Your Guide to
CardiaC Surgery
The Henry Low Heart Center at Hartford Hospital 1
Welcome1.
Welcom
e
In this section you will find:
�»� A�welcome�letter
�»� List�of�key�phone�numbers
�»� Holder�for�important�business�cards
�»� Page�to�record�your�medications
�»� Page�for�your�questions�and�notes
The Henry Low Heart Center at Hartford Hospital 1-1
Welcome
Welcome to The Henry low Heart center at Hartford Hospital.
Wearepleasedyouchoseourcenterforyourheartsurgeryandpledgetodoeverythingwecantomakeyourexperiencecomfortableandyourrecoveryasquickaspossible.
Wewantyoutobeapartnerwithusinmanagingyourhearthealth.Educationiscriticaltohelpingyouunderstandyourindividualheartproblemanditstreatment.Itisquitenormaltohavequestionsaboutwhatwillhappentoyouduringandafteryourheartsurgery.Tohelpyouunderstandtheprocess,wehaveputtogetherthisbinderwichaddressesmanyfrequentlyaskedquestions.
Everyonerespondsdifferentlytosurgery,andtherecoveryfromeachprocedurevariessomewhataswell.Despitethesedifferences,wecanmakesomegeneralizations.
Althoughthisbinderwillbehelpfultoyouandyourfamily,itcannotreplaceourpreoperativeclass.Westronglyencourageyoutoattendthisclasswhichwillreviewalltheinformationyouneedtoknowandaddressanyquestionsyoumighthave.Pleasebringthisbinderwithyoutotheclass.Youshouldalsobringthebinderwithyoutoallyourdoctorandhospitalappointmentsasyourdoctorsorothermembersoftheteammayaddinformationtothebinder.Havingeverythingyouneedinonelocationwillhelpmakeyourexperienceasstress-freeaspossibleforbothyouandyourfamily.
Itisourpledgethatwewilltakegoodcareofyouandcommunicateeffectivelywithyourfamilywhileyouareinthehospitalforyourheartsurgery.
Sincerely,
RobertC.Hagberg,MD
ChiefofCardiacSurgery
Welcome
1-2 The Henry Low Heart Center at Hartford Hospital
cARDIoVAScUlAR
Thoracic and cardiovascular SurgeonsDr. Fusco ............................................... (860) 524-5905Dr. Gallagher ....................................... (860) 525-7181 Dr. Hagberg ......................................... (860) 524-5905Dr. Hammond ..................................... (860) 524-5905 Dr. Humphrey ..................................... (860) 525-7181 Dr. Preissler .......................................... (860) 524-5905 Dr. Takata .............................................. (860) 525-7181Dr. Underhill ........................................ (860) 524-5905
cardiac Surgical Program coordinator
Mary Kate Parker ................................ (860) 545-5478In-house ......................................................... ext. 55478
or Pager 2169Assessment Center ........................... (860) 545-5355 Nurse Manager ................................... (860) 545-3700Appointments for Preoperative Testing ....................... (860) 545-2334
cardiac Rehabilitation
Hartford Hospital ............................... (860) 545-2133Farmington Valley ............................. (860) 674-8509Glastonbury Wellness Center ........ (860) 633-9084West Hartford, Blue Back Square .. (860) 570-4571
GeNeRAl INFoRmATIoN
Hartford Hospital Operator ............ (860) 545-5000Financial Assistance .......................... (860) 696-6010 Patient Relations ................................ (860) 545-1400
...........................or (888) 515-5544 Admitting/Patient Accounts .......... (860) 545-2730 Pastoral Care........................................ (860) 972-2251
AccommoDATIoNS Hudson Suites ..................................... (860) 545-1111
HoSPITAl UNITS
cardiothoracic Intensive careUnit B9I .................................................. (860) 545-5200Nurse Manager ................................... (860) 545-5446
Step-Down/TelemetryB9E/SD ................................................... (860) 545-5299Nurse Manager ................................... (860) 545-5037
oTHeR SeRVIceS
Surgery Time Line .............................. (860) 545-3208Integrative Medicine ........................ (860) 545-4444 (massage, reiki, guided imagery and more)Social Work Services ......................... (860) 545-2966Smoking Cessation ........................... (860) 545-3217Case Coord./Discharge Planning . (860) 545-3192Security ................................................. (860) 545-2147
Cardiac Surgery Patient Care TeamImportant Phone Numbers
The Henry Low Heart Center at Hartford Hospital 1-3
Welcome
My Heart Team
The Henry Low Heart Center at Hartford Hospital 1-4
Welcome
Pleaselistthenameanddosageofeverymedicationyoutake,includingvitamins,herbalsupplementsandover-the-countermedicationssuchasaspirin,coughsyrupandantacids.Thislistwillbeaninvaluableguidetoyourdoctors,asyouprepareforsurgery.
*Ifyouarenotawareofthedosage,pleasebringthemedicationtoyourvisitwiththesurgeon.
My Medications
PrimarycarePhysician(PcP):__________________________________________________________
PcPPhone:____________________________ PharmacyPhone: ____________________________
medication:_____________________________ Dosage*:____________________________________
Frequency:______________________________ Reason:_____________________________________
medication:_____________________________ Dosage*:____________________________________
Frequency:______________________________ Reason:_____________________________________
medication:_____________________________ Dosage*:____________________________________
Frequency:______________________________ Reason:_____________________________________
medication:_____________________________ Dosage*:____________________________________
Frequency:______________________________ Reason:_____________________________________
medication:_____________________________ Dosage*:____________________________________
Frequency:______________________________ Reason:_____________________________________
medication:_____________________________ Dosage*:____________________________________
Frequency:______________________________ Reason:_____________________________________
medication:_____________________________ Dosage*:____________________________________
Frequency:______________________________ Reason:_____________________________________
Welcome
1-5 The Henry Low Heart Center at Hartford Hospital
Listhereanyquestionsyouhaveforanymemberofyourcareteam.
My Questions
The Henry Low Heart Center at Hartford Hospital 2
2. Your Heart &
Heart Surgery
Your Heart and Heart SurgerY
this section contains explanations of heart conditions and the procedures used to correct them:
Coronary�Artery�Disease�and�its�Treatment
�»� Your�coronary�arteries
�»� Coronary�artery�disease
�»� Heart�attack
»� Bypass�grafting
Heart�Valve�Disease�and�its�Treatment
�»� Your�heart’s�valves
�»� Common�valve�diseases
�»� Heart�valve�surgery
Aortic�Aneurysm�Repair
Irregular�Heart�Rhythm�and�its�Treatment
»� Atrial�fibrillation
»� Maze�procedure
Atrial-Septal�Defect�Repair
The Henry Low Heart Center at Hartford Hospital
coRoNARY ARTeRY DISeASe AND ITS TReATmeNT
» Yourcoronaryarteries
» Coronaryarterydisease
» Heartattack
» Bypassgrafting
YoUR HeART & HeART SURGeRY
coronary Artery Disease and Its Treatment
2-1 The Henry Low Heart Center at Hartford Hospital
Like all muscles in the body, the heart muscle needs a continual supply of oxygen to function.Thecoronaryarterieswraparoundtheheart,providingitwithoxygen-richblood.Theleftcoronaryarterysplitsintotwobranchescalledthecircumflexarteryandtheleftanteriordescendingartery.Theysupplybloodtothefront,leftandbackoftheheart.Therightcoronaryarterysuppliesbloodtothebottom,rightandbackoftheheart.
Your Coronary Arteries
Right coronary artery
Posteriordescendingartery
Left coronaryartery
Circumflexartery
Left anteriordescendingartery
Aorta
Venacava Pulmonary
artery
Right coronary artery
Posterior descending artery
left coronary artery
circumflexartery
left anterior descending artery
The Henry Low Heart Center at Hartford Hospital 2-2
coronary Artery Disease and Its Treatment
Coronary Artery Disease
Plaque
Clot
Yourheartisamuscle.Likeothermusclesinthebody,itneedsasteadysupplyofoxygen-richbloodtofunctionproperly.Theheartmusclereceivesitsbloodsupplyfromanetworkofspaghetti-likecoronaryarteriesthatlieonitsoutersurface.
Thecoronaryarteriesaresubjecttoadiseasecalledatherosclerosis,inwhichabuildupofcholesterolandotherfatsintheliningofthearteriesprogressivelynarrowstheinteriorchannel.Thiscausesbloodflowthroughthearteriestobereduced,andtheheartmuscletoreceiveaninadequateamountofoxygen.Whenmoreoxygenisneededthanthearteriescandeliver,theheartmusclecrampsinresponse.Thisiscalledangina.
Overtime,atherosclerosiscanbuilduptoadangerouslevel.Sometimes,itformsaclotthatcanhinderbloodflow.Othertimes,itformsasoftlump(plaque)coveredbyafibrouscapthatcaneasilyruptureandspillitscontentsintothebloodstream.Eitherway,aheartattack-causingclotcanoccur.
Yoursurgeonplanstobypasstheblockagestorerouteoxygenatedbloodaroundthedangerpointstorestorebloodflowtoyourheartmuscle,stopanginaandpreventaheartattack.
coronary Artery Disease and Its Treatment
2-3 The Henry Low Heart Center at Hartford Hospital
Heart Attack
Aheartattackoccurswhenbloodflowthroughthecoronaryarteriesisinterrupted.Theseverityofaheartattackdependsonhowlongbloodflowisstoppedandhowmuchheartmuscleisaffected.Thefasteryoureceivetreatmenttorestorebloodflow,thegreateryourchanceofhavingminimaldamage.
Doctorscallheartattacks“myocardialinfarctions(MIs).”Therearetwotypes:
• NSTemI.ThistypeofheartattackdoesnotcausechangesintheS-TsegmentofanEKG(see Figure 1a).Therefore,itiscalleda“non-STsegmentelevationmyocardialinfarction”(NSTEMI).Therefore,itiscalleda“non-STsegmentelevationmyocardialinfarction”(heartattack).Itisdiagnosedbychemicalchangesinthebloodthatindicatedamagetotheheartmusclehasoccurred.NSTEMIusuallyindicatesaclotistemporaryoroccursinaminorbloodvessel.
• STemI.Thisisamajor,full-blownheartattack,whichclearlyappearsasanelevatedSTsegmentonanEKG(see Figure 1b).STEMIheartattacksarecausedbyprolongedblockagesofbloodflowinmajorcoronaryarteries,whichaffectsasignificantareaofheartmuscle.
