.

Other complications are: suppuration of the surgical suture, incomplete fusion of the sternum, formation of a keloid scar .

Mention should also be made of complications of a neurological nature, such as encephalopathy, ophthalmological disorders, damage to the peripheral nervous system etc.

Despite all these risks, the number of lives saved and grateful patients suffered disproportionately from complications.

Prevention

It must be remembered that coronary artery bypass surgery does not get rid of the main problem, does not cure atherosclerosis, but only gives a second chance to think about your lifestyle, draw the right conclusions and start a new life after bypass surgery.

Continuing to smoke, eat fast food and other harmful products, you will very quickly damage the implants and waste the chance given to you. Read more about diet after heart bypass surgery.

After discharge from the hospital, the doctor will definitely give you a long list of recommendations, do not neglect them, follow all the doctor’s instructions and enjoy the gift of life!

After CABG surgery: complications and possible consequences

After bypass the condition of most patients improves within the first month, allowing them to return to normal life. But any operation, including coronary artery bypass surgery. can lead to certain complications, especially in a weakened body. The most serious complication can be considered the occurrence of heart attacks after surgery (in 5-7% of patients) and the associated likelihood of death; in some patients, bleeding may occur, which will require additional diagnostic surgery. The likelihood of complications and death is increased in elderly patients, patients with chronic lung diseases, diabetes, kidney failure and weak contraction of the heart muscle.

The nature of complications and their likelihood are different for men and women of different ages. Women are characterized by the development of coronary heart disease at a later age than men, due to a different hormonal background, respectively, and according to statistics, CABG surgery is performed in patients 7-10 years older than in men. But at the same time, the risk of complications increases precisely due to advanced age. In cases where patients have bad habits (smoking), when the lipid spectrum is disturbed or there is diabetes, the likelihood of developing coronary artery disease at a young age and the likelihood of undergoing heart bypass surgery increases. In these cases, concomitant diseases can also lead to postoperative complications.

Complications after CABG

The main goal of CABG surgery is to qualitatively change the patient’s life, improve his condition, and reduce the risks of complications. For this purpose, the postoperative period is divided into stages of intensive care in the first days after CABG surgery (up to 5 days) and the subsequent rehabilitation stage (the first weeks after surgery, until the patient is discharged).

The state of shunts and the native coronary bed at various times after coronary artery bypass surgery

Section contains:

• Condition of mammary coronary shunts at various times after surgery
• Changes in autovenous shunts at various times after surgery
• The influence of shunt patency on the state of the native coronary bed

Condition of mammary coronary bypass grafts at various times after coronary artery bypass surgery

Thus, as the analysis of the studies shows, the use of stenting in the endovascular treatment of multivascular lesions can reduce the incidence of acute complications in the hospital period. In contrast to balloon angioplasty, multivessel stenting, according to published randomized trials, is not associated with a higher incidence of in-hospital complications compared to coronary artery bypass graft surgery.

However, in the long term after treatment, relapse of angina, according to the results of most studies, is more often observed after endovascular implantation of stents than after bypass surgery. In the largest BARI study, angina recurrence in the long-term period after angioplasty was 54%; the use of stents in the Dynamic Registry (continuation of the study) reduced the rate of angina recurrence to 21%. However, this indicator was still significantly different from the operated patients - 8% (p< 0.001).

The paucity of information accumulated to date on the results of stenting of multivascular lesions determines the relevance of studying this problem. To date, two large studies have been published in the foreign literature on the comparative effectiveness of stenting and coronary bypass surgery in patients with multivessel disease. The disadvantages of the work carried out include the lack of a comparative analysis of the dynamics of tolerance to physical activity after treatment, and the need for taking antianginal drugs at different times after the intervention. To date, there are no studies in the domestic literature on the comparative effectiveness of endovascular and surgical methods of treating multivascular lesions. In our opinion, in addition to studying the clinical results of endovascular and surgical interventions, an urgent problem is to study the cost-effectiveness of treatment: analysis of the comparative cost of both methods and the length of the patient’s hospital stay.

The state of shunts and the native coronary bed at various times after coronary artery bypass surgery.

