Cardiac Coronary Artery Bypass Surgery (In-depth)
Coronary Artery Bypass Graft Related Issues
Preface
We have found in our clinical work over the years that many patients with coronary artery disease and those who have had bypass surgery do not know much about coronary artery disease and bypass surgery. If patients do not understand the disease they are suffering from and are not familiar with the surgery and some common problems after the surgery, it will not only increase the patients’ unfamiliarity and fear of the surgery, but also create worries about a series of problems such as postoperative treatment and care, which will have a very great negative impact on the patients’ preoperative and postoperative psychology. Therefore, we have summarized some questions frequently raised by patients in clinical practice and edited a series of health education materials, hoping to be helpful to patients and their families.
What is coronary heart disease?
If the coronary arteries become spastic, organically narrowed or blocked, it will cause myocardial ischemia or even necrosis, which is called “coronary heart disease”, also known as “ischemic heart disease”. Clinically, patients may experience angina pectoris, myocardial infarction, heart failure, arrhythmia and sudden death.
So how does coronary heart disease develop?
Atherosclerosis is the most important cause of coronary artery stenosis. Lipids, cholesterol and other substances are gradually deposited in the inner wall of blood vessels, forming lipid plaques that gradually thicken the inner layer of the vessel wall, narrowing the lumen, stiffening the wall and reducing blood flow through it. This pathological process is called “atherosclerosis” and usually begins in childhood and continues throughout a person’s life. This is also the reason why many patients have preoperative carotid ultrasound examinations that reveal sclerotic plaques or even stenosis in the carotid or vertebral arteries.
As the plaque gradually increases and thickens, it may block the coronary artery and gradually reduce the blood supply to the heart. When the plaque blocks 70% or more of the diameter of the coronary artery, ischemia and hypoxia will occur in the heart muscle, manifesting as chest pain, chest tightness, breath-holding and discomfort in the precordial area, which is called “angina pectoris”. It can be relieved by rest or sublingual nitroglycerin, and can also occur at rest in severe cases.
Many patients say that they have never had angina, but only some chest tightness or “unexplained discomfort” in the precordial region, so how can they have angina? In fact, the attack of angina is not necessarily “pain”, most people do not “pain”, only the above-mentioned “chest tightness, discomfort”, and some patients manifest as Some patients have “stomach pain”, “toothache”, “throat discomfort”, etc. Some patients even have no symptoms at all, but only find that they have an abnormal ECG or cardiac ultrasound during physical examination, and then have a coronary artery It is only after a coronary angiogram that a serious coronary heart disease is discovered. No matter how different the symptoms are, coronary angiography is the “gold standard” for diagnosing coronary artery disease, and if there is a problem with the angiography result, it is coronary artery disease.
Then, the plaque may rupture and form a thrombus, causing an acute occlusion of the coronary artery, called an “acute myocardial infarction”. Patients may experience persistent chest pain or discomfort in the precordial region, radiating to the back, left forearm or throat, which cannot be relieved by rest or sublingual nitroglycerin.
The coronary arteries are divided into the left coronary artery and the right coronary artery, of which the left coronary artery divides into the anterior descending branch and the gyrus branch after the shorter left main stem. What we usually call “triple lesion” refers to the narrowing of the anterior descending branch, the circumflex branch and the right coronary artery. Why is the “left trunk lesion” considered to be more severe? As you can see from the diagram below, the left main stem (the location of the “left coronary artery” in the diagram below) is located at the source of the left coronary artery, just like a blocked water source dries up all areas downstream.
What is coronary artery bypass surgery?
A “bypass” is to take a blood vessel from another part of the patient’s body, such as the saphenous vein, radial artery or internal mammary artery, and use it as a “bridge” to create a new channel for the blood supply to the heart, crossing the narrowed part of the coronary artery and anastomosing it with the distal vessel, so that This allows the oxygen and nutrient-rich blood in the aorta to bypass the stenosis and reach the distal end, so that the ischemic myocardium at the distal end of the stenosis can be supplied with blood again, fundamentally solving the problem of myocardial ischemia. Coronary artery bypass grafting has an “immediate” effect on the relief of angina. Depending on the patient’s preoperative condition, many patients are able to walk up and down stairs within a few days of coronary artery bypass grafting. If they recover well, they can go out on the street after a week. One to two months after surgery, they are able to perform light work. In 3 to 4 months after surgery, the patient is basically recovered.