Q
P
S
R
T
Q
P
R
ST
Elevated ST segment
An EKG records the various electrical impulses in the heart that cause the heart to contract, pause for filling and contract again. The diagram on top shows a healthy heartbeat. The diagram on the bottom, in which the segment of the EKG between the S and T waves is elevated, indicates a heart attack.
Figure 1a
Figure 2a
The Henry Low Heart Center at Hartford Hospital 2-4
coronary Artery Disease and Its Treatment
Formorethan40years,coronaryarterybypassgrafting(CABG)—aproceduremostpeoplecall“bypasssurgery”--hasbeenthestandardmethodforrestoringbloodflowtotheheartsofpatientswithcoronaryarterydisease.CABGhasalowmortalityrateandahighrateofsuccessinrestoringtheflowofoxygen-richblood,relievinganginaandpreventingheartattack.
InCABGsurgery,thesurgeoncreatesanewpathwaybyusingbloodvesselslocatedinthechest(mammaryarteries),leg(saphenousveins)orarm(radialarteries).Ifthesaphenousveinsareused,theywillberemovedthroughoneortwosmallincisions(seeillustration).Yoursurgeonwillexplainwhichbloodvesselswillbeusedforyourprocedure.
TRADITIoNAl cABGAsurgeonwillmakeanincisiondownthecenterofyoursternum(breastbone)toaccessyourheart.Youwillbeconnectedtoaheart-lungbypassmachine,whichwillcirculateyourbloodthroughoutyourbodyduringsurgery.Yourheartwillbestoppedsothesurgeoncanperformthedelicatebypassprocedure.Aftersurgery,thesurgeonwillcloseyourbreastbonewithspecialwiresandyourchestskinwithinternalandexternalstitches.Thewireswillstayinyourchestpermanently.
oFF-PUmP cABGThisprocedureallowsthesurgeontooperateontheheartwhileitisstillbeating.Thesurgeonusesadvancedequipmenttostabilizeaportionoftheheartwhileperformingthebypass.Meanwhile,therestoftheheartcontinuestopump,circulatingbloodtothebody.Inoff-pumpCABG,theheart-lungbypassmachineisnotused.
Coronary Artery Bypass Grafting
Sternum Incision
mammary arteries
Radial arteries
Saphenous veins
coronary Artery Disease and Its Treatment
2-5 The Henry Low Heart Center at Hartford Hospital
mINImAllY INVASIVe cABGSometimesCABGcanbeperformedthroughasmallincisioninthesideofthechest(thoracotomy).Yoursurgeonwillletyouknowifyouqualifyforthisprocedure.
RoBoT-ASSISTeD SURGeRYYoursurgeonmaychoosetousearobottoassistinperformingCABG.Therobotdoesnotreplacethesurgeon,butratherenhancesthesurgeon’sabilitytoperformdelicate,precisemicrosurgicalmovements.
Coronary Artery Bypass Grafting (cont.)
The Henry Low Heart Center at Hartford Hospital 2-6
coronary Artery Disease and Its Treatment
Coronary Artery Bypass Grafting
Thisillustrationshowsbypassgraftsusinganinternalmammaryartery(IMA)fromtheinsideofthechestwallandasaphenousveingrafttakenfromtheleg.Ifyouhavemorethanoneblockage,morethanonebypassmaybeneeded.Yoursurgeonwilldrawthelocationsofyourgraftsonthisheartandexplainwhichconduitswillbeused.
Right coronary artery
Saphenousvein bypass
Internal mammaryarterybypass
Left anteriordescendingartery
Aorta
Venacava Pulmonary
artery
Blockages
The Henry Low Heart Center at Hartford Hospital
HeART VAlVe DISeASe AND ITS TReATmeNT
» Yourheart’svalves
» Commonvalvediseases
» Heartvalvesurgery
YoUR HeART & HeART SURGeRY
The Henry Low Heart Center at Hartford Hospital 2-7
Heart Valve Disease and Its Treatment
Thehearthasfourchambers.Theleftatriumreceivesoxygen-richbloodfromthelungs.Therightatriumreceivesbloodfromthebody.Therightventriclesendsbloodtothelungsforoxygen.Theleftventriclesendsoxygen-richbloodoutintothebody.Fourvalvescontrolproperbloodflowthroughthesechambers,servingasone-waydoorstokeepbloodmovingintheproperdirection.
• Theaorticvalvecontrolstheflowofoxygenatedbloodfromtheleftventricle(lowerleftchamber)intotheaortaandtherestofthebody.
• Themitralvalvecontrolsbloodflowbetweentheleftatrium(upperleftchamber)andleftventricle(lowerleftchamber).
• Thepulmonicvalvecontrolsbloodflowoutoftherightventricle(lowerrightchamber)intothelungs.
• Thetricuspidvalvecontrolsbloodflowbetweentherightatrium(upperrightchamber)andrightventricle(lowerrightchamber).
Anyproblemwiththeleaflets,thetoughchordsthatholdtheminplaceorthemusclesthatkeepthevalvestructurestablecancausesymptoms.
Pulmonic valve
Tricuspid valve
Mitral valve
Aortic valve
Your Heart’s Valves
Heart Valve Disease and Its Treatment
2-8 The Henry Low Heart Center at Hartford Hospital
Valvediseaseoccurswhenavalvedoesnotworkthewayitshould.Youcanbebornwithavalveproblemordevelopitlaterinlife.Avalveproblempresentatbirthisknownascongenitalvalvedisease.Acquiredvalvediseaseisoftencausedbyrheumaticfever, infectionsorfattyplaquedepositsonthevalveleaflets.
Themostcommonformsofvalvediseasearestenosisandinsufficiency(regurgitation).
Invalvular stenosis,thevalveleafletsbecomestiff.Thisnarrowstheopeningandreducestheamountofbloodthatcanflowthroughit.Whentheopeningbecomesverynarrow(stenotic),theheartstrainstopumpharder,andbloodflowtothebodyisreduced.
Valvular insufficiency(regurgitation)istheoppositeproblem—aleakyvalve.Itoccurswhentheleafletsdonotclosetightlyandbloodflowsbackwardsthroughthevalve.
Stenosisandregurgitationcanexistsimultaneouslyintwoormorevalves.
Commonsymptomsincludeshortnessofbreath,extremefatigue,weakness,dizziness,rapidweightgain,swellinginthefeetandankles,anginaandpalpitations.Overtime,valvediseasecanleadtodistressingheartrhythmsorheartfailure.
Common Valve Diseases
Aortic valve stenosis Open
Closed
Aortic valve stenosis Open
Closed open closed
Anterior leaflet
Posterior leaflet
Regurgitation
Annulus
The Henry Low Heart Center at Hartford Hospital 2-9
Heart Valve Disease and Its Treatment
Faultyvalvesmayberepairedorreplaced.Valverepairallowsthesurgeontofixafaultyheartvalve,oftenwithoutusingartificialparts.Ifvalverepairisnotanoption,thesurgeonmaychoosetoreplacethevalve.Thismeansthefaultyvalveisremoved,andanewvalveissewninitsplace.Thenewvalvemaybemechanical(man-made)orbiological(naturaltissue).
Themostappropriateproceduredependsonyourage,extentandtypeofvalvediseaseandthelocationofthevalve.ValvesurgerymaybeperformedatthesametimeasCABGorotherheartprocedure.Whenvalvesurgeryisperformedalone,itissometimesdonethroughsmallincisionsmadebetweentheribs.Suchminimallyinvasiveprocedurescanresultinlesspostoperativepain,lessbleeding,lowerriskofinfection,shorterhospitalstayandquickerreturntonormalactivities.
Minimallyinvasivesurgeryisnotappropriateforeverypatient.Yoursurgeonwillalwaysperformtheprocedurethatisbestforyou.Ifminimallyinvasiveapproachisanoption,yoursurgeonwilldiscussitwithyou.
Heart Valve Surgery
Heart Valve Disease and Its Treatment
2-10 The Henry Low Heart Center at Hartford Hospital
VAlVe RePAIRWheneverpossible,valvesarerepaired,ratherthanreplaced.Retainingyournaturalvalvewilleliminatetheneedforbloodthinners,decreasetheriskofinfectionandpreservemusclestrength.
Repairsmaybeperformedtoopenthevalveleafletswider,tightenthevalveleaflets,reshapethevalveorpatchatearorholeinaleaflet.
Robotsaresometimesusedtoassistinvalverepair.Robot-assistedsurgeryisminimallyinvasivesurgerytechnique,meaningitallowsheartsurgerytobeperformedthroughtinyincisionsinthepatient’schest.Therobotsdonotactuallyreplacethesurgeon,butratherenhancetheirabilitytoperformdelicate,precisemicrosurgicalmovements.Theinstrumentsusedfortheoperationareinsertedthroughsmallincisions,reducingtheopportunityforbacterialinfection,decreasingpostoperativepainandallowingforfasterrecovery.
VAlVe RePlAcemeNTWhenvalverepairisnotanoption,thevalveisremovedandreplacedwithamechanicalorbiologicalvalve.
Mechanicalvalves(right)aredesignedtoimitatethefunctionsofthenaturalvalve.Theyopenlikeadooronhinges.Theyareverydurable,butrequirebloodthinnerstopreventthedevelopmentofbloodclots.
Somebiologicalvalves(bottom)areformedfromcow(bovine)orpig(porcine)tissueanddonotrequirelong-termuseofbloodthinners.
Inspecialcases,ahomograftmaybeusedtoreplacethedamagedvalve.Yoursurgeonwilldiscusswhichoptionisbestforyourindividualcondition.
Annuloplasty ringrestores natural shape
to valve
Heart Valve Surgery
The Henry Low Heart Center at Hartford Hospital
YoUR HeART & HeART SURGeRY
AoRTIc ANeURYSm RePAIR
Aortic Aneurysm Repair
2-11 The Henry Low Heart Center at Hartford Hospital
The aorta is the largest artery in the body. It flows from the heart through the chest and abdomen, where it splits in two and continues down the legs. The aorta can develop a weakness in its wall called an aneurysm, which causes the tissue to bulge as blood flows through it. Aortic aneurysms that occur near the heart (thoracic aortic aneurysms) are repaired by cardiothoracic surgeons. Aneursyms that occur in the abdominal area are repaired by general and vascular surgeons.