Condition of mammary coronary bypass grafts at various times after coronary artery bypass surgery

Today, the problem of optimal selection of autotransplants remains relevant in cardiovascular surgery. The limited viability of shunts can lead to the resumption of the clinical picture of coronary heart disease in operated patients. Secondary intervention, whether repeat coronary artery bypass surgery or endovascular angioplasty, generally carries an increased risk compared with the primary revascularization procedure. Therefore, determining preoperative risk factors for damage to coronary artery bypass grafts remains an important practical task. In turn, the formation of artificial coronary anastomoses leads to significant changes in hemodynamics in the coronary bed. The influence of working shunts on the state of the native bed, the frequency of appearance of new atherosclerotic lesions has not been fully studied, and many specialists in the field of cardiac surgery are dealing with this problem.

Large studies have demonstrated significantly better viability of arterial autografts both in the immediate and long term after surgery compared to venous autografts. According to E. D. Loop et al. 3 years after surgery, the rate of occlusion of mammary shunts is about 0.6%; after 1 year and 10 years, 95% of shunts remain patent. According to some randomized studies, the use of the internal mammary artery improves the long-term prognosis of operated patients compared with autovenous bypass. Such results may be due to both the high resistance of the internal mammary artery to the development of atherosclerotic changes, and the fact that this artery is primarily used for bypassing the anterior descending coronary artery, which itself largely determines the prognosis.

The resistance of the internal mammary artery to the development of atherosclerosis is due to both its anatomical and functional features. The IAV is a muscular artery with a serrated membrane that prevents the growth of smooth muscle cells from the media into the intima. This structure largely determines the resistance to intimal thickening and the appearance of atherosclerotic lesions. In addition, the tissues of the internal mammary artery produce a large number of prostacyclin, which plays a certain role in its atrombogenicity. Histological and functional studies have shown that the intima and media are supplied with blood from the lumen of the artery, which preserves the normal trophism of the vessel wall when used as a shunt.

Changes in autovenous shunts at different times after coronary artery bypass surgery

The effectiveness of the internal mammary artery has been established both in patients with normal myocardial contractility and in patients with poor left ventricular function. When analyzing the life expectancy of patients after operations, E. D. Loop et al. demonstrated that patients who used only autologous veins for coronary reconstructions had a 1.6 times greater risk of dying over a 10-year period compared with the group of patients using a mammary artery.

Despite the proven effectiveness of the use of the internal mammary artery in coronary surgery, a significant number of opponents of this technique still remain. Some authors do not recommend using an artery in the following cases: the vessel is less than 2 mm in diameter, the caliber of the shunt is less than the caliber of the recipient vessel. However, a number of studies have proven the good ability of the internal mammary artery to physiological adaptation in various hemodynamic conditions: in the long-term period, an increase in the diameter of mammary shunts and blood flow through them was observed with an increase in the need for blood supply in the area of ​​the shunted vessel.

Changes in autovenous shunts at different times after coronary artery bypass surgery

Venous autografts are less resistant to the development of pathological changes in arterial circulation compared to the internal mammary artery. According to various studies, the patency of autovenous shunts from v. saphena one year after surgery is 80%. Within 2-3 years after surgery, the frequency of occlusions of autovenous shunts stabilizes at 16-2.2% per year, however, then it increases again to 4% per year. By 10 years after surgery, only 45% of autovenous shunts remain patent, and more than half of them have hemodynamically significant stenoses.

Most studies examining the patency of venous shunts after surgery indicate that if the shunt is damaged in the first year after surgery, thrombotic occlusion occurs. And since in the first year after surgery the largest number of autovenous shunts are affected, this mechanism can be considered the leading one among the reasons leading to the failure of coronary bypass grafts of this type.