Coronary artery bypass surgery is the most effective and reliable method for the surgical treatment of coronary artery disease, with a success rate of 98% or more. It can effectively relieve the patient’s angina, improve the patient’s mobility, improve the quality of life, and reduce the occurrence of myocardial infarction, malignant arrhythmia and sudden death, and prolong the patient’s life expectancy.
Does bypass surgery prevent angina from recurring afterwards?
Coronary artery bypass surgery only solves the patient’s current myocardial ischemia problem, but does not completely cure coronary artery disease, nor does it prevent the further development of coronary atherosclerosis, that is, after bypass surgery, the original non-stenosed blood vessels and the bridged blood vessels may become stenosed or blocked again, resulting in the recurrence of angina. However, the chances of such recurrence are very low.
The time interval for restenosis to occur varies from person to person. It is mainly related to the combination of other underlying diseases and the extent of the coronary artery itself, with restenosis occurring within a few months after surgery in a very small number of patients and extending to several years or even decades in the majority of patients. Therefore, long-term medication is still required after coronary artery bypass surgery. Active control of susceptibility factors for coronary artery disease, such as smoking, excessive alcohol consumption, obesity, hyperlipidemia, diabetes, and hypertension, can effectively prevent further development of coronary artery disease and avoid recurrence of angina.
It is generally believed that the 10-year patency rate of venous bridges is 60%, and the long-term patency rate of arterial bridges will be even higher. However, the number of arteries available for bypass in the human body is limited, and some arteries are not suitable for bypass because they are prone to spasm, have too thin lumen or have lesions. Even if a blockage of the bridge vessel occurs, there is no need to worry too much, some patients have 4 bridges, postoperative blockage of 3, only one artery bridge is open, it is not necessarily life-threatening. And with the development of medical technology, even if angina recurs, there are corresponding treatment measures to cope with it, such as putting stents in the bridge vessels, or operating again, etc..
Will taking a blood vessel from the leg to bypass affect the function of the lower limb?
The saphenous vein, the longest superficial vein in the body, extends from the ankle to the base of the thigh. It is one of the most commonly used “bridge” vascular materials for coronary artery bypass surgery because of its small curvature, sufficient length, and matching caliber to the coronary arteries. The human body has two sets of venous return systems in the lower extremities, the deep veins and the superficial veins, and there are abundant traffic side branches between them. After removing the superficial vein, that is, the saphenous vein, the deep and superficial veins will be more abundant after a long enough time of recovery, which will have a compensatory effect on the venous blood return of the lower limbs and will not affect the motor function of the lower limbs.
Why does the leg swell and numb after blood vessel extraction?
As mentioned in the previous question, since the saphenous vein is removed from the leg, the venous blood that originally needs to return through the saphenous vein needs to return through the deep veins to establish a new collateral circulation, and this process takes a period of time, usually several months. During this time, the lower extremity from which the vein was removed will have varying degrees of swelling. Frequent elevation of the affected limb can promote blood return to eliminate swelling. Wearing a high tension medical long elastic stocking when walking down can reduce the swelling to some extent, but do not wear it for a long time and take it off when lying down.
In addition, since obtaining the saphenous vein requires cutting the skin as well as the subcutaneous tissue, the nerves and lymphatic vessels in this area will be cut and damaged, so there will also be different degrees of numbness after the surgery, which is normal and need not be worried.
There are two methods to take the saphenous vein: one is the full incision method: depending on the length of the saphenous vein needed, the skin is taken in the lower leg by the full incision method, which usually requires an incision of 20 to 40 cm long. The trauma is relatively large, the swelling of the leg is more pronounced after the surgery, there is a certain chance of infection, and the scar growth may cause discomfort to the patient and affect the aesthetics, and the postoperative swelling should be longer. The mobility of the lower limbs remains unaffected after surgery. It is the most commonly used method in China because of the simple method of extraction.
Another method is the minimally invasive endoscopic extraction of the saphenous vein. It is to make 2 to 3 small 1-2 cm long holes in the lower leg and use an endoscope with special instruments to separate and completely remove the saphenous vein in the subcutaneous tissue. While ensuring the quality of the vein, it greatly reduces trauma and decreases the chance of swelling, skin numbness, necrosis and infection in the patient’s lower extremity after surgery. It reduces postoperative incision pain, inconvenience of movement, faster healing, and is more aesthetically pleasing. This method is more widely used in Europe and the United States.
What preparations are needed before bypass surgery?