Tube graftrepair
Suture line
Aortic Aneurysm Repair
Symptoms may include pain in the jaw, neck and upper back; chest or back pain; or coughing, hoarseness or difficulty breathing. However, many patients with aortic aneursyms have no symptoms at all. Large aortic aneurysms and those that produce symptoms may be treated to prevent the vessel from rupturing and causing rapid, life-threatening blood loss.
If you are undergoing thoracic aortic aneursym repair, your surgeon will remove the damaged section of aorta and replace it with a strong, flexible Dacron tube.
The Henry Low Heart Center at Hartford Hospital
YOUR HEART & HEART SURGERY
IRREGULAR HEART RHYTHM AND ITS TREATMENT
» Atrial fibillation
» Maze procedure
YOUR HEART & HEART SURGERY
2-12 The Henry Low Heart Center at Hartford Hospital
Irregular Heart Rhythm and Its Treatment
In a normal heart, the upper (atria) and lower (ventricles) chambers beat in perfect harmony, thanks to a complex system of electrical impulses that move with lightning speed. Any deviation in the electrical pathway can cause an irregular rhythm (arrhythmia), either fast or slow. Many arrhythmias can be controlled with medications or a pacemaker.
One of the most common arrhythmias is atrial fibrillation (Afib). Afib is not necessarily life-threatening in itself, but the episodes of racing, irregular heart rhythms can be highly distressing. Afib also causes blood to pool in the atria, where it can clot before being pumped out into the body. For this reason, Afib increases the risk of stroke.
In some people, Afib can be controlled by medication or a catheter-based procedure. When these methods fail to work, a surgeon may be needed to create a new maze of electrical pathways on the surface of the heart. This is called maze surgery.
Maze surgery is performed under anesthesia with the heart-lung machine. The surgeon opens the chest and uses an instrument with a tip that generates radiofrequency waves or extreme cold to make a series of small scars on the surface of the heart in a particular pattern that resembles a maze. As the heart heals, these scars form a barrier that channel electrical impulses into the correct path.
Maze Procedure for Atrial Fibrillation
The Henry Low Heart Center at Hartford Hospital 2-
YOUR HEART & HEART SURGERYYOUR HEART & HEART SURGERY
The Henry Low Heart Center at Hartford Hospital
ATRIAL-SEPTAL DEFECT AND ITS TREATMENT
» Atrial-septaldefectrepair
Atrial-Septal Defect and Its Treatment
ASDs may not cause symptoms until mid-life, at which time the person may begin to experience shortness of breath, fainting, arrhythmias or fatigue. Large ASDs may lead to heart failure, atrial fibrillation, pulmonary hypertension, stroke and damage to other heart valves.
Some ASDs, such as patent foramen ovales (PFO), significantly increase the risk of stroke. Some people with ASDs are unaware they have the condition until a stroke occurs.
Repair techniquesDepending on their size and location, surgery may be required to close the hole with stitches or a patch. Hartford Hospital cardiac surgeons often use a robot to assist with this procedure .
Atrial-Septal Defect Repair
Before birth, blood flows freely through a hole in the membrane (septum) dividing the upper chambers of the heart (atria). The normal process is for this hole to close shortly after birth. When it fails to close, or when a separate hole develops in the septum, blood can pass back and forth between the atria. Such holes are called atrial-septal defects (ASD).
Septal Defect
Right Atrium
Left Atrium
2-13 The Henry Low Heart Center at Hartford Hospital
The Henry Low Heart Center at Hartford Hospital 3
3.
Preparing for Surgery
PreParIng for SurgerY
this section contains information on:
�»� Meeting�with�your�surgeon
�»� Your�appointment�for�preoperative�testing
�»� Meeting�the�Cardiac�Surgical�Program�Coordinator
�»� Verifying�coverage�with�your�insurance�company
�»� Attending�a�preoperative�class
�»� Preoperative�instructions
�»� What�to�do�if�you�have�diabetes
The Henry Low Heart Center at Hartford Hospital 3-1
PRePARINGFoRSURGeRY
meeTINGWITHYoURSURGeoN
Yourcardiologisthasdeterminedyouneedheartsurgeryandhasreferredyoutoasurgeon.Attheappointment,calledasurgicalconsult,yoursurgeonwilldiscussyourheartconditionandexplainthetypeofsurgeryproposedtocorrectit.
Yoursurgeonwillwanttoknowwhatmedicationsyouaretaking,sincesomeofthemwillneedtobestoppedbeforeyouroperation.Ifyoutakediabetesmedications,pleaseseetheinstructionsonpage3-4anddiscussthemwithyoursurgeon.
Yoursurgeonmayusethediagramsinthisbooktobetterillustratetheoperationyouwillbehaving.Besuretowritedownanyquestionsyouhaveonpage1-5,soyoudon’tforgettoask.
Attheendoftheconsult,theofficewillscheduleadateandtimeforyoursurgery.Inmostcases,theofficewillalsomakeanappointmentforpreoperativetesting.
YoURAPPoINTmeNTFoRPReoPeRATIVeTeSTING
YourappointmentinourPre-AdmissionTestingCenter(PATC)isdesignedtotakecareofallthemedicaltestingyouneedbeforeyoursurgerycantakeplace.Theprocessnormallytakesabouttwohours,butcantakeaslongasfour.
ThePATCisopenMondaythroughFridayfrom8:00a.m.to5:00p.m.Appointmentsmaybescheduledbycalling860-545-2334.Yoursurgeon’sofficemayalsohelpyouwithschedulinganappointment.
AtthePATC,youwillundergoaphysicalexaminationandhavebloodworkdrawn.AnEKGandchestX-raywillbetaken.Dependingonyourmedicalhistory,youmayalsoundergoavascularstudyorpulmonaryfunctiontest.
Atthisappointment,youwillalsobeaskedtofilloutadetailedquestionnairethatwillusedbyyouranesthesiologist.Questionsincludewhetherornotyouhaveeverhadareactiontoanesthesiaordifficultybeingintubated,andwhetheryouweardentures.Ourgoalistounderstandyourmedicalhistory,sowecanbetteranticipateandmeetyourneedsduringyourhospitalstay.
meeTINGTHecARDIAcSURGIcAlPRoGRAmcooRDINAToR
ThefinalstepismeetingwiththeCardiacSurgicalProgramCoordinator.Thecoordinatorperformsmanyvaluablerolesdesignedtoensureyouhavethebestpossibleexperienceandfacilitatescommunicationbetweenthehospital,surgeonandallmembersofyourcareteam.Thecoordinatorwillexplainallaspectsofyourhospitalization,surgery,recoveryandrehabilitationandwillmakesureanyspecialneedsyoumayhaveareaccommodated.
PRePARINGFoRSURGeRY
3-2 The Henry Low Heart Center at Hartford Hospital
Afterheartsurgery,somepatientsrequireseveraldaysofrehabilitationbeforetheyarereadytobedischargedhome.AnimportantroleoftheCardiacSurgicalProgramCoordinatoristopromptyoutothinkaboutwhereyouwouldliketogoforrecoveryandrehabilitationafterbeingdischargedfromthehospital.Someskillednursingfacilitiesarelistedalphabeticallybycountyinsection8ofthisbinder.
Wesuggestyoubecomefamiliarwiththefacilitiesinyourarea,visitthem,andchoosewhichoneyouwouldliketouseforyourpostoperativerehabilitation.Askthemtoputyournameonalist,sinceyouwillhaveabetterchanceofgettingintothefacilityofyourchoiceifyoumakeareservation.
VeRIFYINGcoVeRAGeWITHYoURINSURANcecomPANY
Beforeyoursurgery,pleaseverifyyourinsurancecoveragebycallingyourinsuranceprovider.Itisyourresponsibilitytounderstandwhatiscoveredunderyourindividualplan.
Afteryouhavespokenwithyourinsuranceprovider,yourcasecoordinatorortheCardiacSurgicalProgramCoordinatorwillbegladtohelpyou,ifyouhaveanyproblemsunderstandingwhatyourplancovers.
ATTeNDINGAPReoPeRATIVeclASS
Aswementionedinthewelcomeletter,westronglyurgeallpatientsundergoingheartsurgerytotakeapreoperativeclass.Theseclassesexplainthepreparation,surgeryandrecoveryprocessindetail,andareasourceofvaluableinformationandcomfortforpatientsandtheirfamilies.
TheCardiacSurgicalProgramCoordinatorwilltellyouwhenthenextclassisbeingofferedandencourageyoutoattend.Werecommendyoubringalongthefriendorfamilymemberwhowillbehelpingyouafteryoureturnhome.
The Henry Low Heart Center at Hartford Hospital 3-3
PRePARINGFoRSURGeRY
Inthedaysbeforeyoursurgery,youwillneedtofollowcertaininstructions,asdetailedbelow.Theseinstructionsareimportant,sopleasecheckoffeachboxafteryouhavemadenoteoftheinformation:
� Yoursurgeonmayaskyoutostoptakingcertainmedicationsforaperiodoftime.Besuretonotewhichmedicationsshouldbestopped,howfarinadvanceofsurgerytheyneedtobestopped.Ifyouhavediabetes,pleaseseetheinstructionsonpage3-4forguidance.
� Ifyoutakevitamins,supplements,herbsordietaryproducts,pleasetellyoursurgeonatyourfirstmeeting.Youmayneedtodiscontinuetakingsomeofthembeforeyoursurgery.
� IfyouneedCPAPatnightforsleepapnea,tellyoursurgeonatyourfirstmeeting.YoumaybringtheCPAPmachinewithyoutothehospitalforyoursurgery.
� Ifyousmoke,youshouldquitnow.Smokinginterfereswiththehealingprocessandmakesrecoveryfromheartsurgerymuchmoredifficult.Ifyouwouldlikesmokingcessationcounseling,pleaseasktheCardiacSurgicalProgramCoordinatorforareferral.
� Ifyoudrinkalcohol,youshouldlimityourconsumptiontonomorethanoneglassofwinewithdinner.
� Yourskinisnotsterile,soyoucanhelppreventpostoperativeinfectionsbymakingsureyourskinisasgerm-freeaspossiblebeforeyoursurgery.WewillgiveyouspecialcleansingclothscalledCHGwipestousealloveryourbodythenightbeforeyoursurgeryandthemorningofsurgery.WewillalsoaskyoutoswabyournostrilswithBactroban(mupirocin),anantibioticointment,twicedailyforfivedaysbeforesurgery.