The reasons for the high incidence of thrombosis, according to R. T. Lee et al. , lie in the specific structure of the venous wall. Its lower elasticity compared to the arterial one does not allow it to adapt to conditions of high blood pressure and ensure the optimal speed of blood flow through the shunt, which creates a tendency to slow blood flow and increased thrombus formation. Many research works have been devoted to studying the causes of the high incidence of thrombosis in the first year after surgery. As evidenced by major research on this topic, the main reason for early failure of vein grafts is the inability in many cases to maintain optimal blood flow through the graft. This feature is due to insufficient adaptation mechanisms when placing a venous vessel in the arterial bed. As is known, the venous circulatory system functions under conditions of low pressure and the main force providing blood flow through the veins is the work of skeletal muscles and the pumping function of the heart. The middle layer of the venous wall, representing the smooth muscle layer, is poorly developed compared to the arterial wall, which, under conditions of arterial blood supply, plays an important role in regulating blood pressure by changing vascular tone and, thereby, peripheral resistance. A venous vessel placed in the arterial bed experiences increased load, which, under conditions of high pressure and lack of regulatory mechanisms, can lead to impaired tone, pathological expansion and, ultimately, a slowdown in blood flow and thrombosis.

In the case of thrombotic occlusion, the entire shunt is usually filled with thrombotic masses. This type of lesion represents an unpromising area for endovascular treatment. Firstly, the probability of recanalization of an extended occlusion is negligible, and secondly, even with successful recanalization, a large volume of thrombotic masses poses a threat to distal embolization when performing balloon angioplasty.

Factors influencing the condition of shunts after coronary artery bypass surgery.

Due to the current lack of effective therapeutic measures to eliminate occlusion of venous shunts in the first year after surgery, measures to avoid or reduce the risk of thrombosis of this type of shunt after coronary artery bypass grafting are of greatest importance. As the time after surgery increases, the so-called “arterialization” of the venous shunt and hyperplasia of its intima occurs. The shunt acquires the adaptation mechanisms necessary for proper blood flow, however, as long-term observations show, it becomes susceptible to atherosclerotic damage to no less extent than the native arterial bed. According to autopsy data, typical atherosclerotic changes of varying severity are observed after 3 years in 73% of autovenous shunts.

Factors influencing the condition of shunts after coronary artery bypass surgery.

Various studies devoted to the prevention of pathological changes in autovenous shunts after CABG indicate that the influence of various factors on the incidence of shunt damage varies at different times after surgery. Most of the studies have been devoted to the study of clinical risk factors for closure of autovenous shunts. Studies conducted to determine clinical predictors of shunt occlusions in the immediate postoperative period did not reveal clinical factors (diabetes mellitus, smoking, hypertension) that negatively affect the frequency of occlusions in the early postoperative period. At the same time, in the long term after surgery, clinical factors that contribute to the progression of atherosclerosis in the native course also accelerate the development of pathological changes in autovenous shunts. A study conducted in the Department of Cardiovascular Surgery examined the relationship between blood cholesterol levels and the number of occlusions of vein grafts at different times after surgery. When analyzing shuntography data, there was no correlation between high cholesterol levels and a higher incidence of shunt lesions in the first year after coronary artery bypass grafting. At the same time, in the long term, when a morphological restructuring of the venous bed occurred, a significantly higher incidence of shunt lesions was observed in patients with hypercholesterolemia. Prescribing lipid-lowering therapy with statins to patients in this study did not change the number of shunt occlusions in the immediate period, but led to a significant decrease in lesions in the long term.

During the first year after surgery, an extremely important role is played by factors that influence the speed of blood flow through the shunt (the condition of the distal bed, the quality of the anastomosis with the coronary artery, the diameter of the bypassed artery). These factors significantly influence the quality of outflow and, thus, determine the speed of blood flow through the shunt. In this regard, the work of Koyama J et al is interesting, where the degree of influence of a defect in the distal anastomosis on the speed of blood flow in mammary and venous shunts is assessed. It was revealed that the pathology of the distal anastomosis of the mammary shunt practically does not change the speed characteristics of blood flow compared to a shunt without an anastomotic defect. At the same time, a defect in the distal anastomosis of an autovenous shunt significantly slows down blood flow, which is explained by the unsatisfactory ability of the venous wall to change tone in the presence of increased resistance, which in this case is caused by the pathology of the anastomosis.

