At the hospital:

In order to perform the surgical procedure the surgeon has to cut through the breastbone (sternum) to get access to your heart. After surgery the sternum will be held together by steel wires so it can heal properly. The breastbone is like any other broken bone, however it cannot be put into a cast like other bones in your arms or legs. This is why a purpose-designed external chest support is an important additional tool to support your healing breastbone.

You have to be very mindful about your physical activity during the first six to eight weeks of your recovery. This is why we strongly advise you to learn how to look after your breastbone BEFORE surgery. We will cover this in this topic below.

The following activities may vary somewhat from hospital to hospital and will depend on each individual patient's condition.

First day after surgery:
You will be asked to sit up on the side of the bed. You will also be asked to cough and do deep breathing exercises frequently to prevent lung infections. Wearing a comfortable chest support such as QualiBreath or QualiBra Advanced during these activities will make this easier for you.

The second and the following days after surgery:
You will be asked to eat your meals out of bed sitting in a chair and you will also be asked to get out of bed several times per day. You will be encouraged to walk a short distance in the hallway.

Each walk should gradually increase step by step. Walking is your most important activity in the first days after surgery and it helps to prevent complications such as pneumonia (infection in the lungs) and constipation.

The number of days you will be in the hospital after open heart surgery will depend on how well you progress with activities and whether you have any complications such as wound or lung infections. It will also depend on whether you have had bowel movements. Walking is an effective way to stimulate bowel movement. Remember that a chest support such as QualiBreath or QualiBra Advanced has integrated handles/pockets to grasp for protection of your breastbone if you are straining during visits to the toilet.

Typically you would spend between three to five days in the hospital after having been moved from the ICU/CICU. However, no two patients are alike and how they recover and the time it takes will differ, so do not worry if you feel you progress with a slower rate than other patients.

Going home:

Surgeons use different techniques and have different requirements after surgery. Your surgeon and healthcare team will evaluate how well your are recovering and decide when it’s time to go home. Before leaving the hospital, you will be scheduled for follow-up appointments with your cardiologist. If your cardiologist is not at the hospital where you had surgery you will receive a report about your surgery and hospital stay to bring along for him/her.

What typical follow-up appointments may look like:

The first appointment: Three to seven days after discharge. Depending on how “satisfied” your cardiologist is with your recovery progress, the scheduling of following appointments could change.

The second appointment: Six weeks after the initial appointment.

The third appointment: Usually 3 months after the initial appointment.

Annual follow-ups: Once you're recovered, your cardiologist will want to see you regularly, probably once per year.

Your cardiologist evaluates how your recovery is going and gives you instructions on “sternal precautions”, your exercise schedule and your diet. He/she will also advise you when you can be allowed to drive and return to work. If needed your cardiologist will enroll you in a Cardiac Rehabilitation program with the goal to maximise your physical, psychological and social recovery. This will also help you to make lifestyle changes to reduce your risk of future heart problems. Furthermore it will help you to get physically active to a degree tailored just for you.

 A typical Cardiac Rehabilitation program consists of:

• Instructions on “Sternal precautions”
• A structured exercise program with increase of your physical activity under medical supervision.
• Information on how to improve your diet to be heart healthy, rich in lean protein, whole grains, fruits, vegetables, legumes and low in saturated fats.
• Information on how to implement a long-term heart healthy lifestyle integrating diet and exercise into your daily life.
• Information on how to get help from occupational therapists or psychologists as needed.

Sternal precautions are adjustments to your daily routine to help prevent the breastbone (sternum) from being pulled apart (separated - called dehiscence) during healing, and to prevent excessive pulling on the surgical wound (incision). These precautions also help to reduce the risk of wound infection which would slow the healing process of the bone.

Basically “Sternal precautions” are simple rules to take good care of your healing breastbone which is important to do for the first 6 to 8 weeks after your operation, or longer, as instructed by your cardiologist.

The 3 most important rules to remember are:

1. Not to do anything that places more stress on one side of your chest than the other which means using both hands and arms simultaneously.