First, the necessary preoperative tests are performed, including blood tests, electrocardiogram, chest X-ray, cardiac ultrasound, carotid ultrasound and coronary angiography, and other special tests if necessary. Secondly, oral anticoagulants, such as Bolivar, need to be stopped before surgery and wait for a certain period of time. Wait for these drugs to be metabolized and eliminated in the body so as not to increase the risk of bleeding, with the exception of emergency surgery. It is also necessary to reduce activity, rest in bed, avoid mental tension, emotional excitement, etc. Do not eat too much to force bowel movements, keep bowel movements unobstructed, and if necessary, medication can assist in bowel movements. Also, in order to prevent postoperative respiratory complications, you should quit smoking, practice deep breathing and coughing movements, and avoid catching a cold. Get a good night’s sleep and take sleeping pills if necessary. It is very important that you tell your supervising physician if you have had other surgeries or taken other medications before, and if you have had other illnesses such as glaucoma, peptic ulcers, severe hemorrhoids, brain embolism, etc.!
How is the bypass surgery performed?
Coronary artery bypass surgery is performed by taking a section of an autologous saphenous vein or other blood vessel located in the leg and bypassing it between the aorta and the distal end of the blocked lesion of the coronary artery (see exhibit in the ward) so that blood from the aorta is supplied to the distal end of the coronary artery through the grafted vessel to restore blood supply to the corresponding myocardium, improve myocardial ischemia, and relieve angina symptoms. Simply put, a channel is created between the proximal and distal ends of the narrowed coronary artery so that blood bypasses the narrowed area and reaches the distal end. The whole procedure usually takes about 4 hours, and the patient is under general anesthesia and sleeps during the procedure without any discomfort. After the procedure, the patient will be taken to the monitoring room for further treatment. In the care unit, medical staff will be at your side 24 hours a day to monitor your condition at all times.
When can I wake up after cardiac surgery?
Most of the cardiac surgeries are performed under general anesthesia. In general, patients will gradually wake up after 6-8 hours after surgery, depending on their age, circulatory status, operation time, metabolic status, liver and kidney function, etc. Some patients may wake up slowly, but please do not worry. Very few patients may have brain complications and may take a longer time to fully awaken.
How will I feel when I wake up after surgery?
When you wake up after surgery, the patient will already be in the intensive care unit. The patient will feel unconscious, have a feeling of wanting to move, and will have a feeling of thirst. Due to the general anesthesia, the patient has not recovered his or her voluntary respiratory function at first and needs a ventilator to help him or her breathe. There is a tube in the mouth called “tracheal intubation”, which can be very uncomfortable, but most of them can tolerate it. In addition, in the early postoperative period, patients cannot urinate on their own, and a catheter is placed in the urethra to drain the urine produced. It is normal for the catheter to cause a little irritation to the urethra, causing the patient to feel a sense of holding and wanting to urinate. This is normal. The catheter can be removed when the patient can control urination on his own. Also, when the patient wakes up, you will be noticed by the medical staff immediately and they will communicate with you, such as calling your name, opening your eyes, nodding your head, shaking your hand, lifting your leg, etc. If you are able to hear clearly, please ask the patient to shake your hand. If you can hear clearly, please try to cooperate and respond, so that we can make an accurate judgment of your state of consciousness. The discomfort mentioned above will disappear soon and is an integral part of the whole treatment process.
Many patients are concerned about the pain of the incision when they wake up from anesthesia. Please rest assured that you and your family will be treated according to the patient’s pain level, and if necessary, continuous pain treatment (analgesic pump) can be administered to reduce the patient’s postoperative pain discomfort.
What should I pay attention to when I get out of bed for the first time after surgery?
Before getting out of bed for the first time after surgery, it is necessary to sit at the bedside for a while to adapt to the situation, and not to transition directly from lying down to getting out of bed, so as not to cause dizziness, panic and other discomfort. The first time you get out of bed, you should not go out of the ward, but only stand at the bedside or walk slowly along the bedside with the help of your family, and the duration should not be too long, usually 5-10 minutes. If there is discomfort, you need to sit down and rest or lie down in bed in time. If the patient feels well, he/she can walk in the corridor of the ward, but if he/she is going to the toilet, he/she must be accompanied by a family member. In addition, the patient needs to check all kinds of tubes and wires connected to the patient’s body, especially the pacemaker wires, before getting out of bed, and never pull them. Pacemakers must be protected from damage due to falls. Some patients have their heart rate paced entirely by the pacemaker in the early postoperative period, which can have serious consequences if damaged.