Most authors identify the diameter of the shunted vessel as the most important of all the local factors influencing the patency of shunts in the first year after surgery. A number of studies have shown a significant decrease in the percentage of shunt patency in the early and late postoperative periods with autovenous bypass of arteries less than 1.5 mm. The degree of coronary artery stenosis is also considered an important issue in the indications for surgical treatment. There is disagreement in the literature regarding the need for bypass surgery for “borderline” stenoses of 50-75%. A number of studies have noted low patency of shunts during interventions on such lesions (17% according to Wertheimer et al.). The concept of competitive blood flow is most often put forward as the reason for unsatisfactory results: the shunted bed distal to the anastomosis is supplied with blood from two sources and, with good filling in the native bed, conditions are created for a reduction in blood flow through the shunt with subsequent thrombosis. Other studies using a significant amount of material have shown that there are no differences in the patency of shunts to vessels with critical and non-critical stenoses. There are also reports in the literature about the dependence of the condition of shunts on the vascular area in which revascularization is performed. Thus, in the work of Crosby et al. indicate worse patency of shunts to the circumflex artery compared to other arteries.

Factors influencing the condition of shunts after coronary artery bypass surgery

Thus, there remains disagreement among researchers regarding the influence of various morphological characteristics on the condition of shunts. From a practical point of view, it is interesting to study the influence of morphological factors on the condition of shunts both in the immediate and long-term period, when morphological restructuring of the shunts occurs and adaptation to hemodynamic conditions is completed.

The influence of shunt patency on the state of the native coronary bed.

Literary information regarding the impact of working shunts on the dynamics of atherosclerosis in the shunt bed is scarce and contradictory. Among researchers studying the condition of coronary artery bypass grafts, there is no consensus on how functioning shunts influence the course of atherosclerosis in the native coronary bed. There are reports in the literature about the negative impact of functioning shunts on the course of atherosclerosis in segments proximal to the anastomosis. Thus, in the work of Carrel T. et al. It has been shown that in stenotic segments of the coronary arteries, bypassing which the myocardium is supplied with blood, rapid progression of atherosclerotic changes occurs with the development of occlusion of their lumen. An explanation for this is found in the high competitive blood flow through coronary artery bypass grafts, which leads to a reduction in blood flow through stenotic arteries, thrombus formation in the area of ​​atherosclerotic plaques and complete closure of the lumen of blood vessels. In other works devoted to this problem, this point of view is not confirmed and there is no report of provoking the aggressive course of atherosclerosis in bypassed arteries. . The above-mentioned studies address the problem of progression of atherosclerosis in segments that have hemodynamically significant lesions before surgery. At the same time, the question of whether functioning shunts can provoke the development of new atherosclerotic plaques in unaffected segments remains open. In modern literature, there are no reports on studying the effect of functioning shunts on the appearance of new atherosclerotic lesions that were absent before coronary artery bypass surgery.

To summarize the above, it should be noted that determining the anatomical features of the coronary bed that affect the prognosis of shunt performance is as important as studying the clinical risk factors for shunt occlusion. In our opinion, the study of the following issues remains relevant today: determination of the morphological characteristics of coronary artery lesions that affect the condition of shunts in the immediate and long-term periods after coronary bypass surgery; determining the effect of shunt patency on the severity of coronary atherosclerosis in the segments affected before surgery; study of the effect of shunt patency on the incidence of new atherosclerotic changes in the immediate and long-term periods. Analysis of these issues, in our opinion, would help predict the course of coronary artery disease in operated patients and differentiate the treatment of patients with different morphological characteristics.

Coronary heart disease (CHD)

The World Health Organization defines “IHD is an acute or chronic dysfunction of the heart resulting from a relative or absolute decrease in the supply of arterial blood to the myocardium.” Blood for the work of the heart muscles flows through special vessels - the coronary arteries. Almost always, the anatomical basis of coronary heart disease is a narrowing of the coronary arteries of the heart. With atherosclerosis, these arteries become covered from the inside with a growing area of ​​fatty deposits, which gradually harden and form an obstruction to blood flow, as a result of which less and less oxygen reaches the heart muscles.
This decrease in blood flow in a sick person is manifested by the appearance of pain (angina pectoris), first during physical exertion, then as the disease progresses, the level of stress becomes less and less intense and attacks of pain become more frequent. Angina then occurs at rest.
Chest pain - angina pectoris (angina pectoris) - is accompanied by a feeling of discomfort and can radiate to the left shoulder, arm or both arms, neck, jaw, teeth. At this moment, patients feel difficulty breathing, fear, and stop moving until the attack stops. Often the pain becomes atypical with a feeling of pressure and vague discomfort in the chest.
One of the most dangerous outcomes of this disease is the occurrence of a heart attack, as a result of which part of the heart muscle dies. This condition is called myocardial infarction.