2. Keep your elbows close to your body when you push, pull or lift anything.

3. Use your leg muscles to sit or lay down and to get back up again.

Sternal precautions may vary somewhat from one hospital to another. The following list shows typical precautions:

• Avoid reaching your arms above your head, behind your back, or to the sides. Do not sleep with your hands behind you head.
• Always keep your elbows close to your body when you push, pull or lift anything to avoid straining your chest and increasing pain.
• Avoid lifting, pushing, or pulling objects heavier than 5 kg (10 pounds). For example: Average 3-month-old baby, a cat or small dog, a filled laundry basket, a traditional vacuum cleaner, a large watermelon, three 2 liter bottles of soda, a sack of potatoes.
• Do not push with your arms when you stand up.
• Avoid doing things that place more stress on one side of your chest than the other, like walking with pets on a leash, using a walking stick, carrying an item in one hand, mopping the floor, vacuuming or mowing.
• When lifting do it safely by always bending your knees, not your back, and use both hands to pick up objects and keep them close to your body.
• Avoid lifting toddlers or small children. Have them placed on your lap for a cuddle.
• When picking up small objects on a table or countertop, pull them first close to you with both hands and lift with both hands.
• Do not allow others to pull on your arms when helping you to move.
• Use the weight of your whole body to open heavy/large or sealed doors (refrigerator) or when pushing shopping carts.
• Avoid any type of hard exercise that could strain your chest or upper arms, such as swinging a golf club, or playing tennis.

[Click on the infographic below to download it as a summary and overview on how to prepare yourself for open heart surgery]

Some hospitals provide heart surgery patients with a heart shaped pillow and may tell patients to hug it while coughing or sneezing to protect the breastbone. It is important to understand that pillows used in this way can cause more harm than good since pressing inwards on a broken bone could delay healing. Patients can also not walk around with a pillow at all times. A cough or sneeze can appear in a split second, which may cause patients to make a sudden move to reach for the pillow. Such move puts uneven stress on the breastbone and may be harmful for the healing process. Another issue is the risk of infections, since a pillow easily can fall on the floor or be exposed to infection sources during visits to the bathroom.

These are important reasons for using a purpose-designed chest support such as QualiBreath or QualiBra Advanced that is in position on your chest at all times for constant support, and has handles/pockets always ready to be grasped in a split second for stronger support during a cough or sneeze.

You can read more about pillows and chest supports here: 
Heart pillows and sternum protection devices - Very different functions yet important roles in advancing a patients recovery.

 
There are other commercially available chest supports that some hospitals may offer you. It is important to evaluate what these products can do and check if they are comfortable. Do they give continuous support to your ribs and muscles? Can you sleep with them? and can they decrease pain by having tools to gain additional support during coughing, sneezing, straining?
It is important for your recovery that you get to use a chest support that you feel provides you with as many advantages as possible and that you can wear for several months. 
See the main differences with QualiBreath and other chest supports here.

Exercise

This is an important factor in your recovery progress after heart surgery. Try to be as active at home as you were on your last day in the hospital and remember to continue with the breathing exercises you were taught. Walking is the most simple and effective exercise and you need make it part of your daily routine. Check with your cardiologist before you start other more vigorous forms of activity.

You need to build up your activity little by little over the first 6 to 8 weeks. Follow the guidelines your cardiologist or cardiac rehabilitation specialist gives you. The following guidelines are recommended by the American National Heart Foundation which recommends that you do at least 30 minutes of moderate physical activity (such as brisk walking) every day. It does not have to be done in one session but can be split up into 3 x 10 minute sessions a day.

National Heart Foundation Guidelines for walking after leaving hospital:

(On mobile: scroll right to view the rest of the table)

Choose a time for walking that is convenient for you but wait for 1.5 hours after eating. Wear comfortable walking shoes and clothing that is suitable for the weather. If the weather is severe or the temperature makes you uncomfortable then use your treadmill if you have one, or walk indoors at a shopping mall or at a health club.

Begin your activity slowly and try to increase the amount of walking you do a little each day. You may get a little breathless during your activity. This is acceptable but should not exhaust you. If you can talk at the same time as exercising, you are doing fine. Drink plenty of water to replace the amount of sweat lost through exercising.

When you exercise remember it is usual to get aches and pains. Specially the ligaments and muscles around your neck, shoulders, chest and your back might still be sore. When you continue with the exercises this discomfort will disappear.