Do I need to take long-term medication after bypass surgery?
Coronary artery bypass surgery only solves the patient’s current heart ischemia problem and relieves angina pectoris. It does not change the causative factors of coronary artery disease, such as obesity, hyperlipidemia, diabetes, etc. Therefore, long-term regular medication is still required after bypass surgery. For example, lifelong aspirin; long-term lipid-lowering drugs are needed according to lipid control; good control of blood pressure and blood sugar; nitrates need to be taken for 3 months and continued or discontinued according to the recovery of symptoms after surgery; betalactam sometimes needs to be taken for a long time; and so on. The adjustment of dose or discontinuation time of these drugs should be reviewed at the hospital and adjusted by the doctor for you, do not stop the drugs by yourself. Some drugs have contraindications or interactions with each other, so when you take other drugs, you are also recommended to go to the hospital and use them under the guidance of your doctor. Medication is the basic treatment for coronary heart disease and needs to be maintained for a long time.
What should I pay attention to in my diet after bypass surgery?
During the recovery period after coronary artery bypass surgery (usually within 1 month after the surgery), it is usually necessary to increase the intake of calories, protein and vitamins to promote the recovery as soon as possible after the surgery. After this period, however, dietary management of hyperlipidemia is a long-term task for patients with coronary artery disease. This is because coronary artery bypass surgery only treats myocardial ischemia caused by blocked coronary arteries, but not the cause of coronary heart disease. Therefore, in terms of diet, attention to control hyperlipidemia is one of the important measures to prevent and slow down the re-clogging of coronary arteries or after surgery.
Can I turn over after heart surgery?
Many patients are afraid to turn over because of the incision in the chest after surgery, and their bodies are very stiff, and their families are unable to help them. After cardiac surgery, whether it is a median incision or a lateral incision, patients can rest in bed in the supine position, or in the left-sided or right-sided position, and can change positions. However, it should not be excessive, and must not frequently turn over, get up and sit down, etc. This will increase the force on the chest incision and affect the healing of the incision. In addition, there will be 1-3 drains in the chest early after surgery to drain the blood left in the chest cavity. Patients should be careful to avoid pulling these tubes when turning over.
After being discharged from the hospital, patients can turn over when resting in bed and choose a more comfortable position to help them sleep.
Post-operative incision problems are very common and most easily detected, and there are more inquiries, so we will answer them in detail here.
In cardiac surgery, the incision is usually made in the middle of the chest, but there are also incisions on the side of the chest, and in the case of bypass surgery, there is also an incision on the leg to take the saphenous vein, and so on.
It is normal to have mild redness, numbness, abnormal sensation, swelling, and even pain around the incision after surgery, and these symptoms will gradually disappear as the skin and subcutaneous tissue heal. In the early postoperative period, if there is pain around the incision, you can take painkillers to relieve the symptoms, and you can also take sleeping pills to improve sleep, which have no effect on the healing of the incision.
In patients with a median chest incision, the sternum is sawed through the median during surgery and is re-fixed with wires after surgery. Generally, the sternum can heal completely more than three months after surgery, and older patients or patients with diabetes will take longer to heal. In the early post-operative period, if the patient does not pay enough attention to the activities, such as supporting the body with one hand, holding a child, moving furniture or lifting heavy objects, which loosens the fixed sternum, the patient will feel a “thumping” sound in front of the chest when moving the upper limbs or coughing, which is called “bone rubbing sensation “In severe cases, the wire can cut off the sternum, resulting in non-healing of the incision or even infection, requiring a second operation. Therefore, it is very important to actively prevent sternal loosening and cutting in the early post-operative period. So how to prevent it?
In the ward missionary video, we introduce the correct coughing method for post-operative patients. When coughing, patients should put their hands over the forehead, clench both upper arms to the thorax, and clench their arms hard while coughing, which can reduce the impact of coughing action on the chest incision. In addition, the patient lies down and sits up, there must be a family member to help, if two family members, two people holding the patient’s shoulders and hands can; if a family member, the family member holds the patient’s hands in one hand, placed in front of the patient’s chest, the other hand on the patient’s neck against the lower position, the patient’s hands while holding the family member’s hands, symmetrical force, it can help the patient sit up, lying down also.