� Ifyoudevelopacoldbeforeyoursurgery,itdoesnotnecessarilymeanyouroperationmustbepostponed.However,ifyoudevelopafeverhigherthan101°Fwithinaweekbeforeyoursurgery,callyoursurgeonimmediately.
� Donoteatordrinkanything,includingwater,aftermidnightbeforeyoursurgery,unlessyouareinstructedtodootherwise.Youmaybedirectedtotakesomeofyourmedicationsonthemorningofsurgerywithasmallsipofwater.
� Thedaybeforesurgery,youwillreceiveacallbetween1:00p.m.and6:00p.m.lettingyouknowwhattimeyouroperationisscheduledtotakeplaceandwhattimeyoushouldreporttothehospital.IfyoursurgeryisscheduledforaMondayorthedayafteraholiday,youwillreceiveacallonebusinessdaybeforeyoursurgerydate.Ifyoudonotreceiveacallby6:00p.m.,pleasecalltheSurgeryTimeLineat(860)545-3208.
Preoperative Instructions
PRePARING FoR SURGeRY
3-4 The Henry Low Heart Center at Hartford Hospital
Ifyoutakemedicationfortype1ortype2diabetes,followtheinstructionsbelow,unlessyourdiabetesprovidertellsyouotherwise.
Pleasenotethatcombinationpillsarenotlisted.Ifyoutakeapillthatcombinestwomedications,andoneislistedas“Donottake”or“Stop,”donottakethecombinationpill.
Besuretocheckyourbloodsugarbeforemealsandatbedtimeforatleasttwodayspriortoyourscheduledsurgery.Ifyounormallycheckyourbloodsugarmoreoften,continuetodoso.Callyourdoctorifyouhavetworeadingshigherthan150.
THe DAY BeFoRe SURGeRYYou mAY take the following medications:
Actos(pioglitazone) Prandin(repaglinide)Amaryl(glimiperide) Starlix(nateglinide)Avandia(rosiglitazone) Symlin(pramlintide)Byetta(exenatide)Glucophageorotherformsofmetformin,ifyourkidneyfunctionisnormal.Ifyourkidneyfunctionisdecreasedorunknown,stop48hoursbeforesurgery.Glucotrol(glipizide)Januvia(sitagliptin)Micronase,Diabetaorotherformsofglyburide
If you take insulin:
» Youmaytakethefollowingformsofinsulinintheusualdose:Apidra NPHExubera Regular70/30Humalog Regular75/25Novolog Regular50/50
» Ifyouhavetype1diabetes,youmayneedadecreaseddoseoftheinsulinyoutakeatbedtime.Pleasediscussthiswithyourdiabetesprovider.
THe DAY oF SURGeRYDo NoT take these medications in the morning:
Amaryl(glimiperide)Glucophageorotherformsofmetformin
check with your doctor when to restart:
Glucotrol(glipizide)Micronae,Diabetaorotherformofglyburide
Do not take the following medications the morning of your surgery. You may resume taking them after surgery:
Actos(pioglitazone) Prandin(repaglinide)Avandia(rosiglitazone) Starlix(nateglinide)Byetta(exenatide) Symlin(pramlintide)Januvia(sitagliptin)
If you take insulin, the morning of your surgery:
» Takehalftheregulardoseof:NPHRegular75/25Regular70/30 Regular50/50
» Ifyouhavetype1diabetes:YoumayneedadecreaseddoseofLantusorLevemir.Pleasediscussthiswithyourdiabetesprovider.
» Ifyouhavetype2diabetes:YoushouldtakethefulldoseofLantusorLevemir.Pleaseverifythiswithyourdiabetesprovider.
» Aftersurgery,restartthefollowingformsofinsulinwhenyoubegineatinganormaldiet:Apidra Regular70/30Exubera Regular75/25Humalog Regular50/50Novolog
If You Have Diabetes
The Henry Low Heart Center at Hartford Hospital 4
4.
the day of Surgery
tHe daY of SurgerY
this section contains information on:
�»� Checking�in�on�the�day�of�your�surgery
�»� What�your�family�can�expect�while�you�are�in�surgery
�»� Your�care�team
�»� What�you�can�expect�in�the�operating�room
�»� In�the�Intensive�Care�Unit�(ICU)
The Henry Low Heart Center at Hartford Hospital 4-1
THe DAY oF SURGeRY
cHeckING IN oN THe DAY oF SURGeRY
• Ifyouhavediabetes,besureyoufollowtheinstructionsonpage3-4abouttakingorstoppingyourdiabetesmedicationsonthedayofsurgery.
• Leavemoney,jewelryandothervaluableitemsathome.
• Leaveyourcarwiththevaletandbringtheparkingticketwithyoutobevalidated:Parkingisfreeonthedayyouareadmittedandthedayyouaredischarged.
• Pleasearriveon timetoCenter8.Takethemainlobbyelevatorstothe8thfloorandfollowthesignsfor“Center8.”WhenyouarriveatCenter8,anursewilltakeyourweightandvitalsigns.Thenursewillinsertanintravenousline(IV)inaveininyourarm,askyousomequestions,performaphysicalassessmentandclipthehairoffyourbody.Atemporarydressingwillbeplacedtoprotectyourtailbone.Onceyouareupandmovingaroundafteryoursurgery,itwillberemoved.
WHAT YoUR FAmIlY cAN exPecT
Manyofyouwillwantyourfamilytobekeptinformedaboutyourrecovery,butduetopatientprivacylaws(HIPAAregulations),ourabilitytoshareinformationaboutyourconditionoverthetelephoneislimited.That’swhywerecommendyoudecideaheadoftimewhoyourFamilySpokespersonwillbe.Itshouldbesomeoneyoucantrusttorelaymessagesaccuratelytoconcernedfriendsandfamilymembers.
Whenyoucheckin,wewillaskyouforthenameofyourFamilySpokesperson.Wewillcallthispersonwithupdates,andthispersonmaycallusforinformation.
Whenyouaretakentotheoperatingroom,yourfamilymembersorfriendsaccompanyingyouwillbeaskedtowaitintheSurgicalWaitingAreaonthe5thfloor(BlissWing).Duringandimmediatelyfollowingsurgery,ourtrackingsystemwillmakeiteasyforthemtoknowyourstatus.Whenyougototheoperatingroom,youwillbegivenacasenumbertoprotectyourprivacy.Flatscreentelevisionswilldisplayyourstatus.Whenyouareinsurgery,itwillsay,“Procedure.”WhenyouhavebeenmovedtotheICU,itwillsay,“DischargedtoB91.”B91isonthe9thflooroftheBlissWing.WhenthescreenindicatesyouhavebeenmovedtoB91,yourfamilymaygototheICUtovisityou.TheyshouldringtheintercombellontheoutsideoftheICU.Assoonasyouarereadyforvisitors,thestaffwillletthemin.
AliaisonintheSurgicalWaitingAreawillalsobeavailableforquestionsandwillbeabletohelpyourFamilySpokespersondeterminehowlongitwillbebeforeyoursurgeonwillgiveyourfamilyanupdateonyourcondition.
YoUR cARe TeAmHeartsurgeryisateameffort,andyouroperatingroomwillbefilledwithmedicalprofessionals.Inadditiontoyoursurgeon,therewillbeananesthesiologist,nurseanesthetist,perfusionist(personwhooperatestheheart-lungmachine),surgicaltechnicians,nursesandnursingassistants.
Aftertheoperation,yourcarewillbeprovidedbyanintensivist(aphysicianspecializinginintensivecare),acardiologist,nursepractitioners,physicianassistantsandnurses,whoworkwithyoursurgeon.
THeDAYoFSURGeRY
4-2 The Henry Low Heart Center at Hartford Hospital
INTHeoPeRATINGRoom
Theoperatingroomwillbecold,brightandbustlingwithactivity.Anursewillcheckyournameandthenameofyoursurgeonandverifythisinformationonyourwristband.
YouranesthesiologistwilladministeryouranesthesiathroughyourIV.Althoughyouwillfallasleepquickly,yourhearingwillbethelastsensetoleaveyou.Youcanbeassuredthatbeforetheoperationbeginsyouwillbecompletelyanesthetizedandwillfeelnopain.Duringthesurgery,yourEKG,bloodpressure,breathing,pulseandotherfunctionswillbecloselymonitoredatalltimes.
INTHeINTeNSIVecAReUNIT(IcU)
Afteryoursurgeryisover,youwillawakenintheIntensiveCareUnitonBliss9I(B9I).Youmayawakenslowly,firstbyhearingnursescallingyournameandtalkingtoyou.Ifyouhaveabreathingtubeinyourthroat,youwillnotbeabletospeakwhenyouawaken.Thistubewillberemovedonceyouareawakeenoughtobreatheonyourown,usuallyaboutsixhourslater.
Youwillalsohavealargenumberoftubesandlinesattachedtoyourbodyandlinkedtothemonitoringequipmentatyourbedside.AtubecalledaFoleycatheterwillemptyyourbladder.Chesttubeswillbeplacedaroundyourhearttoremoveanyfluidthatmaycollectaftersurgery.Thetubeswillberemovedoverthenextfewdays.
Yourfaceandbodymaybeswollen.Thisisentirelynormal,andistheresultofbeinggivenfluidsduringyoursurgery.Wemaygiveyoumedicationstohelpeliminatethisextrafluid.
ICUvisitinghoursareposted,buttheyareflexible.However,weaskthatyourfamilymemberslimittheirinitialvisitto10-15minutes,sincewemustprovideyouwithagreatdealofcareduringthistime.Weaskthatyouhavenomorethantwovisitorsatatime,sinceitisimportantforthenursestohaveaclearviewofyourbedandtomonitoryoucloselyduringyourstayintheICU.NochildrenareallowedinICU.Also,itisimportantforyourfamilytoknowfood,drinkandflowersarenotallowedintheICU.
YouwillstayinICUovernightandbemovedtoatelemetryfloor(B9E)withotherheartpatientswhenyourconditionisstable,likelythefollowingday.Ifwefeelitisinyourbestinterests,wewillkeepyouinICUlonger.