Make sure to rest in between your exercise schedule. You might be overdoing your activity if you feel you get easily tired. Then walk shorter distances or reduce the activity you do. Rest immediately if you get short of breath or dizzy, or begin to feel very tired. If you get a headache, pain in your chest, arms, jaws or ears, feel nausea or need to vomit, contact your cardiologist and do not start your activity again before he/she approves.

It is very variable what amount and type of exercise patients can do in the first weeks after surgery. Most patients are able to walk about 1.5 - 2.5 km (1-1.5 miles) daily 4 weeks after surgery. The best is to do what you can without becoming too tired or too short of breath and to make sure to get as much rest as you need including a good nights sleep.

Although you might be anxious to get back to your daily routine, do not overdo your activities as that can slow your recovery. Your body must have time to heal properly.

Healthy diet with healthy food choices help the healing process:

It is common not to feel like eating right after your surgery. Try to eat smaller meals more often and you appetite should come back in a few weeks. Tell you cardiologist if you keep having a poor appetite.

Healthy foods and drinks are very important for your healing process and for your future health. The wrong foods and drinks can lead to high blood fats (cholesterol), high blood pressure, diabetes, being overweight and other severe illnesses. Wrong foods and drinks increase the risk of heart disease.

See the section “Before your surgery” of this guide where we discussed how to start enjoying a heart healthy balanced diet before your surgery to make it easier during your recovery.

What you need to know about fats:

Fats are an important part of a healthy balanced diet but it is very important to pay attention to the type of fats you eat.

• The “good” fats are unsaturated fats (Monounsaturated and polyunsaturated fats). Examples of foods high in good fats: Olive and canola oils, soy, nuts, seeds, and fish.
• The “bad” fats are saturated and trans fats which increase risk of diseases, even when eaten in small quantities. Examples of foods high in bad fats that you should avoid: coconut and palm oils, lard, butter, milk fat, meat, skin from chicken and pork, ice cream and cheese.
  Furthermore:
• Commercially-baked pastries, cookies, doughnuts, muffins, cakes, pizza dough.
• Packaged snack foods (crackers, microwave popcorn, chips)
• Stick margarine, vegetable shortening.
• Fried foods (French fries, fried chicken, chicken nuggets, breaded fish)

Besides what we described in the diet section “Before your surgery”, here are additional tips to eating healthy:

• Make it a habit to read nutrition labels when you shop. Look for foods with fat content less than 10-15% per 100g, low sodium (salt), no added sugar, no artificial sugars, high in fiber and protein.
• Make grains, legumes, pulses, and vegetables the major part of each meal to get fibre, proteins, vitamins and minerals. 
• Learn to use the huge variety of legumes and pulses and include canned beans (e.g., kidney beans and three bean mix), dried peas and beans, chickpeas and lentils.
• Choose wholegrain breads, pasta, noodles and rice.
• Eat lean meats (veal) and poultry without skin, fish, egg whites, tofu, nuts and seeds.
• Use hummus or avocado instead of spreads.
• Make salad dressings from canola or olive oils and fresh lemon juice instead of mayonnaise.
• Limit processed meats (e.g. sausages) and deli meats (e.g. ham or salami).
• Avoid sugary, fatty and salty take-away meals and snacks including pastries, pies, pizza, fried fish, hamburgers, hot chips and creamy pasta dishes. Healthier take-away choices include sushi or sashimi, Asian stir-fries, tomato-based pasta dishes, grilled fish, chicken and lean meat.
• Avoid fat cheese. Lower fat cheeses such as light cheddar, ricotta, cottage and light mozzarella are healthier choices.
• Flavor with herbs and spices instead of salt.
• Snacks: limit snacks and instead of cake, biscuits or crisps, choose fresh fruit, raw vegetables with hummus, unsalted nuts, seeds, rice cakes and low fat dairy products,.
• Drink plenty of water. Avoid drinks containing added sugars, sugar-sweetened soft drinks, fruit drinks, vitamin waters, energy and sports drinks.
• Drink coffee and tea in moderation. If you use milk, choose low or no fat milk.
• Limit alcohol intake. Current recommendations for men and women: No more than 2 standard drinks a day on average. Include 1–2 alcohol free days per week.

When you start on your healthy way of nutrition you will quickly find that your body and yourself will feel much better which will inspire you to continue. Vegetables, legumes and fruits are packed with nutrients (antioxidants, vitamins, minerals and fibre) and help you maintain a healthy weight by keeping you full for longer.

