Heart Transplant

WHAT YOU SHOULD KNOW

Risks

IF YOU'RE HEADING FOR THE HOSPITAL...

When You Arrive

• Check with your doctor before taking insulin, diabetes pills, blood pressure medicine, heart pills, or any other medication on the day of surgery.
• Do not wear contact lenses to the hospital. You may wear glasses.

What to Expect While You're There

• Taking Vital Signs: These include your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
• Blood Tests: You may need blood taken for tests. It can be drawn from a vein in your hand or from the bend in your elbow. Several samples may be needed.
• Blood Transfusion: If you have anemia (a shortage of red blood cells) or lose a lot of blood during surgery, you may need a transfusion. Although you might be worried about catching AIDS or hepatitis from tainted blood, the risks posed by going without a transfusion are actually much greater. Your chance of receiving infected blood is about 1 in a million; severe blood loss, on the other hand, can easily trigger a heart attack.
• Chest X-ray: The surgeon will use this picture of the heart and lungs to help plan the operation.
• Heart Monitor: (Also called an electrocardiogram [e-LEK-tro-KAR-di-o-gram] or EKG). Typically, three to five sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen or to a small portable box (telemetry unit) that shows a tracing of each heartbeat.
• IV: A tube placed in your vein for giving medicine or liquids. It will be capped or have tubing connected to it.
• Pulse Oximeter: With a little clip connected to your ear, finger, or toe, this machine measures the oxygen in your blood.
• Special Tubes: For this type of operation, a variety of special-purpose tubes may be inserted in your blood vessels.
• Arterial Line: This tube, also called an "art line" or an "A-line," is inserted in an artery, usually in the wrist or groin. Nurses will keep the line filled with liquid to keep it from getting plugged. It can be used for measuring blood pressure or for drawing blood.
• Swan-Ganz: This thin tube is passed into a vein near the collarbone or neck, then maneuvered through the heart and into the lungs. One of the tube's outlets is hooked to a heart monitor. Another can be used to give medicine.
• Cardiac Outputs: These tests check the heart's pumping capacity. First, an IV liquid is pushed into your Swan-Ganz line very quickly. Then sensors in the line measure how long it takes the heart to push the liquid out into your system.
• General Anesthesia: This type of pain-killing medication puts you completely to sleep during the operation. It is given either as a liquid in your IV or as a gas through a face mask or endotracheal (END-o-TRA-kee-ull) tube placed in your mouth and throat.

During Surgery

After Surgery:

