Learning About Your Health

Coronary Artery Bypass Graft (CABG) & Heart Valve Surgery:
Caring for Yourself at Home

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Preparing to Go Home

This information will help you manage your care at home. Please review the checklist carefully. Please ask your doctor, nurse, or therapist if you have any additional questions.

  • You cannot drive yourself home. Please make arrangements for transportation home.

  • Know what medication(s) to take, their purpose, and possible side effects. Know the pharmacy from where you plan to get your medication(s).

  • Recognize the danger signals related to your illness or operation. Call your doctor if you experience any of these symptoms before your next doctor’s appointment.

  • Schedule the date for your next doctor’s appointment.

  • If you are taking Coumadin (Warfarin), schedule the date for your next laboratory appointment. You will need to have your blood drawn to monitor the PT/INR (Prothrombin Time/International Normalized Ratio), a blood clotting test.

  • Know your activity limitations, lifting restrictions, and when to resume usual activity.

  • Know your dietary restrictions if you are on a special diet.

  • Know how to change your dressing if you have one.

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Arranging Your Transportation Home

  • You cannot drive yourself home. You should be able to go home safely in a family member or friend’s car.

  • Ask to speak to an RN Case Manager if you need help getting home or help getting up the stairs. Most insurance plans will not pay for transportation home.

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Making Your Follow-up Appointments

  • Your cardiologist needs to see you in the office about 7-10 days after your hospitalization. Call the cardiologist’s office to make an appointment.

  • Cardiac Rehabilitation programs are usually recommended for people with heart disease.

  • California Pacific Medical Center offers a Cardiac Rehabilitation program for patients with a written prescription or referral from your doctor. Call (415) 600-3361 for more information about this service.

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Recognizing Danger Signals


Call Your Doctor Immediately if You Experience Any of the
Following Symptoms
Do Not Wait Until Your Next Appointment
  • Leg or chest incisions that separate, become red or tender, or begin to drain.
  • Severe incisional pain, chest pain (angina), or difficulty breathing.
  • Fever over 101°F or shaking chills.
  • Fast or irregular heartbeat.
  • Bleeding or easy bruising.
  • Increased swelling (edema) in the legs or weight gain greater than 3 pounds overnight.
  • Other symptoms as explained by your doctor.


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Understanding Your Medications

How to Take Coumadin (Warfarin) if Ordered by Your Doctor:
Coumadin (Warfarin) is a "blood thinner" that prevents blood clotting, and may prevent stroke or heart attack. Note: Coumadin (Warfarin) should not be taken if you are pregnant or could become pregnant during the course of treatment. Consult with your doctor if you are pregnant or breastfeeding. Please read through all of this information if you are taking Coumadin. Talk to your doctor, nurse, or pharmacist if you have additional questions about Coumadin, or the laboratory blood test referred to as PT/INR (Prothrombin Time/International Normalized Ratio).

Coumadin (Warfarin) Increases Your Risk of Bleeding
  • To prevent complications, your dosage will be adjusted according to a blood test referred to as PT/INR (Prothrombin Time/International Normalized Ratio).
  • Be sure your dosage is correct each time you take a dose.

Arranging Your Next Laboratory Blood Test (PT/INR blood test):
Arrangements will be made at the time you are going home for your next PT/INR blood test. These results will be reported to your doctor the same day.

After Having the PT/INR Blood Test, Contact Your Doctor Before Taking Your Next Dose of Coumadin:
After taking your PT/INR blood test, contact your doctor during office hours before taking your next dose of Coumadin. They may want to change the amount of Coumadin you are taking.

Continue to Take Coumadin Daily at Dinnertime:
This gives us time to evaluate the PT/INR blood test and contact you, if we need to adjust your Coumadin dosage.

Do Not Take Other Medications That Alter Blood Clotting:
Aspirin, Advil (Ibuprofen), Motrin (Ibuprofen), and Plavix (Clopidogrel) can prolong bleeding and interact with Coumadin. Take them only if ordered by your doctor. You may take Tylenol (Acetaminophen) for pain.


Special Precautions With Coumadin (Warfarin)
  • Call your doctor immediately if you have any unusual bleeding or bruising.
  • Do not take any prescriptions or over-the-counter medications, including vitamins and herbal preparations (especially those containing Vitamin E or Vitamin K), unless ordered by your doctor. Many of these medications may interact with Coumadin.
  • If you forget a pill, don't take another to "catch up." Call your doctor for directions.
  • Tell your doctors, dentist, and pharmacist that you take Coumadin, especially before starting a new medication or having a medical or surgical procedure.
  • Try to maintain a consistent diet. Do not dramatically vary your dietary intake of foods high in Vitamin K, as these foods can interfere with how you process Coumadin. These foods include: liver, broccoli, cabbage, cauliflower, spinach, lentils, chickpeas (garbanzo beans), turnip greens, soybean oil, seaweed, green tea, and herbal teas which contain coumarin.