Wound Care

The breastbone is typically held together by metal wires after open heart surgery. They are usually not removed, but some people may experience persistent pain or allergic reactions related to the wires. Removal of the wires usually resolve these symptom and it is generally an uncomplicated procedure.

The tissue and skin over your breastbone is held together by stitches or staples while it heals. Depending on the type of stitches used, they dissolve on their own. Non-dissolvable stitches and staples need to be removed about a week later. 

Your skin normally seals within the first days after surgery. Some bruising around the incision is normal. The wound may itch and feel sore, tight or numb for a few weeks. If you have had a bypass surgery where the surgeon used a vein from your leg as grafts, your leg could hurt more than your chest and be sore and stiff. This will go away with time. Modest exercise and daily activities will help ease these symptoms.

Before you leave the hospital, you will be instructed on how to care for your wound(s) on your chest and the site where the grafted blood vessel was removed from your leg or forearm.

It’s important to:

• Check your wounds at home.
• Always wash your hands before touching your wounds.
• Your wounds will heal and scab over in the next couple of weeks. If the wounds are itchy, do not scratch them. The scab will gradually fall away and the scar will begin to fade over the next few months.
• Keep the wound(s) clean and dry. You can shower but avoid using soap directly on your wound(s) and carefully pat the incision(s) dry afterward.
• Use a fresh towel each time you shower.
• Do not use creams, talcum powder, or lotions on your wounds until they have fully healed.
• Some fluid may leak from your chest tube sites the first week after surgery and must be covered with sterile bandages. Call your surgeon's office if you have to change the bandages more than once per day.
• Avoid bathing and swimming until your wounds are completely healed or until your cardiologist gives the OK.
• Avoid direct sun on your wound(s) for the first year. Sun exposure can cause the scar to darken.
• If you have wounds from graft sites on your legs: Put your legs up on a foot rest or stool when you are sitting down. This will reduce swelling and will help the wounds to heal more quickly. Wear compression stockings for six weeks after surgery or for as long as your cardiologist advises.

Check your wound for signs of infection:

• Increased oozing
• Wound edges pull apart
• Increased swelling/tenderness along incision line
• Pain
• Redness and warmth around the cut
• Bad odor
• Grinding/clicking sensation
• Fever higher than 38°C (101°F) 

If you have any of these signs, or if your breastbone feels like it shifts, pops or cracks when you move, call your cardiologist immediately.

The wound will leave a scar in the chest area and at the graft site (if you had a bypass surgery). It is normal that the scar will be red during the healing period. It will fade and become lighter over time.

Check list for things you should do every day at home:

• Check your resting pulse and keep a record to bring to your follow-up appointments. Your pulse should be within the range of 60 - 100 beats per minute. Call your cardiologist if your pulse is out of this range.
• Weigh yourself and keep a record of your weight to bring to your follow-up appointments. If you experience a sudden increase in your weight it could be a sign of fluid retention and that your heart is not pumping efficiently. Inform your cardiologist if you gain 1 - 1.5 kg (2-3 pounds) or more in one day, or 2 -3 kg (4 -6 pounds) or more in one week.
• Take your temperature. If you feel warm or chilled, measure your temperature 3 times a day (morning, afternoon and evening) and keep a record. Call your cardiologist if your temperature exceeds 38°C (101°F).
• Take your medications as prescribed. Continue to take your prescribed medications at home. Talk to your cardiologist before making any changes.
• Follow the heart healthy diet recommendations and work on making it a habit.
• Follow your exercise program and make it part of your daily routine.

Listen to your body. Call your doctor, or go to your hospital if you get warning signs like:

• Chest pain not caused by your incision, pain in your arms, jaws, or ears.
• Shortness of breath, nausea or vomiting, a severe headache, fainting.
• Palpitations or an irregular heartbeat and dizziness.
• Increased swelling of legs, ankles and/or feet.
• Wound pain that is getting worse  and not relieved by medication.
• Wounds that become red, swollen, inflamed, begin to ooze or start to open.
• Chills, or fever above 38°C (101°F).
• Coughs and colds that don’t go away.
• Blood in urine or stool.