If you feel the thumping sensation mentioned above, you should pay extra attention to it. You must strictly limit the movement of the upper limbs and tighten the chest strap so that you can feel the tightness when you inhale in principle, but it will not affect your breathing. You should also inform your doctor about your sensations in a timely manner. If you find that the gauze wrapped around the chest incision has become soaked with ooze, you should also inform your doctor promptly.
The doctor will check the healing of your incision and remove the stitches before the patient is discharged from the hospital, usually 7-9 days after the surgery. The 7-9 days after surgery can only determine the initial healing of the incision and cannot ensure that there are no problems later. You need to keep the incision gauze for 1 day after you go home, and continue to keep the incision and the surrounding skin clean and dry. If you sweat a lot, you need to go to the hospital in time to change the gauze and observe whether there is new redness around the incision, whether there is water or pus flowing, etc. There may be threads coming out after a long time. In these cases, there is no need to panic, you can contact your doctor in charge or go directly to the hospital for examination. Do not treat the wound yourself to avoid increasing the risk of infection. If the scab has not fallen off yet, do not force it off, just leave it to fall off naturally. If the incision is uncomfortable with the chest band, you can wear a body shirt without buttons to reduce the direct friction between the chest band and the incision.
Neck lump above the chest incision: Many patients will find that after open-heart surgery, a piece of skin under the neck will be more prominent, and it is a soft feeling to press up with hands, and the pain is not very obvious, which is a normal phenomenon. What is not normal? If you find that the swelling in this position is getting stronger day by day, and it is not soft when you press it, but there is a certain tension, like there is water inside, and even there is tenderness, then you need to go to the hospital for examination in time.
Shoulder and neck pain: In addition, many patients will have pain in the shoulder, back, neck and forehead after they go home from the hospital, and the performance is different depending on the individual’s feeling. Patients need to adjust the tightness of the chest belt, sleep position, reduce the time of bed rest, appropriate indoor walking activities, adjust the mentality, etc. There is no need to worry too much about this. If the pain affects sleep, you can take painkillers or sleeping pills to help you sleep. If the pain is uncomfortable for a long time or gradually worsens, you need to go to the hospital in time.
Scar: Some patients have keloid, the scar is very obvious after the healing of the chest incision scar, higher than the surrounding skin, forming a protrusion, the protrusion of the scar and clothing friction, it will lead to pain, stabbing pain-like feeling. In such a case, try to wear cotton underwear without buttons to reduce friction. No special treatment is usually needed.
Leg swelling: Bypass patients will experience varying degrees of swelling in their legs after blood vessel removal, requiring 2-3 months or more to recover. In the early stage of surgery, patients need to raise the lower extremities too high 20-750px when lying in bed to promote lower extremity venous return, reduce lower extremity swelling and promote incision healing. If the edema is not eliminated for a long time, it can lead to malnutrition of the incision, non-healing, or even cracking of the incision due to excessive skin tension, leading to infection, etc. Diabetic patients, in particular, should pay attention. Or use medical elastic stockings, put them on when moving down and take them off after lying in bed, avoid wearing them for a long time.
Thread problem: Both chest incisions and leg incisions are closed with sutures. Considering the material and tension of the sutures, only the shallowest layer of intradermal tissue is made with absorbable sutures, and the sutures used in the tissue below the skin are not absorbable. This part of the suture may be displaced to the subcutaneous as the tissue heals, especially the knotted part, which may be visible to the skin. There is no need to worry about this situation, it can be treated promptly at our hospital or local hospital, and it will grow back in 1-2 days. Individuals do not pay attention to it, infection and pus around the threads will occur, do not squeeze it by yourself, you must go to the hospital for disinfection and medication change to avoid aggravation or spread of infection.
About chest pain need to pay attention to the problem: general pain around the incision, there is pressure local pain, sitting position for a long time when getting up, there is a chest incision out of the pulling pain, these are normal phenomena. If the post-operative chest pain is similar to the pre-operative chest pain, or if the chest pain is related to activity and exertion, it is necessary to pay attention to it, and it is better to go to the hospital for consultation.
When can I take a shower after heart surgery?
