A New Beginning 2012-7 - UHSM

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What are the risks and complications of Coronary Artery Bypass Grafting? You will have a chance to discuss your individual risk and possible complications with your surgeon. CABG surgery, like any other surgery, carries a risk of complications. The risk of complications varies for each person and will depend on several factors including: • your age and sex • whether you are having additional surgery at the same as your CABG • whether you have diabetes, lung problems, kidney damage or any significant problems with the circulation to your brain or legs • the urgency of the operation • your weight • whether you are a smoker and/or a heavy drinker. Your surgeon will take the above factors into account when assessing your individual risk. Possible complications • Bleeding – you may need to be taken back to theatre to treat excessive bleeding. • Infection – this may involve one of the wounds (chest, leg or arm), or the lungs, and will be treated with appropriate antibiotics depending on the severity of the infection. • Heart attack – on rare occasions during surgery the heart can suffer a heart attack. • Kidney problems. Bypass surgery can affect your kidney function. If you have any problems, you will be referred to a specialist. • Stroke – which may be temporary or permanent. A member of the surgical team will ask you to sign a written consent form for the operation to be carried out. Your surgeon will discuss the risks, benefits and alternatives for you as an individual. If you have any questions, please talk to the doctor before you sign the consent form. What is heart valve disease? Your heart has four valves. They ensure that blood is pumped in one direction only within the heart and towards the lungs and body. These valves can be damaged in many ways; for example be abnormal from birth, after rheumatic fever, from wear and tear or following a heart attack. There are two main types of valve problem: • the valve may become narrowed (called stenosis), which causes a block to normal blood flow • the valve may become leaky and allow blood to flow in the wrong direction called regurgitation. In both cases the heart has to work harder and eventually surgery may be necessary. The drainage of blood from the lungs to the heart may be affected. This will result in a build up of fluid on the lungs and cause breathlessness. The drainage of blood from the rest of the body to the heart may also be affected causing swollen ankles. Chest pain, palpitations and dizziness may also be experienced. How much omega-3 fats do I need to eat each week? • If you’ve had a heart attack aim for 2 - 3 large servings of oily fish per week • Everyone else should aim for one serving of oily fish and one serving of white fish per week • A serving is roughly 100 -150g (4 - 6oz) of fresh, frozen, or smoked fish • To help lower salt intake, keep smoked fish to no more than once a week. I do not eat fish, how do I get omega-3 fats? • Your body can convert a type of fat called alpha-linolenic acid (ALA), into small amounts of the more useful omega-3 found in oily fish. • To help your body convert as much omega-3 fats as possible from plants, it is important to eat a varied mixed diet with plant rich sources daily. − − − − − rapeseed, walnut, soya, flax or linseed oil ground or crushed linseeds, flax or pumpkin seeds unsalted nuts e.g. walnuts, pecans, peanuts, almonds soya beans and tofu dark green leafy vegetables, sweet potato and whole grains • Some foods have omega-3 added to them e.g. eggs, milk, yogurt and yogurt drinks. Omega-3 contents vary greatly, so check labels. Should I take omega-3 supplements? • If you eat oily fish you do not need to take a supplement. • If you have had a heart attack and do not eat oily fish either: − Take a prescribed or bought over the counter capsule containing 1.0g omega-3 (EPA and DHA) daily. Or − If you are unable to take fish oil capsules, try a supplement derived from algae (a good source of DHA). If using fish oil capsules, look at the label and check the content of omega-3 fats. These may be listed as EPA and DHA. Just add the total of both EPA and DHA together to find the total omega-3 fat content. Cholesterol Cholesterol (as discussed on page 40), is an important fatty substance found in every cell of the body. Too much cholesterol in your blood can increase your risk of heart disease. The most common cause of high cholesterol levels is eating total fat especially saturated fat. Fruit and vegetables Government agencies recommend that you aim to include five portions of fruit and vegetables a day because of the health benefits this brings. Fruit and vegetables contain vitamins and minerals and are low in fat. Aim to eat a variety to get the most benefit. These can be fresh, frozen, canned, dried or as a juice. 8 45