On the Day of Surgery
The Henry Low Heart Center at Hartford Hospital 5
5.
recovering in the Hospital
recoverIng In tHe HoSPItal
this section contains information on:
�»� What�to�expect�each�day�after�surgery
�»� Your�stay�on�B9E
�»� Managing�pain
�»� Caring�for�your�body�after�surgery
�»� Postoperative�nutrition
�»� Postoperative�medication
�»� Preparing�for�discharge
The Henry Low Heart Center at Hartford Hospital 5-1
RecoVeRINGINTHeHoSPITAl
everyday,youcanexpectto:
• Beweighedeverymorning
• Haveyourbloodpressure,heartrate,oxygenlevelandtemperaturechecked
• Getoutofbedforeachmeal
• Useyourincentivespirometer10timeseveryhourwhileyouareawake
• Useyourheartpillowtohelpyoucoughandbreathedeeply
• Haveyourfluidintakeandoutputmonitored
• Havetubes,wiresandIVsremoved
• Seeanincreaseinyouractivitylevelandtolerance
onthefirstdayaftersurgery,youcanexpectto:
• Haveyourdressingschanged
• Sitinachairforyourmeals
• Walkinyourroomwithassistance
• Begineatingaheart-healthydiet
ondays2and3aftersurgery,youcanexpectto:
• Haveyourdressingschangedorremoved,ifpossible
• HaveyourFoleycatheterremoved
• Takeashower
• Walkinthehalls2to4timesperdaywithassistance
• Haveyouroxygenremoved
• Increasetheamountoffoodyoueat
• Begindischargeplanningwiththecareteamandyourfamily
ondays4and5aftersurgery,youcanexpectto:
• Walkinthehalls3to5timesperday
• Walkupanddownstairswithstaffassistance
• Continuetoincreaseyourfoodintaketohelpthehealingprocess
• Receivedietandmedicationinstructionsinpreparationfordischarge
• Finalizedischargeplans
What to Expect Each Day After Surgery
RecoVeRINGINTHeHoSPITAl
5-2 The Henry Low Heart Center at Hartford Hospital
What to Expect After Surgery
HelPFUlINFoRmATIoNFoRYoURSTAYoNB9ePreventingpneumoniaoracollapsedlung(postoperativeatelectasis)isapriority.Weexpectyoutouseyourincentivespirometer(breathingexerciser)10timeseveryhourwhileyouareawake.Youwillbegivenaheartpillowtohugwhileyoucoughandbreathedeeplyafterusingthespirometer.Thispillowwillhelpsupportyourchestandallowyoutotakedeeperbreaths.
Everydayyouwillbeweighed,haveyourbloodpressure,heartrate,oxygenlevelandtemperaturechecked.Atmealtime,youwillgetoutofbedandwalktoachair,whereyouwilleatyourmeals.Mealswillbeservedatthefollowingtimes:
Breakfast: 8:30a.m.-9:00a.m.
Lunch: 12:30p.m.-1:00p.m.
Dinner: 5:30p.m.-6:00p.m.
Thephoneinyourroomwillbeshutofffrom10:00p.m.to8:00a.m.
Atfirst,youwillfindthesmallesttaskstiring.Beassuredthatyourstrengthandstaminawillincreaseasyouprogressthroughyourstay.Beforeyouaredischarged,youwillbeabletowalkaroundthehallsandclimbstairswiththehelpfromstaff.
mANAGINGPAINTohelpusminimizeyourpainaftersurgery,wewillaskyoutoratetheintensityofyourpainthroughtheuseofapainscale:
Ifyoustarttofeelpainatanytime,pleaseaskthenurseforpainmedication.Donotwaituntilyouareveryuncomfortable,oruntilitisoffered.Thesooneryourequestpainmedication,thebetteryouwillmanageyourpain.Whenyourpainiswell-controlled,youwillbeabletouseyourincentivespirometerandbreathedeeplyandbemoreactive.
Onceyouareabletoeatsolidfood,youwillbegivenoralpainmedications.Untilthattime,painmedicationwillbegiventhroughyourIV.Ifyouneedpainmedication,pleaseaskforit.Ifyouhaveanyconcernsaboutaddiction,pleasediscussthemwithyoursurgeonornursesbeforeyoursurgery.
excruciating-unabletodoanyactivitiesbecauseofpain
Severe-unabletodomostactivitiesbecauseofpain
Unabletodosomeactivitiesbecauseofpain
moderate
Candomostactivitieswithrestperiods
mildpain-doesnotlimitactivity
Nopain
10
9
8
7
6
5
4
3
2
1
The Henry Low Heart Center at Hartford Hospital 5-3
RecoVeRING IN THe HoSPITAl
What to Expect After Surgery (cont.)
cARING FoR YoUR BoDY AFTeR SURGeRYAlmosteverypatientisswollenaftersurgeryfromwater-weightgain,butwewillgiveyoumedicationtoeliminatetheextrafluid.
Lyinginbedwillleaveyoususceptibletoskinbreakdown.Weencourageyoutogetoutofbedasoftenaspossibletositinachairorwalk.Whileyouareinbed,youshouldturnoftentorelievethepressureonanyareaofskin.
Donottouchyourincision.Donotputlotionsorcreamsonit.Donotscratchitorremovethescabs,astheyarebarrierstoinfection.Youwillbeallowedtoshowerassoonasyourchesttubesareremoved,usuallybyday3.
Theanesthesiaandpainmedicationsyoureceived,combinedwithlackofactivity,willslowdownyourbowelcycle.Donotbeconcerned.Wewillgiveyoumedicationstohelpnormalbowelfunctionresume,alongwithastoolsoftenertopreventstraining.Afewdaysaftersurgery,youshouldbebacktonormal.
PoSToPeRATIVe NUTRITIoNYouwillneedextracaloriestoheal,butthesecaloriesshouldbeintheformofhigh-qualityproteins,vegetablesandfruits.Yourcareteamwillmonitoryourdietandmodifyitasnecessary.
Evenifyoudonothaveyournormalappetite,weencourageyoutoeat.Yoursurgeonmayrecommendyoufollowalow-fat,no-added-saltdietafterdischarge.Yournursewillgiveyoumoredetaileddietinstructionstofollowathome.
mANAGING BlooD GlUcoSe leVelSAftersurgery,manypatientsexperienceelevatedbloodsugarlevels,eveniftheydonothavediabetes.Ifthishappenstoyou,youprobablyfallintooneoffourcategories:
1. Elevatedbloodsugarisatemporaryreactiontothestressofsurgeryandwillresolveinafewdaysorweeks.Youmayneedinjectionsofinsulinuntiltheconditionresolves.
2. Youhaddiabetesbeforesurgery,butdidnotknowit.Thisisacommonoccurrence.
3. Youhaddiabetesbeforesurgery,butwereabletocontrolyourbloodglucoselevelswithoralmedications.Youmayneedinsulinforashorttimeaftersurgerytoregaincontrol,butthereisagoodchanceyouwillbeabletoresumeusingoralmedicationsafewdaysorweeksafterdischarge.
4. Youhaddiabetesbeforesurgery,andcontrolledyourbloodglucoselevelswithinsulinoracombinationofinsulinandoralmedications.Youmayneedlargerdosesofinsulintocontrolyoursugarsinthefirstfewdaysorweeksaftersurgery.
RecoVeRING IN THe HoSPITAl
5-4 The Henry Low Heart Center at Hartford Hospital
PoSToPeRATIVe meDIcATIoNSYoumayneedtobegintakingnewmedications.Ifyouhadbypasssurgery,thesemayincludePlavix(clopidogrel),whichyoumaytakedailywithaspirin.Ifyouhadvalvesurgeryoramazeprocedure,youmayneedtotakeCoumadin(warfarin),abloodthinner.Donotdiscontinuetakingthesemedicationsforanyreasonwithoutyourdoctor’sknowledgeandpermission.Ifyouexperienceanyworrisomesideeffects,callyourdoctor’soffice.
PRePARING FoR DIScHARGeYouwillstayonB9Euntilyouarereadyforthenextphaseofyourrecovery.Thisnextphasemayincluderehabilitation,homecareoroutpatientcardiacrehabilitation.Thelengthoftimeyouwillneedforthisphasedependsonyourindividualprogressandneeds.
Onthedayyourdoctorfeelsyouareready,ourgoalistohaveyoudischargedby11a.m.Pleasemakearrangementsforyourfamilytopickyouupthatmorning.
Ifyouaregoingtoaskillednursingorrehabilitationfacility,yourcasecoordinatororsocialworkerwillassistyouandyourfamilyinmakingthesearrangementsbeforeyouaredischargedfromthehospital.Alistoffacilitiescanbefoundinsection8ofthisbinder.
Wewillsendyouhomewithalistofthemedicationsthatyoushouldbetakingforyourheartandothermedicalproblems.Itisveryimportantthatyoutakeallmedicationsasdirected.Itisequallyimportantthatyounottakeanyothermedication(over-the-counterorprescription),vitaminorherbalsupplementthatisnotonthislistwithoutthepermissionofyourdoctor.Manymedicationsyouthinkaresafemayinteractwithyourheartmedications,makingthemstrongerorweaker.
What to Expect After Surgery (cont.)
The Henry Low Heart Center at Hartford Hospital 6
6.
recovery after
Hospital d
ischarge
recoverY after HoSPItal dIScHarge
this section contains:
�»� Daily�do’s�and�don’ts
�»� Helping�your�incision�to�heal
�»� Your�emotional�health
�»� Follow-up�appointments
�»� Resuming�activity
�»� Progressive�walking�program
�»� Cardiac�rehabilitation
�»� Returning�to�work
�»� Watching�for�weight�gain
The Henry Low Heart Center at Hartford Hospital 6-1
RecoVeRYAFTeRHoSPITAlDIScHARGe
Ifyoudevelopanyofthefollowingsymptoms,gotothenearestemergencyroomorcall911:
� Brightredstool� Angina-likechestpainsimilartothatyouexperiencedbeforeyoursurgery� Coughingupbrightredblood� Faintingspells� Heartratefasterthan150beats/minwithshortnessofbreathornewirregularheartrate� Newonsetofnausea,vomitingordiarrhea� Severeabdominalpain� Shortnessofbreathnotrelievedbyrest� Suddennumbnessorweaknessinarmsorlegs� Suddensevereheadache
Ifyoudevelopanyofthefollowingsymptoms,callyoursurgeon:
� Drainage,redness,inflammation,warmthornewsorenessatthesiteoftheincision� Feverof101degreesormore� Newpainsinthechest� Difficultybreathing� Shortnessofbreathwhilelyingflat� Increasingweaknessanddifficultydoingregularactivities� Extremefatigue� Swellinginthelegs,anklesorstomach� Dry,hackingcoughwithoutacold� Lessurinationduringthedayandmoreatnight� Dizziness,lightheadedness� Paininthecalfthatbecomesworsewhenpointingtoeupwards
Whenyourideinacar,besureyouwearaseatbeltwithashoulderharnessforprotectionagainstinjury.Yoursurgeonwillletyouknowwhenitisokaytoresumedriving.