Getting through the first weeks at home

The first few weeks after hospital discharge can be tough both physically and emotionally for many who have had heart surgery. Fear of pain, fatigue, worry, stress, or being overwhelmed about how to comply with drastic changes in lifestyle including a new diet may create common emotions like:

• Mood swings, Irritability, sadness, crying frequently
• Distressed about not yet being able to return to work
• Frustration about having strict activity limitations such as lifting and driving restrictions
• Difficulty concentrating, low or lack of energy, easily fatigued
• Intermittent pain with the need for pain medication
• Sleep disturbances
• Commonly symptoms of depression

If you go through some or all of these feelings it is important you remember that they are very normal and usually do not last long. A change in our health situation has an effect on our feelings too, not only on our bodies. You will experience good days and bad days. As you increase your daily activity, follow your exercise plan and get plenty of rest. This will help you to an emotional recovery as well.

Start seeing family and friends with visits limited to 15 minutes the first week at home. Talk over your feelings and progress with your loved ones. As you start feeling stronger and less tired, you can increase your time with visitors.

If the feelings of sadness or depression do not disappear, it is important to talk to your cardiologist about a possible referral to a licensed counselor or a clinical therapist. You may want to join a local or online support group. Talking with others who are going through similar experiences can help. There is a wealth of educational information and resources available such as the American Heart Association's online support network.

During the first week or two at home, you should have a caregiver helping you. This can be a family member, friend or a home care helper. Make sure you get dressed every day and walk daily and follow other activities that might be recommended for you. This will help to keep your spirits up. 

Pain medication

It is common to experience some pain in your wounds after your surgery. Pain may also be caused by sore muscles and ribs. It should not be like the angina pain you may have experienced before your operation. Most people also move more once they get home which may result in more pain during your first few days back home.

Pain is normally worse at night time and in the morning after sleeping in the same position. Make sure you continue to follow your exercise program as this will help you to move your joints and muscles and make you feel better.

Most likely your cardiologist will prescribe pain medication for you to use at home. Make sure to follow the instructions strictly on how to take them.

See the section in this guide about “Plan for how to cope with pain at home”.

Wear a comfortable and effective chest support such as QualiBreath or QualiBra Advanced to help your healing breastbone and to make you feel physically supported around your chest. It will help relieve pain from sore ribs and muscles. It is also a tool to get more support and control pain during coughing, sneezing, straining and when you do respiratory exercises. It will give you a good feeling of being held together and give you more peace in mind about your breastbone being safe.

Use also the CryoPouch to apply frozen gel packs over your incision to deal with incision pain. Both the chest supports and CryoPouch are “non-drug” pain relieving tools that can help to avoid unnecessary amounts of pain medication.

Rest and Sleep

You should rest after activities, but don’t take a lot of naps during the day as it could give you difficulties to sleep at night. Sleep will help your body to recover and help to restore your energy.

Try to get 6 to 8 hours of sleep every night. You should sleep less than an hour every afternoon for the first month after surgery.

If you have trouble sleeping at night, try the following:

• Go to bed and get up at the same time every day.
• Start a routine to let your body know it’s bedtime, like reading or listening to relaxing music.
• Avoid caffeine like coffee, tea, and sodas before bedtime.
• Arrange the pillows so you can stay in a comfortable position.  
• Make sure to sleep with your chest support such as QualiBreath or QualiBra Advanced so you always have help at hand when you need to cough or sneeze at night.
• Use the CryoPouch cold treatment if you have incision pain.
• Sleep on your back as much as possible for the first months while your breastbone heals.

If you continue to have trouble sleeping at night and it affects your mood or behaviour, call your cardiologist for advice.

6 Weeks After Your Heart Surgery

Six weeks after your surgery you might feel you can do many of the activities you used to before your surgery. This may also be the time you undergo the critical test whether you can be serious about sticking to lifestyle changes. Do it for you! Read motivating books and surround yourself with people who support your lifestyle changes.