Coronary artery bypass surgery (coronary artery bypass grafting)

Bypass surgery is an operation in which a section of a vein (usually the saphenous vein of the leg) is taken and sutured to the aorta. The second end of this segment of the vein is sutured to a branch of the coronary artery below the level of the narrowing. This creates a path for blood to bypass the diseased or blocked section of the coronary artery, and the amount of blood that flows into the heart increases. For the same purpose, the internal mammary artery and/or the artery from the forearm can be taken for bypass surgery. The use of arterial or vein grafts depends entirely on individual clinical cases. Recently, the technique of using arteries instead of veins for shunts has been quite often used. Arterial shunts, as a rule, last longer than venous ones. This ensures more complete functioning of the shunt (its functionality and durability). One of these arteries is the radial artery of the hand; it is located on the inner surface of the forearm closer to the thumb. If you are offered to use this artery, your doctor will conduct additional studies to rule out any complications associated with the removal of this artery. Therefore, one of the incisions may be located on the arm, usually on the left.

Coronary bypass surgery. Doctor's advice.
Purpose of coronary bypass surgery

The goal of bypass surgery is to improve blood flow to the heart muscle. The surgeon eliminates the main cause of angina and creates a new bloodstream that provides the heart muscle with a complete blood supply, despite the damaged coronary vessel.
This entails:
- reduction in the frequency or complete disappearance of angina attacks.
- significant reduction in the risk of myocardial infarction.
- reduction in mortality
- increase in life expectancy.
In this regard, the quality of life significantly improves - the volume of safe physical activity increases, working capacity is restored, and the life of healthy people becomes accessible.

Coronary bypass surgery. Doctor's advice.
Hospitalization

Before surgery, some of the necessary tests can be performed on an outpatient basis, while others cannot. Usually the patient is hospitalized 2-5 days before surgery. In the hospital, not only the examination takes place, but also preparation for the operation begins, the patient masters the techniques of special deep breathing and coughing - this will be useful after the operation. The patient gets to know his operating surgeon, the surgeon, as well as the cardiologist and anesthesiologist who will care for him during and after the operation.

Excitement and fear

These are normal reactions of a person undergoing any operation. You should definitely talk to doctors, ask all questions and complain about excessive anxiety.

On the eve of the operation

On this day, the patient will usually meet with the surgeon again to discuss the details of the upcoming operation. In addition, the patient is also examined by an anesthesiologist, with whom issues of anesthesia can be discussed. In the evening and morning, the nurse will perform preparatory procedures, including a cleansing enema.

Day of surgery

Usually in the morning the patient gives the nurse glasses, removable dentures, contact lenses, watches, and jewelry for temporary storage. About an hour before surgery, a medicine is given that makes you drowsy. Then the patient is taken to the operating room, where everything is ready for the operation. Several injections are made in the arm to connect the IV, and sensors of the monitoring system are applied. Then the patient falls asleep.

Operation

The operation usually lasts from 3 to 6 hours. It is natural that the more arteries that need to be bypassed, the longer the operation will take. But the final duration of the operation depends on the specific complexity, i.e. depending on the patient's characteristics. Therefore, it is very difficult to say in advance exactly how long this or that operation will last.

The first hours after surgery

As soon as the operation is completed, the patient is transported to the intensive care unit. When the patient wakes up, the effect of some anesthesia drugs continues; in particular, the patient cannot yet breathe adequately on his own and a special apparatus helps him breathe. He “inhales” a mixture of oxygen and air into a person through a special tube that stands in the mouth. Therefore, you need to breathe through your mouth, but you cannot talk at this time. The nurse will show you how to approach others. Usually, during the first 24 hours, there is no need for breathing support and the tube is removed from the mouth.
For safety reasons, until the patient finally wakes up, his hands are fixed, since uncontrolled movements can lead to disconnection of IVs, pulling out of the catheter, development of bleeding and even damage to the sutures in the postoperative wound. In addition, wires and tubes are attached to various parts of the body to help you recover quickly and easily from surgery. Small tubes called catheters are inserted into blood vessels in the arms, neck or thigh. Catheters are used for intravenous administration of medications, fluids, drawing blood for analysis, and continuous monitoring of blood pressure. Several tubes are inserted into the chest cavity to help suck out fluid that accumulates there after surgery. The electrodes allow the healthcare team to continually monitor the rhythm and rate of your heart.