Daily Do’s and Don’ts
RecoVeRYAFTeRHoSPITAlDIScHARGe
6-2 The Henry Low Heart Center at Hartford Hospital
• Eathealthyfoods,suchasfruitsandvegetables.
• Eatprotein-richfoods,suchaseggs,leanmeats,chickenandfish,unlessotherwiseinstructed.
• Whileyourincisionsarehealing,avoideatingfoodsthatarehighinsugar.
• Weencourageyounottosmokeandwillprovideyouwithsmokingcessationinformation.TocalltheHartfordHospitalStopSmokingforLifeProgram,pleasecall860-545-3127.
• Ifyouhavebeeninstructedtowearabra,youmaywishtoplaceagauzedressingovertheincisiontoprotectitfromrubbingandirritation.
• Takeashowerdailyandwashyourincisiongentlywithwarm(nothot)water.Avoidvigorousscrubbing.Besuretodrytheincisionthoroughly.Donottakeabath,useahottuborswimuntiltheincisionisfullyhealed.Donotputcreams,oils,powdersorlotionsonyourincision,orscratchit.Theincisionwillhealgraduallyovertime.Leavethescabsalone.Donotcoveryourincisionunlessitbeginstodrain.Inthiscase,coveritwithsterilegauze(availableatyourpharmacy)andcallyoursurgeon.
• Ifyourincisionhasadressing,changeitdailyormorefrequentlyifitbecomeswetorsoiled.
• Whenthedrainagestops,youshouldstopapplyingthedressingsandallowtheincisiontohealintheopenair.
• Notify your surgeon if you notice any of the following:» Increasedtendernessaroundtheincision» Increasedrednessorswellingaroundtheedgesoftheincision» Anydrainagefromtheincision» Youneedtochangethedressingmoreoftenduetoincreaseddrainage» Theincisionorthedrainagedevelopsabadsmell
Thereisnoneedtobeafraidofsexualintimacyafterheartsurgery.Asaruleofthumb,youarereadytoresumesexualrelationswhenyoucanwalkupaflightofstairsatanormalpace.Untilyoursternumhashealed(about6-8weeks),choosepositionsthatlimitpressureonyourarmsandchest.Ifyouhaveanyconcerns,speakwithyoursurgeon.
Itisnormaltobeemotionallyfragileaftersurgery.Youmayexperiencehighsandlows,andevenseemirrationalattimes.Thisiscommon,asare“theblues.”Ifyouremotionalhealthhasnotresolvedwithinamonth,orifyoufeelchronicallydepressed,speakwithyoursurgeon.Yourbody’schemistrymaybeout-of-balance,andyoumayneedsomehelptoputyouonthepathtohealing.
Helping Your Incision to Heal
Your Emotional Health
The Henry Low Heart Center at Hartford Hospital 6-3
RecoVeRy AFTeR HoSPITAl DIScHARGe
Your Follow-Up AppointmentsYouwillbeexpectedtoseeyoursurgeonandcardiologistwithin2weeksafteryouhavebeendischargedfromthehospital.Youwillbegiventimeframesfortheseappointmentswhenyouaredischarged,anditisyourresponsibilitytobooktheappointments.
Resuming ActivityYouneedabalanceofexerciseandrestasyoucontinuetorecover.Itmaybenecessarytomodifysomeofyourdailyactivitiesuntilyourbodyheals.
Itisimportanttogetupandgetdressedeachmorning.Wearcomfortable,loosefittingclothesthatdonotputpressureonyourincisions.
Youmayclimbstairs.Whenyoufirstgohome,besuretogoslowly,takingonestepatatimeifnecessary.Rememberthatittakesmoreenergytoclimbstairsthantowalk.Ifyoubecometiredasyouclimb,stop,restandcontinue.DONOTpullyourselfupthestairs.
Paceyourself.Don’ttrytodotoomuchtoosoon,oryouwillbeverytiredthefollowingday.Restatleasttwiceaday,restfor20-30minuteswithyourlegselevated.Payattentiontoyourbody.Itmaygiveyousignalsthatyouneedtorest.Thesesignalsmayincludeshortnessofbreath,fatigue,dizziness,painordiscomfort.Ifyouexperiencethesesignals,stopyouractivityimmediately.Takeanap,ifnecessary.
Youmustavoidstrenuousactivitywhileyoursternumishealing.Donotlift,pushorpullanythingheavierthan5to10pounds—approximatelytheweightofagallonofmilk—forsixweeksaftersurgery.Thismeansyoushouldavoidcarryingchildren,groceries,mowingthegrass,vacuumingorshoveling.
Followtheguidelinestoresumeyouractivitiessafely:
WeekS 1 AND 2:Activities you can do:
• Shower,shaveandwashyourhair.
• Preparebasicfoods.
• Dolighthousework:washdishes,dust,makebeds.Donotchangesheets.
• Write,readandtype(deskwork).
• Read,watchTVandlistentomusic.
• Sew,knitanddoothercrafts.
• Playcardsandboardgames.
• Rideinacarasapassengerforshorttrips.Wearasafetybelt.
• Walk8-12stairs,oneatatime.Donotpullyourselfupthestairs.
• WalkdailyasoutlinedintheProgressiveWalkingProgramonpage6-5
Activities you should avoid doing:
• Don’tliftmorethan5lbs.
• Don’tliftinfantsorsmallchildren.
• Avoidarmmotionthatcausespainattheincisionsite.
• Avoidpush-pullarmmovements(vacuuming,sweeping,scrubbing).
• Don’tuseatreadmill.
• Don’tshovel,digorcutgrassorhedges.
• Don’twalkamedium-tolarge-sizeddog.
• Don’tdoanycompetitivesports.
continued
RecoVeRy AFTeR HoSPITAl DIScHARGe
6-4 The Henry Low Heart Center at Hartford Hospital
• Don’tdriveuntilyoursurgeongivespermission.
• Don’twalkupgradesorhills.
• Avoidputtingextrapressureonyourarmswhenclimbingstairsorrisingfromachair.
WeekS 3 AND 4:Activities you can do:
• Dineoutandpreparemeals.
• Runerrandsandshopforgroceries(avoidlifting!).
• Attendreligiousservices,bingoandmovies.
• Playmusicalinstruments.
• Dolighthousework.Donotchangesheets.
• Graduallyresumesexualactivity.Usenon-weight-bearingpositions.
• Contactyourlocalcardiacrehabilitationprogram.
• ContinuetheProgressiveWalkingProgramdaily.
Activities you should avoid doing:
• Don’tliftmorethan10lbs.
• Don’tliftinfantsorsmallchildren.
• Avoidarmmotionthatcausespainattheincisionsite.
• Avoidpush-pullarmmovements(vacuuming,sweeping,scrubbing).
• Don’tuseatreadmill.
• Don’tshovel,digorcutgrassorhedges.
• Don’twalkamedium-tolarge-sizeddog.
• Don’tdoanycompetitivesports.
• Don’tdriveuntilyoursurgeongivespermission.
• Don’twalkupgradesorhills.
• Avoidputtingextrapressureonyourarmswhenclimbingstairsorrisingfromachair.
WeekS 5 AND 6:Activities you can do:
• Moderatehousework-laundry,sweeping
• Painting,lightcarpentry.Noceilingorladderwork.
• Ridethemowerandgarden
• Walkthedog
Activities you should avoid doing:
• Don’tliftmorethan20lbs.
• Don’tshovelheavyloads.
• Don’tplaycontactsports.
• Don’twalkupsteephills.
Manypeoplecanreturntoworkfourtosixweeksaftersurgery.Howsoonyoucangobackdependsonhowwellyouarehealingandwhattypeofjobyouhave.Yoursurgeonwilltellyouwhenitissafeforyoutoreturntowork.
Resuming Activity (cont.)
Returning to Work
The Henry Low Heart Center at Hartford Hospital 6-5
RecoVeRYAFTeRHoSPITAlDIScHARGe
Watching for Weight GainYoumaybeaskedtoweighyourselfatthesametimeeverymorningandrecordit.Besuretowearthesameamountofclothesandtousethesamescaleeveryday.Thishelpsusmonitorhowwellyourheartispumpingandwatchforthedevelopmentorworseningofheartfailure.Notifyyourdoctorifyougainmorethan2poundsinonedayor5poundsinoneweek.
Recordyourweightdailyonthispageandbringittothenextappointmentwithyourcardiologistorcardiacsurgeon.
Date Time Weight
Regularexerciseisessentialtoyourrecovery,andtheProgressiveWalkingProgramisthebestwaytoincreaseyourendurancesafely.Itaccomplishesthisgoalbygraduallyincreasingthedistanceoramountoftimeyouareabletowalk.Startingatweek1or2afterdischargeandcontinuingovera4-to8-weekperiod,youwillgraduallyincreasethelengthofyourexercisetime,whiledecreasingthenumberofwalksyoutakeperday.
Itisimportantthatyouwalkonlevelground.Ifyourneighborhoodishilly,ortheweatherisextreme,walkindoors.Walkinginamallorfromroomtoroominyourhomeareperfectlyacceptable.
Guideyourprogressionbasedonhowyoufeel.Continuerepeatingthesamestepuntilyounolongerfeelfatigued.Atthatpoint,youarereadyforthenextstep.Youshouldbeabletocarryonaconversationwhileyouwalk.Ifyoubecometooout-of-breathtotalk,theactivityistoovigorous.
The6-StepProgressiveWalkingProgram
Step1: Walk3-5minutesthreeorfourtimesdailyforatotalof12-20minutes.
Step2: Walk5-7minutesthreeorfourtimesdailyforatotalof15-28minutes.