At this time make sure your cardiologist agrees to when it’s okay to perform activities like:

• Driving: Most surgeons recommend waiting at least six weeks after surgery since it only takes a minor accident to press your chest on the seatbelt or worse, on the steering wheel which could delay normal healing of your breastbone. You may be allowed to drive sooner if the surgeon did the operation with just a small cut. You can of course be a passenger in the car but protect your wound with a padding like the purpose-designed QualiPad seat belt protection for heart patients.
• Returning to work: If your job includes strenuous physical labor, you will have to wait longer to get back to work than people who work at a desk all day.
• Lifting heavier items: Remember a healthy bone takes between 6-8 weeks to heal. Heart surgery patients often have weaker bones due to age, osteoporosis, diabetes or other conditions which may cause healing to take much longer. The breastbone is no different than another bones in the body. Since it cannot be placed in a cast make sure to continue to use the chest support like QualiBreath or QualiBra Advanced for protection and listen to your body: If it hurts stop doing what you do. It’s important not to push yourself before your weight lifting restriction is eliminated.
• Resuming sexual activity: Many patients are worried about resuming sex after surgery. It often depends on how you feel physically and mentally. Most doctors agree on these guidelines: Sexual intercourse requires about the same energy as walking approximately 1 km or walk up 2 flights of stairs. If you are having difficulty with these activities, becoming short of breath, or too tired, then wait resuming sexual activity. When you are ready, make sure to be well rested, relaxed and use positions that place less stress on your breastbone and arms to avoid pain in your chest wound. Be aware that anxiety about performance and depression can reduce sexual interest and capacity. Some medications may also interfere with performance. Talk with your cardiologist if any of this applies to you.

Important: Do not assume that when the wound has healed nicely the breastbone is also healed. The breastbone takes much longer to heal than the wound. How long will depend on your age, whether you have diabetes, or other health conditions that delay bone healing. At best, the breast bone heals in about 8 weeks, at worst it may take up to 2 years, therefore be mindful about the stress you expose to your breastbone.

Twelve Weeks After Heart Surgery

Most people find that it takes around 3 months after the surgery for them to fully recover and return to a new normal with lifestyle changes. Obviously there is considerable variation for each individual depending on how fit you were before your operation and the type of operation performed. Older people may have a longer recovery time than younger people.

Even after twelve weeks you should still make sure your surgeon or cardiologist agrees with the type of exercise you want to do, or any other hard work you have plans to perform. You should also continue to use your chest support like QualiBreath or QualiBra Advanced for protection of your breastbone until you are completely free from any pain during exercise or work.

Useful tips:

• Prioritise your daily activities to conserve energy. Do the most important jobs first just in case you should run out of time or energy. Planning your tasks and your time will help you to protect your energy levels.
• Plan activities when you know your energy level is high and rest in between the tasks you have to do. If you need to rest an hour after an activity, you might have pushed yourself too hard and have waited too long to take a break.
• Make sure to have a good posture at all times. It is very important for a healthy effective breathing which helps decreasing risk of lung infections. Keep a good posture during the activities you are doing. A poor posture can lead to joint fatigue and pain.
• When doing activities such as lifting an object from the floor, place your feet apart at shoulder distance, keep your head and back straight, then bend your knees and hips (not your waist) and do not twist your upper body. Pick up the object with both hands and keep it close to your body when you get up.
• Avoid rapid change of position as it could make you dizzy e.g. sitting to standing or vice versa.
• Use your leg muscles to get in or out of a chair or bed. Do not put stress on your breastbone by using your arms to lower or raise yourself from your chair.

There are many things to keep in mind while your body is healing. Do not get overwhelmed. Having the proper knowledge and making use of purpose-designed tools for open heart patients will make your journey easier and help you to skillfully manage every step along the way to full recovery.

This article serves as a general recovery guide. It is essential to recognize that each person will experience recovery differently, depending on the type of procedure, any health issues, and adherence to post-operative protocols. Your surgeon or cardiologist will provide you with a post-operative care plan tailored to your needs and the type of surgery.

References:

https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/protein/

https://www.heart.org/

https://www.hopkinsmedicine.org/heart_vascular_institute/_pdf/cardiac_surgery_patient_guide.pdf

https://www.mayoclinic.org/documents/mc0389-pdf/doc-20078765

https://www.bhf.org.uk/-/media/files/publications/heart-conditions/his12_0318_heart_surgery_a6-web.pdf?rev=7742cff4ba884bfe884a395d8bd21b45

https://www.heartonline.org.au/articles/exercise/post-surgical-care#sternal-stability-management