CardioSurgeon.co.uk
Heart disease is influenced by several risk factors, some of which can increase the chance of developing the condition or make it progress more quickly. The encouraging news is that many of these factors can be improved or controlled. Even if you already have heart disease, had a heart attack, or had a heart operation making positive changes can still have a meaningful impact. Small, steady steps can help protect your heart and improve your overall health. It’s never too late to make a difference. With the right support and guidance, many people are able to reduce their risk, feel better, and live full, active lives.
Follow a heart healthy diet — Diet counseling is helpful for people who need to lose weight or reduce cholesterol levels. A registered dietitian is the best person to consult about foods that are helpful and harmful, appropriate portion sizes, total calorie recommendations, and realistic ways to change bad eating habits. Most cardiac rehabilitation programs have a dietitian who is knowledgeable and experienced in advising people who are recovering from a heart surgery.
Stop smoking — Cigarette smoking significantly increases the risk of coronary heart disease and heart attack, and stopping smoking can rapidly reduce these risks. One year after stopping smoking, the risk of dying from coronary heart disease is reduced by about one-half and the risk continues to decline with time. In some studies, the risk of heart attack was reduced to the rate of nonsmokers within two years of quitting smoking. Your GP practice and cardiac rehabilitation programs can recommend a treatment to help stop smoking, such as group programs; nicotine patches, gum, or
Treat high blood pressure and high cholesterol — Medicines to control high blood pressure and high cholesterol are usually recommended after bypass surgery. It is important to take these medications exactly as prescribed.
Manage diabetes — People with diabetes are at an increased risk of developing complications after cardiac surgery. Tight control of blood glucose levels can help to reduce the risk of these and other types of complications. Tight control can be achieved by losing weight, managing the diet, exercising, monitoring blood glucose levels regularly, and taking oral hypoglycemic medications (for people with type 2 diabetes) or insulin (for people with type 1 and sometimes type 2 diabetes).
Psychosocial treatment — Feelings of depression, anxiety, and denial are common after bypass surgery, occurring in up to 40 percent of people. Depression can reduce a person’s ability to exercise, decrease energy levels, cause more fatigue, or reduce a person’s quality of life and sense of well-being. Women, and in particular younger women, are at an especially high risk for depression.These symptoms can cause problems within the family, marriage, and the workplace. Your GP and cardiac rehabilitation programs have trained personnel, including psychologists, psychiatrists, or social workers, to help manage these issues. Treating depression and anxiety can improve a person’s long-term outlook and general sense of well-being.
Reduce stress — Long-term stress in the home, at work, or with finances can increase the risk of heart attack, stroke, and chest pain. Your GP practice and local cardiac rehabilitation programs teach patients how to reduce stress in an attempt to lower these risks.
When you are advised to continue taking antiplatelet medication, such as Aspirin, Clopidogrel, or Ticagrelor, it is very important not to stop them without medical advice, even if you are feeling well. These medicines play an important role in protecting your heart. They work by reducing the ability of your blood to form clots, which can otherwise block the arteries supplying the heart and lead to a heart attack. Taking them regularly helps keep your blood flowing smoothly and lowers the risk of further cardiac events. Stopping suddenly can increase your risk of complications, particularly if you have had a stent placed in your heart or recent heart operation.
If you experience any side effects, such as unusual bruising, bleeding, or stomach discomfort, or if you have concerns about your medication, please speak to your GP or cardiac specialist. They can review your treatment and make any necessary adjustments.
If you are due to have surgery, dental work, or any new treatment, make sure to inform your healthcare provider that you are taking antiplatelet medication.
There are a large percentage of people who may be or may become resistant to the prescribed antiplatelet therapy. Patients who are resistant to Aspirin and/or Clopidogrel are at a greater risk of clinically important cardiovascular morbidity than patients who are sensitive to Aspirin/Clopidogrel.
You may be asked by our team to have the effectiveness of the prescribed antiplatelet therapy tested and the dose or the medication used adjusted to meet your personal needs.
You may also find that you have been discharged home on dual antiplatelet therapy, which currently is our usual practice for an initial period of six months, following which you will most probably converted to a single antiplatlet therapy by your local cardiologist or your GP.
Antiplatelet medication is a key part of protecting your heart and reducing the risk of future problems. Taking your treatment regularly, exactly as prescribed, and staying in touch with your healthcare team can make a real difference to your long-term health. If you have any questions or concerns, don’t hesitate to ask, support is always available. With the right treatment and guidance, you can take positive steps to keep your heart healthy and stay well.
Like all operations, valve surgery isn’t risk free. Your own risk will depend on your age, your current state of health and the degree of valve disease. Before your procedure, your surgeon will discuss with you both the benefits and risks of the operation.
New, prosthetic heart valves, although sitting within your blood stream, they do not have blood supply of their own and as such, they can not fight infections in the same way your native valve does. When a prosthetic heart valve becomes infected (prosthetic valve endocarditis), antibiotics can not treat the infection and there is usually a need for a re-operation. If not treated quickly, infective endocarditis (IE) can be life-threatening condition and it is a major public health challenge.If you have a heart valve problem or have had surgery on your valve, you are at risk of developing endocarditis. You are also at risk if you have had endocarditis before.