If the wound has healed, you can start bathing, usually after 2 weeks after surgery, when the scabs on the chest incision have faded and there is no redness, swelling or oozing from the incision, you can take a shower. Do not immerse the wound directly in the bathtub or swimming pool until your doctor has given you permission. Do not use excessively hot water, which can cause dizziness, and avoid spraying the wound directly with high velocity water. Do not rub the wound, use neutral soap when cleaning the wound, be gentle and then gently dry the wound with a dry towel. This is also a good time to check for changes in the wound and to contact the physician promptly if there is any redness, swelling, or oozing. Patients with bridgework may have a slow recovery of the leg wound, with crusts generally not receding until 3-4 weeks after surgery, or longer in some cases, and steps should be taken to protect the incision from immersion when showering. If the incision is still oozing, red and swollen, or the crusts have not faded, please do not shower to avoid infection and contact your doctor or follow up with him/her promptly.
How can I exercise after cardiac surgery?
You should be as active as you are able to be after heart surgery to help with early recovery. Initially, you can walk around the room and the house, holding on to something while walking. Then, when you feel no difficulty, you can start walking, which is a good and effective exercise method. This method can improve blood circulation and increase the strength of muscles and bones, and start walking at a speed and pace that feels comfortable. Later, gradually accelerate the pace to increase the heart rate and breathing rate. Can be three times a day, five minutes each time, starting with a comfortable walk, and then gradually increase the time and distance of the walk, to be able to tolerate themselves, more walks a day, than a long walk is more beneficial, adhere to the daily walk, and the daily walk distance gradually increased, as long as it can be tolerated, you can slowly go up the stairs, up a small hill, in the process of movement and exercise, if the chest pain It should be stopped immediately, shortness of breath, asthma and fatigue should also be stopped immediately, if these symptoms disappear, you can continue the activity at a slower pace, and then increase day by day. Fatigue is inevitable until you have fully recovered your strength. You may feel your heart beating very strongly when you are active, but as long as the heartbeat rules are not particularly fast, this is normal and should not be a concern. In a few cases, some people feel a sudden loss of control of their heart or a fast heartbeat, and may feel mild dizziness, weakness, and irregular pulse. If any of these conditions occur, please contact your doctor. Here are the training recommendations.
Week 1: Two five-minute walks per day.
Week 2: Two ten-minute walks per day.
Week 3: Two twenty-minute walks per day.
Week 4: This should be increased to one kilometer of walking per day.
During the winter or hot summer months, it may not be possible to walk outdoors. If this is the case, you can rent or buy an indoor bike or exercise machine and exercise twice a day for 30 minutes each time, which can replace your exercise outdoors, and you can walk slowly on your jogger (exercise machine).
Can I drink alcohol after heart surgery?
It is not possible to say absolutely whether drinking alcohol has a good or bad effect on a heart patient. It is possible to drink alcohol in moderation, but patients with diabetes, high triglycerides or poor heart function should avoid drinking alcohol altogether, as it can aggravate pre-existing conditions. Patients taking warfarin for valve surgery should never drink large amounts of alcohol, as large amounts of alcohol can increase the burden on the heart and can also affect liver function and have an impact on warfarin metabolism, thus affecting the anticoagulant effect. If none of these problems exist, you can still enjoy a small glass of wine before meals or at bedtime, but you are better off limiting your drinking to one glass of wine or one glass of beer twice a day. In addition, alcohol still has a harmful effect on the major organs of the body. Since alcohol increases the side effects of sleeping pills, do not mix sleeping pills, sedatives and alcoholic drugs if you are taking them.
If you can walk at a moderate speed and climb stairs easily, or climb 2-3 flights of stairs without any discomfort, you can resume sex, but you must remember that it takes about three months for the sternum to heal, so during this process you should Take care to protect them from compression of the sternum. You should pay attention to whether you experience pain and shortness of breath, fatigue or feel abnormal heartbeat, such as significant changes in heart rate and rhythm, and if these symptoms appear, you should stop the activity immediately and go to the hospital. You should clearly know that coronary atherosclerotic heart disease does not affect your sexual organs and sexual function in the slightest, therefore, heart disease does not cause diminished sexual function in men or women, however, patients with this heart disease, accompanied by other classes of vascular disease or taking certain drugs which can interfere with normal erection or cause impotence, you suffer from heart disease and cause psychological stress, which can also cause you in terms of sexual function The psychological stress caused by your heart disease can also cause you to malfunction sexually. Neither you nor your sexual partner should feel stressed about the process, and you should allow yourself plenty of time to adjust in a step-by-step manner. Generally speaking, returning to normal life requires a good mental state and a good physical state.
When should I join the workforce after surgery?
Returning to work depends on how well you recover your energy and strength after surgery. Avoid making major decisions, such as those regarding investments, finances, work, family, etc., for at least one month after surgery.