Step3: Walk7-10minutestwoorthreetimesdailyforatotalof20-30minutes.
Step4: Walk10-15minutestwicedailyforatotalof20-30minutes.
Step5: Walk15-20minutestwicedailyforatotalof30-40minutes.
Step6: Walk20-30minutesonceaday.
Onceyouareabletowalk20minutes,youwillbenefitfromaddingwarm-upandcool-downperiods:
Warmup:Walkslowlyfor5minutes.
Exercise:Walkbrisklyfor20minutes.
Cooldown:Walkslowlyfor5minutes.
Progressive Walking Program
RecoVeRYAFTeRHoSPITAlDIScHARGe
6-6 The Henry Low Heart Center at Hartford Hospital
HartfordHospitalcardiacsurgeonshighlyrecommendthatpatientsparticipateinacardiacrehabilitationprogramafteraheartattackorheartsurgery.Cardiacrehabilitationisaprovenwaytoreducetheriskofafutureheartproblem,includingfatalornonfatalheartattack.ItissoeffectivethatmostMedicareplanscover36cardiacrehabsessions.
Youwillbenefitfromcardiacrehabilitationifyouhavehad:
• Arecentheartattack• Chestpain(angina)• Angioplastyorstentprocedure• CABG• Heartvalvesurgery• Heartfailure• Cardiomyopathy• Hearttransplant
WHATcARDIAcReHABINVolVeSCardiacrehabilitationisasupervisedexerciseandeducationprogramdesignedspecificallytohelppatientsrecoverfromhearthospitalization.Threetimesaweek,participantsexercisegently,graduallyincreasingtheirenduranceunderthewatchfuleyeofnursesandexercisephysiologists,whomonitortheirEKGandbloodpressure.
Inadditiontosupervised,safeexercise,cardiacrehabprogramsprovidegroupandindividualcounselingandeducationsessionsdesignedtohelpyoumakehealthylifestylechanges.Thesesessionscoverheart-healthydietarychanges,weightloss,smokingcessationandstressmanagement.
Youmusthaveaphysician’sreferraltobegintheprogram.Yourcardiologistwilllikelyworkwithyoutoarrangeyourrehabilitationatacardiacrehabprograminyourarea.HartfordHospitalofferscardiacrehabilitationprogramsatfourlocations:atHartfordHospitalinHartford,inWestHartfordatBlueBackSquare,andatourWellnessCentersinAvonandGlastonbury.
Cardiac Rehabilitation
“The doctors saved my life, but Cardiac Rehabilitation taught
me how to live it.” -HartfordHospitalcardiacrehabpatient
GeARINGUPFoRBeTTeRHeARTHeAlTH
Inadditiontoextendingsurvivalandimprovinghearthealth,thebenefitsofparticipatingincardiacrehabinclude:
• Improvedenergyandphysicalfitness
• Improvedsenseofwell-being
• Improvedabilitytomanagestress
• Increasedabilitytoperformjobortasks
• Lowerbloodpressure
• Lowercholesterolandbloodsugarlevels
• Weightloss
Cardiac Rehabilitation Referral
Patient’s Name: _________________________________________________ DOB:_________________
Address:_______________________________________________________________________________
Phone: ________________________________________________________________________________
_____ MI
_____ Stable Angina
_____ PCI
_____ Cardiac Surgery
________CABG _______Cardiac Valve _____Cardiac Transplantation
_____ CHF
______ Cardiomyopathy
Signature of referring physician ____________________________________ Date:_____________ Time:___________
Upon discharge, please fax referral to patient’s preferred site:
Hartford HospitalPhone: 860.545.2133 Phone: 860.545.3352
West Hartford - Blue Back SquarePhone : 860.570.4571 Fax: 860.570.4570
Glastonbury Wellness CenterPhone: 860.633.9084Fax: 860.633.9204
Avon Wellness CenterPhone: 860.674.8509Fax: 860.678.8493
Patient Label Info
HH-C-482_10/11
The Henry Low Heart Center at Hartford Hospital 7
7.
resources
reSourceS
this section contains information on:
�»� Mended�Hearts,�Inc.
�»� Informational�websites
�»� Further�reading�on�heart�disease�and�heart�surgery
»� Circulation�article�on�benefits�of�cardiac�rehabilitation
The Henry Low Heart Center at Hartford Hospital 7-1
ReSoURceS
Formorethan50years,MendedHeartshasofferedhope,encouragementandinformationtoheartpatientsandtheirfamilies.HartfordHospitalispleasedtopartnerwithMendedHeartsinordertohelppatientslikeyouhaveagoodexperience.
Beforesurgery,someonefromMendedHeartswillcallorvisityou.Aftersurgery,yourMendedHeartscontactwillbehappytoprovideanswerstoanyquestionsyoumayhaveandtoprovidereassurancethatyourlifeaftersurgerycanberichandrewarding.
Formoreinformationonthisnationalnonprofitorganization,pleasevisitwww.mendedhearts.org.
Mended Hearts, Inc.
YourHeartValvewww.yourheartvalve.comAmericanHeartAssociationwww.americanheart.org
AmericanCollegeofCardiologywww.acc.org
SocietyofThoracicSurgeonswww.sts.orgNationalHeart,LungandBloodInstitutewww.nhlbi.nih.gov/health
Web Sites You May Find Helpful
TheopenHeartcompanion:PreparationandGuidanceforopen-HeartSurgerybyMaggieLichtenberg
ThecardiacRecoveryHandbook:ThecompleteGuidetolifeafterHeartAttackorHeartSurgerybyPaulKligfield,MD
Suggested Reading on Heart Disease & Heart Surgery
ReSoURceS
7-2 The Henry Low Heart Center at Hartford Hospital
littlepain,lotsofgain:Stickingwithcardiacrehabboostssurvival,studyfinds
MARILYNNMARCHIONE,APNewsDec21,2009
Study: Sticking with heart rehab boosts survival
If you’ve had a heart attack or a bypass operation, there’s an easy way to help prevent another one: stick with rehab.
People who get all 36 sessions of cardiac rehabilitation that most Medicare plans cover are less likely to die or suffer a heart attack in the next three to four years than people who have fewer sessions, a new study finds.
The research could encourage the multitudes of heart patients who don’t follow doctors’ orders to heed their advice. Only about one-fifth of heart patients even try rehab. Of those who do, few get all the sessions that are recommended.
The new study is one of the first big efforts to look at how survival is affected by the “dose” of rehab that heart patients get. Researchers saw a clear trend in this 65-and-older group.
“What this study shows in a very convincing manner is that the more sessions a cardiac patient goes to, the better off they are,” said Dr. Stanley Hazen, preventive cardiology and rehabilitation chief at the Cleveland Clinic.
He had no role in the study, which was led by Duke University scientists and published online Monday in Circulation, an American Heart Association journal. Federal grants paid for the work.
Say “rehab” and many people envision weak heart patients being pushed to run on a treadmill. Exercise is crucial, but “they don’t need to be grimacing and jogging around the track,” Hazen said. “It can be just a brisk walk or swimming or a stationary bike. That’s the key: find something you enjoy and are willing to do.”
To be covered by Medicare, rehab also must include lifestyle counseling — nutrition advice, weight management, help to stop smoking, even cooking classes and pointers on reducing stress, said the study’s leader, Duke biostatistician Bradley Hammill.
Many patients find they enjoy the counseling, he said. For some, it’s the first time anyone has explained the “how-to” of healthy living.
“After you’ve been hospitalized and somebody then talks to you about these lifestyle changes, it might be more likely to sink in. It’s the teachable moment,” Hammill said.
His study used records on more than 30,000 Medicare recipients who went for at least one rehab session after being hospitalized for a heart attack, a bypass operation, or chronic and severe chest pain due to clogged arteries.
More than three years later, 18 percent of those who attended fewer than 12 cardiac rehab sessions had died versus 11 percent of those who went to all 36 sessions. After taking into account age and other differences in these groups of patients, that works out to a 47 percent reduction in the risk of death for those attending 36 sessions. Heart attacks also were less common in that group.
There was a strong trend: as the number of classes went up, the risk of having a heart attack or dying in the next few years went down.
Surprisingly, only 18 percent of study participants went to all 36 sessions, even though Medicare — the government health care program for those 65 and over — was footing the bill. Researchers don’t know why so few stuck with it.
“It can be everything from the time required multiple times a week for so long, or transportation issues. Or it may just be that they feel better and don’t feel the need to finish,” Hammill said.
That’s the case with Tony Rugare, an 84-year-old Cleveland area man who had a quadruple bypass operation in October. He attended his fourth rehab class on Monday and plans to do only a dozen more.
“It’s a hassle getting here and parking,” he said. Once he’s had 16 classes, “by that time I think I know what to do and can go on my own.”
However, it could be that sicker patients drop out of rehab sooner, Dr. William Weintraub wrote in an editorial in the journal. He is a heart specialist at Christiana Care Health System in Newark, Del. Because the study can’t account for why people went to fewer or more sessions, it cannot prove that rehab alone accounted for better survival, he wrote.
But there’s good reason to believe it did: researchers did a separate analysis on only folks who went to at least six sessions and still saw the trend of fewer heart attacks and deaths with greater attendance.
Dorothy Roberts went to her seventh session at the Cleveland Clinic on Monday. She walks on a treadmill and is trying to quit smoking. Roberts, 62, said that her artery-opening angioplasty procedure was a “very scary” experience, so she plans to complete all 36 rehab sessions covered by her private insurer.
“If you have a second chance at life, you do what you can to stay here,” she said.