• Ventilator: This is a special machine that can do your breathing for you. It can be hooked up to an endotracheal (END-o-TRA-kee-ull) tube in your mouth or nose, or a tube called a trach (TRAYK) that's passed into your airway through an incision in the front of your neck.
• Wrist Restraints: These strips of cloth or leather fasten your wrists to the sides of your bed. They are needed to keep you from accidentally pulling out your breathing tube. The restraints will be taken off as soon as the tube is removed.
• Blood Gases: This test measures the amount of oxygen, acids, and carbon dioxide in the blood. The blood sample for the test is taken from an artery in the wrist, elbow, or groin.
• Chest Tubes: After the operation, these tubes may be left in your chest to remove air, blood, or fluid from the area around your lungs. This will make it easier for the lungs to refill with air when you inhale. The tubes will be attached to a container of bubbling water.
• Drains: Thin rubber tubes may be put into the area around your incision to drain off excess fluid. They will be taken out when no longer needed.
• Day or Night Confusion: Patients recovering in the ICU often can't tell whether it's day or night, since the lights are on 24 hours a day. This problem will disappear once you are moved to a room on a regular floor.
• Activity: Even while you are confined to bed, it's important to exercise your legs in order to stop blood clots from forming. Lift one leg off the bed and draw big circles with your toes, then repeat with the other leg. You can also try lying on your side and pretending to pedal a bike. When you're told it's OK to get out of bed, make sure someone is with you the first time you try. If you feel weak or dizzy, sit or lie down right away.
• Deep Breathing and Coughing: These exercises help prevent a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum from your lungs and keep them clear. You should deep breathe and cough every hour while you are awake, including any time you spend awake during the night.
• Hold a pillow tightly against your abdomen to help reduce pain from your incision. Take a deep breath and hold it as long as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
• Eating: When your doctor can hear bowel sounds (stomach growling) through a stethoscope, you'll be able to eat. You will probably get ice chips first and then liquids (water, broth, apple juice, or soda). If you do not have problems with the liquids, you'll then be allowed to eat soft foods such as ice cream, applesauce, or custard. If these foods agree with you, you can return to a regular diet.
• Bowel Movements: Regular bowel movements can be difficult after surgery. Don't strain if the stool is too hard. Walking will help to stimulate the bowels. Eating foods rich in fiber, such as fruit, bran, cereal, and beans, will also help restore regularity. Drink plenty of liquids; prune juice may help make the stool softer. Or, if your doctor approves, you can take an over-the-counter fiber laxative.
• Foley Catheter: This is a tube that is sometimes inserted into the bladder to drain your urine. The catheter may make you feel as though you have to urinate. Relax and the catheter will drain the urine for you.
• Don't pull on the catheter because this could cause injury.
• Don't kink the catheter; this will stop the flow.
• Don't lift the bag of urine above the catheter. If you do, the urine will flow back into your bladder, possibly causing an infection.
• The catheter will be taken out when you can urinate on your own.
• Heat: After the first 24 to 48 hours you may use heat for pain or swelling. Apply a heating pad (turned on low) or a hot water bottle, or sit in a warm water bath for 15 to 20 minutes out of every hour as long as you need relief. Do not sleep on the heating pad or hot water bottle. Heat brings blood to the area of the operation and helps it heal faster.
• Strict Intake/Output: Your doctor may need to know the amount of liquid you are taking in versus the amount you lose in your urine. This is often called an "I&O."
• Unless told otherwise, drink 6 to 8 large glasses of water each day. Keep a record of exactly how much liquid you drink.
• Your output of urine may have to be measured. Ask your doctor whether it's OK to use the toilet.
• Neuro Signs: Nurses will regularly check your eyes, memory, hand grasp, and balance, and see how easily you can be awakened. These signs indicate how well your brain is recovering from the trauma of surgery.
• Nasogastric Tube: This type of tube, also called an NG tube, is threaded through your nose and throat and down into your stomach. It is attached to suction, which will keep your stomach empty. It may also help to get your bowels working. Food or medicine is sometimes given through the tube.
• Pacer Wires: These special wires may be attached to the donor heart near the end of the operation. The ends will come out of your chest, and may be covered with plastic for protection. If necessary, they can be connected to a pacemaker. If they aren't needed, they'll be taken out a few days after surgery.
• Pacemaker: This little box-like machine connects to the pacer wires threaded into your heart. It may be needed after surgery to keep your heartbeat regular.
• Pressure Stockings: These tight elastic stockings keep blood from collecting in the legs and causing clots.
• Pneumatic Boots: For extra insurance against blood clots, these plastic boots or leggings are applied over pressure stockings or ace wraps and connected to an air pump machine. The pump rhythmically tightens and loosens different parts of the boots, helping to push the blood back up to the heart.
• Ultrasound: This painless device uses sound waves to build pictures of the internal organs on a TV-like screen. The doctor can use it to examine the new heart.
• Medicines:
• Anti-Rejection Medicine: (Also called immunosuppressives). These drugs prevent the immune system from attacking the transplanted heart. However, the large doses you'll need immediately after the operation will also make you more vulnerable to infection.
• Antibiotics: These medicines will help prevent bacterial infection. They may be given by IV, as a shot, or by mouth.
• Anti-Fungal Medicine: These drugs fight off fungal infections. They may be given in your IV, by mouth, or as a cream.
• Antacids: Anti-rejection medicine can give you an acid stomach, possibly leading to ulcers. To prevent this, the doctor may prescribe an antacid. Take it between meals right before taking your medicines. Do not take it with meals.
• Pain Medicine: To ease pain after the operation, your doctor will probably prescribe medication to be given by IV, as a shot, or by mouth. Tell the doctor or your nurses if the pain won't go away or keeps coming back.
• Anti-Nausea Medicine: This medicine calms your stomach and controls vomiting. Your doctor may suggest you take it at the same time as your pain medicine, which sometimes upsets the stomach.
• Diuretics (DI-u-REH-tiks): (Often called "water pills.") These drugs help the kidneys get rid of excess fluid. (Fluid build-up in the lungs can make breathing difficult.) The drugs can be given as a pill or in your IV.
• Stool Softeners: These medications make bowel movements softer so you won't need to strain.