To help reduce your risk of endocarditis (an infection of the heart lining or valves), it is important to take a few simple precautions in your daily life. Looking after your teeth and gums is essential, so make sure you brush your teeth twice a day with fluoride toothpaste and attend regular dental check-ups, usually every six months. You should avoid body piercings and tattoos, as these can introduce bacteria into your bloodstream. Do not inject any substances unless they have been prescribed by your doctor. It is also important to seek medical advice promptly if you notice any signs of infection, such as fever, swelling, redness, or feeling unwell, so that treatment can be started early.
If you experience flu-like symptoms with a high temperature, you should see your GP as soon as possible and tell them you have had a heart operation with a heart valve, aortic graft or other prosthetic material.
Warfarin is an anticoagulant, which means that it increases the time it takes for your blood to clot. It works by reducing the effects of vitamin K, which is a vitamin your body uses in the process of blood-clotting. Warfarin is used to prevent unwanted clots from forming if you have a condition that puts you at risk of this happening, such as atrial fibrillation or presence of a mechanical valve.
You will be given a yellow anticoagulant treatment booklet; read this carefully as it gives you information about when you should contact a doctor for advice and means or recording your INR levels. Carry it with you at all times in case of an emergency and a doctor needing to know that you are on Warfarin, and at what dose. You will need regular blood tests to check on how quickly your blood clots. Blood tests may be needed quite often at first, but should reduce in frequency quite quickly. Several mobile phone Apps exist to either support and educate and support patients.
The extent to which Warfarin is working is measured by the International Normalised Ratio (INR), which is a measure of the ability of your blood to prevent clotting. The amount of warfarin that you need to take will depend upon the result of these blood tests, and this is why your dose may change from time to time. The aim is to get the dose of Warfarin just right for you and a personal tester can be very useful (example: CoaguCheck).
If you are taking Warfarin, it is important to keep your diet consistent because sudden changes can affect your INR, which measures how quickly your blood clots. Eating more foods rich in vitamin K, such as green vegetables and salads, can lower your INR, while eating less of these foods, for example when starting a weight-loss diet, can raise it. You should not make major changes to your diet or begin a new diet without speaking to your doctor, as you may need closer monitoring or an adjustment to your Warfarin dose. Alcohol should only be consumed in small amounts, as it can affect how Warfarin works in your body, so try to limit intake to one or two units per day and avoid binge drinking. It is also best to avoid cranberry juice, as it can interfere with Warfarin and affect your INR. If you do make changes to your diet, increasing the frequency of INR checks can help keep your levels within the safe and recommended range advised by your doctor, and this can be done using point-of-care self-testing devices such as CoaguChek.
If you are taking Warfarin, it is important to keep your diet consistent because sudden changes can affect your INR, which measures how quickly your blood clots. Eating more foods rich in vitamin K, such as green vegetables and salads, can lower your INR, while eating less of these foods, for example when starting a weight-loss diet, can raise it. You should not make major changes to your diet or begin a new diet without speaking to your doctor, as you may need closer monitoring or an adjustment to your Warfarin dose. Alcohol should only be consumed in small amounts, as it can affect how Warfarin works in your body, so try to limit intake to one or two units per day and avoid binge drinking. It is also best to avoid cranberry juice, as it can interfere with Warfarin and affect your INR. If you do make changes to your diet, increasing the frequency of INR checks can help keep your levels within the safe and recommended range advised by your doctor, and this can be done using point-of-care self-testing devices such as CoaguChek.
If you buy any medicines, check with a pharmacist that they are safe to take with Warfarin. Because Warfarin is used to prevent blood clots from forming, you should try to avoid activities that could cause you to cut or bruise yourself, such as contact sports. Let your doctor know if you have any falls or injuries.
If you are due to have any injections, or any medical or dental treatment, tell the person carrying out the treatment that you are taking Warfarin, and show them your anticoagulant booklet. It is important that they know you may take longer to stop bleeding. If you are due to have surgery, you may be advised by the clinic to stop taking Warfarin for a few days beforehand.
For patients with On-X mechanical heart valve prostheses, anticoagulation with Warfarin remains essential to prevent valve thrombosis and thromboembolic events, but the target intensity can be lower than with traditional mechanical valves. Based largely on evidence from the PROACT trial, patients with an isolated aortic On-X valve (and no additional thromboembolic risk factors) can be managed with a reduced INR target of 1.5–2.0, combined with low-dose aspirin (typically 75–100 mg daily), after an initial 3 months of standard anticoagulation (INR 2.0–3.0). This lower target has been shown to reduce bleeding risk without significantly increasing thromboembolic complications in appropriately selected patients. However, for patients with additional risk factors, such as atrial fibrillation, prior thromboembolism, left ventricular dysfunction, or hypercoagulable states—a conventional INR target of 2.0–3.0 (or higher depending on risk) is still recommended. Careful INR monitoring, patient education, and individualized risk assessment remain critical in optimizing outcomes.
