Be Young At Heart: Tips, dos and don'ts

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Our Cardiac Sciences department provides the international “Heart team approach” followed by leading cardiac institutions across the world. Situated on the 8th floor of the OPD facility, the department provides access to arguably the best cardiologists in Mumbai. For more information visit us on https://bit.ly/2MXUQTQ

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29.10.14 Hinduja Healthcare Surgical • 11 th Road Khar W Mumbai 52. For Appointments: +91 22 3091 8989/6154 8989 • For Enquiries: +91 22 6174 6000/2646 9999 For Emergency: +91 22 6174 6098/99 • www.hindujahealthcare.com BE YOUNG AT HEART Tips dos and donts and lifestyle advice to keep your heart in good shape Learn more by participating in our Heart Disease Risk Factors Assessment.

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What is to be done after completion of Chemotherapy Risk factors are all traits and lifestyle habits that increase chances of a heart attack. The deposition of cholesterol and other substances on the inner lining of artery walls marks is the precursor to heart diseases. They form plaques that block the smooth flow of blood to the heart. To reduce the chances of heart diseases it is important to decrease the progression of plaque formation and control all risk factors that speed up the development of plaque. Risk factors that can lead to heart diseases are: Risk factors you can control or change / Modifiable risk factors: WHAT ARE THE RISK FACTORS FOR HEART DISEASE Risk factors that you cannot change / Non modifiable risk factors: Since you cannot control these risk factors it is especially important to make the necessary lifestyle and diet changes to reduce risks. Age: The incidence of atherosclerosis increases as we get older. Sex: Men have a tendency to develop atherosclerosis at a higher rate and at a younger age than women. However post menopause females are likely to get heart disease as their body’s production of estrogen drops. Heredity: A family history of Coronary Artery Disease puts you at increased risk for developing it. Elevated Cholesterol Levels High cholesterol levels directly increases the risk for heart diseases. Excess cholesterol gets deposited in the walls of the arteries reducing the supply of blood to the heart. The most important constituents of cholesterol are LDL bad cholesterol and HDL good cholesterol. In general it is recommended that your total cholesterol should be less than 200mg/dl. Whereas HDL should be higher than 40mg/dl in men and 50mg/dl in women and LDL should be less than 100mg/dl in adults. Cigarette Smoking / Tobacco Chewing People who smoke a pack of cigarettes a day or consume any tobacco product have more than twice the risk of heart attack than non-smokers or non tobacco users.Smoking increases risk of heart diseases by accelerating the development of plaque in the arteries decreasing the level of the good HDL cholesterol and increasing the stickiness of blood cells creating blood clots inside the arteries. The risk of heart disease begins to significantly drop as soon as you quit smoking or stop using tobacco. High Blood Pressure High blood pressure or hypertension is often referred to as the “silent killer” since people often are unaware that their blood pressure is high. Systolic pressure higher than 140 mm of mercury and diastolic pressure being over 90 mm of mercury is considered as hypertension. Regular cardio exercise and reduction in the intake of salt is the first step to control high blood pressure. Depending on your individual health and stress level your doctor might put you on medication to lower the BP. Generally normal BP is 120/80 or less for people of all ages. Diabetes Diabetic patients are twice as likely to have heart diseases. Indians have one of the highest genetic risks for diabetes and therefore are at a higher risk of developing heart diseases. Diabetes can be controlled through healthy diet regular exercise weight control and medication. Other than increasing the risk for heart diseases diabetes also aects the eyes kidneys and blood vessels.Normal fasting blood sugar level is 70-110 mg/dl. Physical Inactivity Sedentary lifestyle and physical inactivity increase the risk of heart diseases. Even 30 minutes of aerobic exercise or activities like gardening or household work can significantly reduce the risk for a heart attack. Obesity Obesity puts you at higher risk for heart diseases. Besides obesity can induce diabetes increase high blood pressure raise cholesterol levels as well as other complications like arthritis. Eating right and regular exercise is the best way to control and maintain weight in the long-term. Stress While a direct relationship between stress and the risk of heart disease has not yet been clearly established by medical sciences yet high levels of stress increases risk factors like blood pressure and cholesterol. Stress levels can be controlled by yoga exercise and relaxation techniques. STRESS 1 2