Temperature increase

After surgery, the temperature rises in all patients - this is a completely normal reaction. Sometimes, due to an increase in temperature, profuse sweating is observed. The temperature may persist for several days after surgery.

Speed ​​up your recovery

In the first hours after surgery, strict adherence to the recommendations is required:
- the nurse on duty must be immediately notified of any changes in health for the worse.
- independently or with the help of caregivers, the patient must maintain clear control of the fluid consumed and excreted, making notes that the attending physician will ask.
- some efforts are needed to restore normal breathing and prevent postoperative pneumonia.
For this purpose, breathing exercises are done and an inflatable toy is used, usually a beach or children's inflatable ball. In addition, to stimulate coughing, massaging movements are made over the surface of the lungs with light tapping on the chest. This simple technique creates internal vibration, which enhances the secretion of secretions in the lungs and makes coughing easier. You should not be afraid to cough after surgery; on the contrary, coughing is very important for rehabilitation after surgery. Some patients find it easier to cough if they press the palms of their hands or a ball to their chest. In addition, to speed up the healing process, it is important to change your body position in bed more often. The surgeon will explain when you can turn over and lie on your side. For more successful healing of the surgical wound, a chest corset is recommended.

Physical activity

Immediately after surgery, all patients require care. In each specific case, the level of recommended activity will be individual. At first, the patient will only be allowed to sit on a chair or walk around the room. Later, it is recommended to leave the room for a short time, and as the day of discharge approaches, take the stairs or take a long walk along the corridor.

Position in bed

It is better to lie on your side at least part of the time and be sure to turn over every few hours. Lying motionless on your back can cause fluid to accumulate in your lungs.

Often, in the first time after surgery, unpleasant sensations occur, but there will be no severe pain; they are avoided with the help of modern painkillers. Unpleasant sensations are caused by the incision and muscle pain. Typically, a comfortable position and persistent self-activation reduce the intensity of pain. If the pain becomes severe, then you must inform your doctor or nurse about this and adequate pain relief will be provided.

Wound healing

The incision to access the heart is made vertically in the middle of the chest. The second incision or incisions are usually made on the legs. There, the surgeon takes a section of vein that is used for a shunt. If multiple bypasses are done, there will be multiple incisions in the leg (or legs). When harvesting the artery, an incision is made in the forearm.

Shortly after surgery, the bandage will be removed from the chest incision. Air promotes drying and healing of the postoperative wound. During the first days, the sutures are washed with antiseptic solutions and dressings are performed. The sutures are removed approximately on the 8-9th day. On the 10-14th day, the postoperative wound has healed so much that it can be washed with soap and water. Often at night or when standing, swelling appears in the legs and a burning sensation in the place where the veins were taken. Gradually, with the restoration of blood circulation in the legs, this will disappear. Wearing elastic support stockings or bandages is usually suggested to improve circulation in the legs and reduce swelling. Complete fusion of the sternum will occur only after a few months, so until this time there may be unpleasant sensations in the chest, in the postoperative area.

Extract

Typically, after bypass surgery, patients spend 14-16 days in the clinic. It is clear that the length of stay for each person may be individual. An improvement in your general condition and a surge of strength will be observed every day. Some patients feel confused when discharged; they are afraid to leave the hospital, where they felt safe under the supervision of experienced doctors. You need to know that the doctor will not discharge any patient from the clinic until he is sure that the condition has stabilized and that further recovery should take place at home. Typically, patients are taken home by their relatives. If you plan to travel by bus, train or plane, you should tell your doctor about it, who will give you full recommendations.