After You Leave

• Always take your medicine exactly as directed. If it doesn't seem to help, let the doctor know, but keep taking it until told otherwise. If you've been prescribed antibiotics, be sure to use them up. If a medicine makes you drowsy, avoid driving or using dangerous machinery.
• Do not change the amount or type of your anti-rejection medicine, or the time that you take it, without your doctor's approval. You will need to take this medicine on a regular basis for the rest of your life. If you stop even briefly, rejection could set in.
• You may also be given steroid medicine to reduce inflammation and swelling of the donor heart. Although this medicine can be effective, it can also produce side effects, such as a "moon face" and changes in your abdomen or back. Don't stop taking this medicine without your doctor's OK. Quitting on your own can cause additional problems.
• Every week, check how much medicine you have left. Try always to have a 1- to 2-week supply of each medicine.
• If you forget a dose, do not double the next one. Return to your regular schedule. If you forget more than one dose, call your doctor.
• Check with your doctor before taking any over-the-counter medicines. Some might interact harmfully with the drugs you're already taking.
• Some of your medicines may cause a rash or acne on your face, chest, or back. Your doctor can give you medication for this problem. Remember, too, to always wear sunscreen with an SPF of 15 or higher while you are outside.
• Take your temperature every morning before you get out of bed. Call your doctor if the reading is high.
• Weigh yourself on the same scale every morning before dressing. Call your doctor if you gain more than 3 pounds in 1 day.
• Take your pulse each day at the same time and in the same position (either sitting, lying, or standing). Rest at least 5 minutes beforehand. Call your doctor if the rate seems high.
• In a notebook, write your temperature, weight, and pulse each day. Also write down anything about which you are worried or have questions. Bring this notebook with you to your appointments with your doctor.
• Anti-rejection medicine may cause cataracts in your eyes. You will need eye exams every 6 months to help keep your vision at its best.
• When you are allowed to bathe or shower, carefully wash the stitches or staples with soap and water. Then put on a clean, new bandage. Change the bandage any time it gets wet or dirty.
• Eat healthy meals from all 5 food groups: fruits, vegetables, breads, dairy products, and meat. This will increase your energy level and promote faster healing. Be careful, though, to watch your weight. Steroids can stimulate your appetite, making it all too easy to become overweight.
• Unless instructed otherwise, drink 6 to 8 large glasses of liquid, such as water, juices, and milk, each day. Limit caffeinated beverages, such as coffee, tea, and soda.
• Slowly start to do more each day, resting as needed. Once you feel stronger, start a regular exercise program. Exercise makes the heart stronger, lowers blood pressure, and keeps you healthy. Your doctor can help you plan the program.
• Do not lift anything heavier than 5 pounds during the first 6 weeks after surgery.
• Do not use your arms to get out of bed or rise from a chair. This can put too much strain on your chest incision.
• Do not drive for 2 to 6 weeks after surgery.
• Wait 6 weeks after surgery before having sex. If you're a woman, use birth control, since a pregnancy could put the new heart at risk.
• You may be able to return to work 6 to 8 weeks after surgery. This depends on many things, such as your age, the type of job you have, and your other medical problems. Your doctor will help you decide what is best for you.
• Remember that anti-rejection drugs leave you more vulnerable to infection. To reduce the chance of catching one, avoid people who have colds or flu, and try to stay away from large groups of people. You may need to get flu and pneumonia shots.
• Avoid alcoholic beverages for at least 1 year after your transplant. If you decide to drink on a special occasion, limit yourself to 1 glass of wine or 1 can of beer.
• If you haven't already quit smoking, you owe it to yourself to do it now. If you have trouble, ask your doctor for help.

Call Your Doctor If...

• Your incision becomes red and swollen, or begins oozing pus. These are signs of infection.
• You develop a high temperature.
• Your pulse rate goes up.
• You feel as though your heart is skipping beats.
• Your ankles become swollen.
• You feel that something is not quite right in your body. This may be the first sign that something is wrong with your new heart.
• Your urine turns dark yellow or brown, or you have not urinated in several hours.
• You gain more than 3 pounds in 24 hours.
• You develop itchy, swollen skin or a rash. You may be allergic to your medicine.
• You feel tenderness over the incision in your chest.
• Your stitches or staples come apart.
• Your bandage becomes soaked with blood.
• You have diarrhea or vomiting for more than 24 hours.
• You have a cough or sore throat.

Seek Care Immediately If...

• You have sudden chest pain or trouble breathing. This could be a sign of a blood clot in your lung, or an allergy to one of your medicines.
• One leg swells up a lot more than the other. This could mean a blood clot.
• You are too dizzy to stand up.
• You feel as though you are going to pass out.