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Excessive fatigue that lasts more than an hour post exercise. Chest neck jaw teeth shoulder or arm pain that seems unusual. Remember you may experience some discomfort in the chest due to the fact that your breastbone sternum was cut during surgery and requires 6-8 weeks to heal completely. Excessive shortness of breath. Dizziness or nausea. Ankle swelling or increase in weight. Heart rate over target. Skipped heartbeats that appear more frequently than usual. Joint muscle or ligament pain/problems. Not have much appetite. You may experience that your sense of taste is diminished or absent. Have constipation problems. Consult your doctor who may prescribe some laxa- tives if required. Have diculty in sleeping at night. However avoid sleeping during the day as this will aect your sleep pattern. Experience several mixed emotions. It is quite normal after surgery to have feelings of anxiety sadness or depression. However if these emotions trouble you and prevent you from sleeping consult with your doctor who may put you on medica- tion. Have a little lump at the top of your incision. This will disappear with time. PRECAUTIONS TO TAKE POST HEART SURGERY IT IS PERFECTLY NORMAL TO Notice an occasional "clicking noise" or sensation in your chest in the first days after surgery. This should occur less often with time and go away completely within the first couple of weeks. If you have an incision in your forearm you may experience numbness in the fingers. Experience muscle pain or tightness in your shoulders and upper back between your shoulder blades. Your pain medicine will also help relieve this discomfort. Have swelling in your feet especially if you have an incision in your leg. The swell- ing should decrease when you elevate your leg but it might re-occur when you stand. If you continue to have leg swelling or it becomes worse notify your doctor. DO NOT exercise or STOP exercising if you note any of the following: Caring for your wounds. Taking your medicines. Improving your heart and lung health. Making changes in your lifestyle. Follow the instructions given for your wound care by your doctor at the time of discharge. Your surgeon will want you to make a follow-up appointment to check your progress. The date and time of your follow-up appointment will be on your discharge instructions sheet. Do not apply oils creams and powders on your incision unless prescribed by your surgeon. Check your incisions every day. Notify your doctor if you notice any of the following: 1 Increased redness swelling of /around the incision site. 2 Drainage from the incision site. 3 Persistent fever. SETTLING AT HOME SHOWERING You can start showering once the sutures are removed or as instructed by the surgical team at the time of removal of the sutures. Until then you may clean your body using a sponge dipped in water and soap. CARING FOR YOUR WOUNDS: You have several responsibilities while you are recovering from Coronary Artery Bypass GraftingCABG/Open Heart Surgery. BREATHING EXERCISES As instructed by the physiotherapist continue to do your breathing exercises after your discharge. Coughing and deep breathing are important to prevent infection in your lungs 3 4

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A heart healthy diet focuses on adding more healthy foods to your diet and cutting on foods that are not good for you.Heart healthy food helps to curb the progression of the heart disease and also to maintain healthy weight. It is part of a heart healthy lifestyle that includes regular activity and not smoking. You are bound to feel weak experience easy fatigability or chest soarness as a result of your surgery but you can work your way back up to normalcy by participating in a structured cardiac rehab program Eat more fruits and vegetables and other high fiber foods. Choose foods that are low in saturated fat transfat and cholesterol. Eat at least 2 servings of fish each week. Oily fish which contains Omega 3 fatty acids are the best. If you can not eat fish you can also get Omega 3 fats from eggs walnuts flax seed and canola oil. Limit salt alcohol and sugar. Avoid climbing stairs for the first few weeks post surgery. However if you must take the steps then climb up slowly and gradually taking a break for a few seconds after every few steps. Pay attention to your body’s clues - if you feel breathless and need to take a longer break go ahead and do so. After complete recovery it’s a good idea to climb steps as part of your everyday activity. Cardiac RehabilitationRehab program can start in the hospital or as soon as you go home after surgery. Cardiac rehab helps you recover and teaches you how to be more active and make lifestyle changes that can lead to a stronger heart and better health. Cardiac rehab can help you feel better and lower your risk of future heart problems. A cardiac rehab team consists of a cardiac surgeon/physician a dietician an exercise therapist and a physical therapist. The team designs a program just for you based on your health and goals. Then they give you support to help you succeed. ATTENDING CARDIAC REHABILITATION: Your physician/cardiac surgeon along with the exercise therapist will help you design a rehab plan. The following is a general guideline for increasing your exercise: Spread your walks throughout the day. Gradually increase the duration and distance of your walks. Stop and rest if you are tired or feel any unusual discomfort. Preferably do not walk alone. Do not overdo. CLIMBING STAIRS Lifting Do not lift anything heavier than 3-4kgs for 6 weeks. Heavy lifting can cause the bone in your chest to separate and prevent it from healing. Avoid pushing/pulling heavy objects or working with your arms overhead. These activities disproportionately elevate blood pressure and put added strain on a healing heart. Travel The best way to travel is by car but do not drive yourself. Do not travel by public transport for the first few weeks. While sitting in the car keep a pillow with you to cover your chest region. If a seat belt is present please use it. If you live outside the city and need to travel home ask your doctor when you will be able to do so.In cases of long distance travel take 15 minutes break hourly to avoid exhaustion. Driving Avoid riding bike/3 wheelers for about 3 months.You may start driving 4 wheeler after about 8 weeks of surgery post consultation with your surgical team/cardiologist. YOUR CHEST Your surgeon may cut through your chest bone or sternum to perform your CABG Surgery. Unlike other bones in your body your sternum cannot be placed in a cast while it heals. Instead your surgeon wraps heavy wire around it to hold the edges together. The sternum can heal properly only if the ends are held together constantly for several weeks. Therefore following care needs to be taken while: PLEASE NOTE: If your ejection fraction is on the lower side less than 40 consult your doctor or cardiac rehab specialist before initiating stair climbing. SOME TIPS FOR GETTING BACK TO FITNESS POST CABG/ OPEN HEART SURGERY EAT HEART HEALTHY DIET A few simple Ideas 5 6

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