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Planning Your Activity

  • Do not lift anything heavier than 5 pounds for at least 6 weeks after surgery.

  • Do not drive until your doctor instructs you to do so.

  • Follow the home walking program prescribed by physical therapy. Gradually increase your activity.

  • Everyone recovers differently. Please check with your doctor about when to return to work and resume your usual activities.

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Caring for Your Incisions

  • Wash your incisions daily with soap and water, gently pat dry.

  • Elevate your legs when sitting to minimize swelling.

  • Place pillows under the foot of your mattress to elevate your legs while sleeping, if leg swelling is a problem.

  • Wear elastic stockings for 1 month or as directed by your doctor. Remove these stockings for sleeping and bathing.

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Tips on Bathing

  • You may shower as soon as you feel able.

  • Do not take tub baths for the first week at home.

  • Be prepared to sit down or get assistance if you feel dizzy.

  • Arrange to have a family member or caregiver stand close by and assist you during your shower in case you become dizzy while bathing.

  • Use plain soap without creams or lotions.

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Sleeping

  • You will feel more tired than usual. Plan to take rest periods or naps during the day until your strength returns.

  • You can sleep in any comfortable position without hurting your incisions. Some patients prefer sleeping on a couch or in a lounge chair for a few days.

  • Difficulty sleeping is common for a few days. Pain pills taken before bedtime may help you sleep.

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About Your Diet

  • After you go home, there are no dietary restrictions for the first 2 weeks, unless you have diabetes.

  • If you have diabetes, always follow the diabetic diet.

  • After 2 weeks, follow the low cholesterol/low salt guidelines as directed by the dietitian.

  • Take a multivitamin with minerals daily.

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Taking Antibiotics

  • During certain medical procedures and dental treatments, bacteria can enter the bloodstream and cause infection of the heart valves and tissues.

  • Antibiotics may be necessary prior to medical and dental procedures for patients with abnormal heart valves, pacemakers, or within the first 6 months after heart surgery.

  • Speak to your doctor about your heart condition prior to any medical procedure or dental work.

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Setting Up Help at Home

An RN Case Manager will meet with you if you need extra help or equipment at home. Usually no special equipment or supplies are needed. However, an RN Case Manager will find out what services your insurance plan pays for and, if needed, will help make the necessary arrangements.

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More Ways to Learn

Ask About a Cardiac Rehabilitation Program
To participate in outpatient cardiac rehabilitation, you must obtain a written prescription from your doctor. California Pacific offers a Cardiac Rehabilitation Program located at 2360 Clay Street. Call (415) 600-3361 for an appointment or information.

Visit the Community Health Resource Center
The Community Health Resource Center is located at 2100 Webster Street in San Francisco, (415) 923-3155. Services include classes, counseling and written information on a wide variety of health topics.

Visit the Health & Healing Library, a Planetree Affiliate
The Health & Healing Library is located at 2040 Webster Street, near the corner of Sacramento Street, in San Francisco. Ask about their Personalized Research Service. A fee will be charged for this service.

Telephone: (415) 600-3681
Hours: 11:00 a.m. to 5:00 p.m., Monday through Friday, Noon to 5:00 p.m. on Saturdays

Visit these Web Sites:

Are You at Risk for a Heart Attack?
Use this interactive tool to measure your chance of having a heart attack in the next 10 years.

Produced by the Center for Patient and Community Education in association with the staff and physicians at California Pacific Medical Center. Last updated: 11/04

References: Lexi-Comp Inc. (1978-2004). Coumadin (Wafarin). Retrieved November 14, 2004 from www.crlonline.com/crlonline. American Dental Association (1995-2004). Preventitive Antibiotics and Your Dental Health. Retrieved October 1, 2004 from www.ada.org/public/topics/health_oral_faq.asp. Opie, L. (2001). Drugs for the Heart (pp. 296-302). Philadelphia: WB Saunders Company.

© 2002-2008 California Pacific Medical Center

Funded by: A generous donation from the Mr. and Mrs. Arthur A. Ciocca Foundation.

Note: This information is not meant to replace any information or personal medical advice which you get directly from your doctor(s). If you have any questions about this information, such as the risks or benefits of the treatment listed, please ask your doctor(s).

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