It is very important to reduce the amount of salt, sugar and fat you consume. If you do not make significant changes to your usual diet and lifestyle, the risk of the disease returning will remain very high - the same problems will again appear with the new transplanted vein grafts that previously existed with your own coronary arteries. That is, the operation will not bring the expected effect. Don't let this happen again. In addition to strictly following the diet, monitor your weight. Moderation and common sense are the best guides when choosing food and drink.

You should never smoke. The risk of recurrence of coronary disease for an operated patient increases enormously when smoking. If the patient smoked before bypass surgery, then after the operation he has only one option left - quit smoking forever!

Medicines

You should only take medications that are prescribed by your doctor. If the patient is taking any medications for other diseases, you should definitely tell the doctor about this while still in the clinic. You should not use medications that are sold without a prescription without the consent of your doctor.

After discharge

It is normal for everyone to feel weak after discharge. This is not a consequence of the surgical intervention itself, it is the weakening of especially large muscles that have become unaccustomed to work. It is not surprising that a person who has been in the hospital for two weeks or more will quickly become tired and weak when he returns home and tries to resume normal duties. The best way to restore muscle strength is exercise. After surgery, short walks are especially effective. The main criterion for dosing loads is the pulse rate; it should not exceed 110 beats per minute during loads. If this value is above 110 beats per minute, you need to sit down and give the body a break. Patients themselves usually notice that the pace and distance of comfortable walking increases.
Sometimes patients complain of a depressed mood after returning home, and sometimes it seems that recovery is going too slowly. If such experiences become permanent, you should contact your doctor, who will professionally help relieve this condition by prescribing the necessary treatment.

Important practical issues of life after discharge of a patient who has undergone coronary artery bypass surgery are discussed here Coronary artery bypass grafting. Life after coronary bypass surgery.

When is it necessary to see a doctor?

Contact your doctor if there is redness of the surgical scar, discharge from it, fever, chills, increased fatigue, shortness of breath, swelling, rapid weight gain, spontaneous changes in heart rate, or any other signs that seem unusual.

When to visit a doctor if nothing bothers you

How often you should visit your doctor after surgery depends on your recommendations. Typically, patients are given a date for follow-up consultation upon discharge. After discharge, you should also visit a local cardiologist (general practitioner) at your place of residence.

Job

Patients who performed sedentary work can resume it on average 6 weeks after discharge. Those who do hard physical work have to wait longer. The need for advice and documents from attending physicians is obvious to any person here.

Schedule

After the operation, the patient should think of himself as a healthy person, gradually gaining strength.
It should be remembered that the serious illness is behind us. It is necessary to be active from the first days of discharge, but alternate periods of activity with rest. Walking is especially useful; it speeds up recovery. In addition to walking, you should do housework, go to the movies, shops, and visit friends. In some cases, your doctor may prescribe a more strict gradual progression schedule. Following this program, a few weeks after the operation you can walk 2-3 km. in a day. In very cold or very hot weather, you can walk the same distance at home.

Sex life

You can resume sexual activity whenever you want. You just need to remember that complete fusion of the sternum will be achieved in about 3 months, so positions that minimize the load on the sternum are preferable.

Automobile

You can drive a car as soon as your physical condition allows you to do so. This usually occurs 6 weeks after discharge. However, it is better to limit the time of continuous driving by two hours. After this, you should stop and walk for a few minutes. If driving a car is unavoidable, you should discuss this with your doctor, since in the process of driving a car, not only emotional, but also physical stress arises (for example, certain stresses when turning the steering wheel).

Lifestyle

Typically, coronary artery bypass surgery allows you to return to a healthy lifestyle. This is precisely one of the goals of the operation - returning to work or, if the person is already retired - returning to his usual activities and a full life.
It should be remembered that quitting smoking is mandatory. It is also necessary to maintain normal blood pressure (your doctor will help you with this). Be sure to limit salt, sugar, fats and control weight. All this will help you maintain your health for a long time and avoid new problems.

Often after surgery, patients treat lifestyle changes not as a strict rule, but as something optional. This is wrong! Eating a normal diet, recommended physical activity, normal blood pressure and the absence of nicotine can prevent the return of coronary heart disease. Without this, bypass surgery may be useless!