How to reduce saturated, hydrogenated and trans-fats • Choose lean cuts of meat, lean mince, low fat pate. Trim all visible fat and remove poultry skin. • Skim fat from gravy. Choose tomato-based sauces rather than cheesy or cream sauces. • Choose potato topped pies instead of pastry e.g. shepherd’s pie, fisherman’s pie. • Vegetarian options. Base meals on pulses, tofu, quorn, soya meats, nuts and seeds. • Use rapeseed oil, olive oil, sunflower oil instead of lard, ghee, suet, vegetable suet. Avoid deep-frying or re-using oil. Use olive spread, sunflower spread, low fat spread instead of butter or ordinary margarines. • Choose fat-reduced cheese and limit quantity to 110g (4oz) per week. Spread this out over three meals. Avoid eating cheese as a snack unless it is very low-fat such as cottage cheese. • Choose semi-skimmed (in moderation), skimmed milk, low fat yogurt, low fat fromage frais. (If you have diabetes or wish to lose weight, choose healthy eating or diet yogurts as these are low in fat and low in sugar). • Desserts. Fresh or frozen fruit, tinned fruit, low fat custard or milk pudding, jelly, meringue, low fat ice cream or frozen yogurt, trifle sponge cakes, sponge flan are lower fat options. • Cakes and biscuits. Malt loaf, garibaldi, ginger nuts, fig rolls, marie biscuits, rice cakes, oatcakes are better choices but remember to limit the quantity eaten. Once you have reached your target weight, you could try making your own biscuits or cake using suitable fats and oils. The most common valves, which require surgery, are the mitral and aortic valves (see picture). They are found in the left side of the heart. Surgical treatment has a very good success rate for severe valve disease and is the treatment of choice. However, alternatives to valve surgery, including other medical treatments, may have already been discussed with you by your cardiologist and surgeon. Check food labels To find out if a product has ‘a lot’ or ‘a little’ fat and saturated fat, look at the nutrition information label. Compare the ‘per 100g’ figures with the information below. This is a lot (per 100g of food) This is a little (per 100g of food) 20g of fat or more 3g of fat or less 5g of saturated fat or more 1g of saturated fat or less Omega-3 (polyunsaturated fats) Omega-3 fats are healthy fats which help to protect your heart by: • helping the heart to beat more regularly • reducing the stickiness of blood, making it less likely to clot • helping to keep arteries smooth and supple. Omega-3 fats are also known as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Sources of omega-3 fats • Oily fish • Other sources are rapeseed (or canola) oil, nuts and dark green leafy vegetables. Examples of oily fish: mackerel kippers pilchards fresh tuna trout salmon sardines herring sild. 44 Heart valve surgery Heart showing valves and chambers There are two types of valve surgery. The damaged valve can either be repaired or replaced. A replacement valve can either be mechanical (metal or plastic) or tissue (obtained from an animal, usually a pig or cow). • Mechanical valves are longer lasting, but you will need to take anti-coagulant drugs (those which thin the blood) for the rest of your life (see page 20). • Tissue valves do not last indefinitely, but you are less likely to require anti-coagulant drugs. Your surgeon will discuss with you the most suitable valve in your case. All valve operations are performed using the heart-lung bypass machine. What are the benefits of valve surgery? The benefits of valve surgery vary for each person. The benefits for you will depend on your particular symptoms before the operation. You can expect to see an improvement in your symptoms. The surgery will also help to prevent your heart valves from deteriorating further. 9
Page 1 and 2: Editorial board no. 1033/12 Copyrig
Page 3 and 4: Weeks 8 - 10 May be able to return
Page 5 and 6: Wythenshawe Hospital (UHSM) contact
Page 7 and 8: Support groups Ticker Club Tel: 016
Page 9: A guide to portion size: − pineap
Page 13 and 14: Non-modifiable risk factors Family
Page 15 and 16: High levels of fats in the blood (c
Page 17 and 18: Stress Research evidence has shown
Page 19 and 20: Studies show that benefits of using
Page 21 and 22: Generally you may return to: Light
Page 23 and 24: Active hobbies and sports In most c
Page 25 and 26: Home exercises The following exerci
Page 27 and 28: Perceived exertion scale When carry

A New Beginning 2012-7 - UHSM

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