The Henry Low Heart Center at Hartford Hospital 8
this section contains a list of skilled nursing facilities in the following counties:
�»� Fairfield
�»� Hartford
�»� Litchfield
�»� Middlesex
�»� New�Haven
�»� New�London
�»� Tolland
�»� Windham
8. SkIlled nurSIng facIlItIeS
Skilled nursing facilities
The Henry Low Heart Center at Hartford Hospital 8-1
SkIlleDNURSINGFAcIlITIeS
FAIRFIelDcoUNTY
BethelBethelHealthCareCenter13ParkLawnDrive(203)830-4180
BridgeportAstoriaPark725ParkAvenue(203)366-3653
BridgeportHealthCareCenter600BondStreet(203)384-6400
BridgeportManor540BondStreet(203)384-6400
NorthbridgeHealthCareCenter2875MainStreet(203)336-0232
DanburyDanburyHealthCareCenter107OsborneStreet(203)792-8102
FilosaConvalescentHome13HakimStreet(203)744-3366
GlenHillCare&RehabilitationCenter1GlenHillRoad(203)744-2840
HancockHall31StaplesStreet(203)794-9466
PopeJohnPaulIICenter33LincolnAvenue(203)797-9300
FairfieldCambridgeManor2428EastonTurnpike(203)372-0313
CaroltonChronic&ConvalescentHospital400MillPlainRoad(203)255-3573
JewishHomefortheElderly175JeffersonStreet(203)365-6400
LudloweCenterforHealth&Rehabilitation(203)372-4501
GreenwichConnecticutHealthofGreenwich1188KingStreet(203)531-8300
GreenwichWoodsHealthCareCenter1165KingStreet(203)531-1335
NathanielWitherell70ParsonageRoad(203)869-4130
NewcanaanWavenyCareCenter3FarmRoad(203)966-8725
NewtownMasonicareofNewtown139ToddyHillRoad(203)426-5847
NorwalkHoneyHill34MidrocksRoad(203)847-9686
NotreDame76WestRocksRoad(203)847-5893
ParadigmHealthcareofNorwalk23ProspectAvenue(203)853-0010
RidgefieldLaurelRidgeHealthCareCenter642DanburyRoad(203)438-8226
SheltonAppleRehabSheltonLakes5LakeRoad(203)924-2635
BishopWickeHealth&RehabilitationCenter584LongHillAvenue(203)929-5321
GardnerHeights172RockyRestRoad(203)929-1481
HewittHealth&RehabilitationCenter45MaltbyStreet(203)924-4671
StamfordCourtlandGardensHealthCenter53CourtlandAvenue(203)351-8300
EdgehillHealthCenter122PalmersHillRoad(203)323-2323
LongRidgeofStamford710LongRidgeRoad(203)329-4026St.CamillusHealthCenter494ElmStreet(203)325-0200
SmithHouseSkilledNursingFacility88RockrimmonRoad(203)322-3428
WilliamandSallyTandetCenter146WestBroadStreet(203)964-8500
StratfordLordChamberlainManorNursing&Rehabilitation7003MainStreet(203)375-5894
SouthportConnecticutHealthofSouthport930MillHillTerrace(203)259-7894
TrumbellMaefairHealthCareCenter21MaefairCourt(203)459-5153
St.JosephManor6448MainStreet(203)268-6204
WestportWestportHealthCareCenter1BurrRoad(203)226-4201
WestReddingMeadowRidge100ReddingRoad(203)544-1000
WiltonLourdesHealthCareCenter345BeldenHillRoad(203)762-3318
WiltonMeadowsHealthCareCenter439DanburyRoad,Rte7(203)834-0199
SkIlleDNURSINGFAcIlITIeS
8-2 The Henry Low Heart Center at Hartford Hospital
HARTFoRDcoUNTY
AvonAppleRehabAvon652WestAvonRoad(860)673-3265
AvonHealthCenter220ScovilleRoad(860)673-2521
BloomfieldAlexandriaManor55TunxisDrive(860)242-0703
BloomfieldHealthCareCenter355ParkAvenue(860)242-8595
CalebHitchcockHealthCareCenter-Duncaster40LoefflerRoad(860)726-2000
SeaburyHealthCenter200SeaburyDrive(860)286-0243
WintonburyCareCenter140ParkAvenue(860)243-9591
BristolCountrysideManorofBristol1660StaffordAvenue(860)583-8483
ThePinesofBristol61BellevueAvenue(860)589-1682
IngrahamManor400NorthMainStreet(860)584-3400
SheridenWoods321StonecrestDrive(860)583-1827
collinsvilleCherryBrook102DyerAvenue(860)693-7777
eastHartfordEastHartfordHealthcare&RehabilitationCenter51ApplegateLane(860)568-7520
RiversideHealth&RehabilitationCenter745MainStreet(860)289-2791
eastWindsorChestnutPointCareCenter171MainStreet(860)292-5394
KettleBrookCareCenter96ProspectHillRoad(860)623-9846
enfieldBlairManor612HazardAvenue(860)749-8388
ParkwayPavilionHealthCare1157EnfieldStreet(860)745-1641
St.JosephResidence2365EnfieldStreet(860)741-0791FarmingtonAmberwoodsofFarmington416ColtHighway(860)677-1671
FarmingtonCareCenter20ScottSwampRoad(860)677-7707
ForestvilleSubacuteCenterofBristol23FairStreet(860)589-2923
GlastonburyGlastonburyHealthCareCenter1175HebronAvenue(860)659-1905
SalmonBrook72SalmonBrookDrive(860)633-5244
GranbyMeadowbrookofGranby350SalmonBrookStreet(860)653-9888
HartfordAveryNursingHome705NewBritainAvenue(860)527-9126
ChelseaPlaceCareCenter25LorraineStreet(860)233-8241
EllisManor210GeorgeStreet(860)296-9166
ParkPlaceHealthCenter5GreenwoodStreet(860)236-2901
TrinityHillCareCenter151HillsideAvenue(860)951-1060
kensingtonLedgecrestHealthCareCenter154KensingtonRoad(860)828-0583
manchesterBidwellCareCenter333BidwellStreet(860)647-9191
CrestfieldRehabilitationCenter&FenwoodManor565VernonStreet(860)643-5151
ManchesterManor385WestCenterStreet(860)646-0129
WestsideCareCenter341BidwellStreet(860)647-9191
marlboroughMarlboroughHealthCareCenter85StageHarborRoad(860)295-9531
NewBritainAndrewHouse66ClinicDrive(860)225-8608
BrittanyFarms400BrittanyFarmsRoad(860)224-3111
JeromeHome975CorbinAvenue(860)229-3707
MonsignorBojnowskiManor50PulaskiStreet(860)229-0336
WalnutHillCareCenter55GrandStreet(860)223-3617
NewingtonBel-AirManor256NewBritainAvenue(860)666-5689
JeffersonHouse1JohnH.StewartDrive(860)667-4453(Hartford Hospital is a corporate affiliate and is likely to be considered to have a discloseable financial interest)
The Henry Low Heart Center at Hartford Hospital 8-3
SkIlleDNURSINGFAcIlITIeS
NewingtonHealthCareCenter240ChurchStreet(860)667-2256
PlainvilleAppleRehabFarmingtonValley269FarmingtonAvenue(860)747-1637
PlantsvilleAlzheimer’sResourceCenterofConnecticut1261SouthMainStreet(860)628-9000
TheSummitatPlantsville261SummitStreet(860)628-0364
RockyHillAppleRehabRockyHill45ElmStreet(860)529-8661
MapleViewManor856MapleStreet(860)563-2861RockyHillSkilledNursing&Rehabilitation60WestStreet(860)529-2521
SimsburyGovernor’sHouse36FiretownRoad(860)658-1018
McLeanHealthCenter75GreatPondRoad(860)658-3700
SouthingtonSouthingtonCareCenter45MeridianAvenue(860)621-9559
SouthWindsorSouthWindsorNursing&RehabilitationCenter1060MainStreet(860)289-7771
SuffieldTheSuffieldHouseOneCanalRoad(860)668-6111
WestHartfordBishop’sCornerHealthcare&RehabilitationCenter2432AlbanyAvenue(860)236-3557
HebrewHomeandHospital1AbrahmsBoulevard(860)523-3960
HughesHealth&RehabilitationCenter29HighlandStreet(860)236-5623
TheReservoirOneEmilyWay(860)561-7022St.MaryHome2021AlbanyAvenue(860)570-8200
WestHartfordHealth&RehabilitationCenter130LoomisDrive(860)521-8700WethersfieldWethersfieldHealthCareCenter341JordanLane(860)563-0101
WindsorKimberlyHallNorth1EmersonDrive(860)688-6443
KimberlyHallSouth1EmersonDrive(860)688-6443
WindsorRehabilitation&HealthCareCenter581PoquonockAvenue(860)688-7211
WindsorlocksBickfordHealthCareCenter14MainStreet(860)623-4351
lITcHFIelDcoUNTY
canaanGeerNursing&RehabilitationCenter99SouthCanaanRoad(860)824-5137
kentTheKent46MapleStreet(860)927-5368
litchfieldRoseHaven31NorthStreet(860)567-9475NewmilfordCandlewoodValleyHealth&Rehabilitation30ParkEastLane(860)355-0971
VillageCrest19PoplarStreet(860)354-9365
PlymouthCook-WillowConvalescentHome81HillsideAvenue(860)283-8208
TorringtonLitchfieldWoodsHealthCareCenter255RobertsStreet(860)489-5801
ParadigmHealthcareofTorrington80FernDrive(860)482-7668
TorringtonHealth&RehabilitationCenter255WyomingAvenue(860)482-8563
ValerieManor1360TorringtonStreet(860)489-1008
WolcottHallNursingCenter215ForestStreet(860)482-8554
SalisburyNobleHorizons17CobbleRoad(860)435-9851
SharonSharonHealthCareCenter27HospitalHillRoad(860)364-1002
WatertownAppleRehabWatertow33BunkerHillRoad(860)274-5428
WatertownConvalarium560WoodburyRoad(860)274-6748
WinstedLaurelHillHealthCenter108EastLakeStreet(860)379-8591
SkIlleDNURSINGFAcIlITIeS
8-4 The Henry Low Heart Center at Hartford Hospital
mIDDleSexcoUNTY
chesterAaronManorNursing&Rehabilitation3SouthWigHillRoad(860)526-2436
Chesterfield’sHealthCareCenter132MainStreet(860)526-5363
cobaltCobaltLodgeHealth&RehabilitationCenter29MiddleHaddamRoadRoute151(860)267-9034
cromwellCromwellHealth&RehabilitationCenter385MainStreet(860)635-5613
PilgrimManor52MissionaryRoad(860)635-5511
RidgeviewHealthCareCenter156BerlinRoad(860)635-1010
DurhamTwinMaplesHealthCareFacility809RNewHavenRoad(860)349-1041
essexEssexMeadowsHealthCenter30BokumRoad(860)767-7201middletownAppleRehabMiddletown600HighlandAvenue(860)347-3315
MiddlesexHealthCareCenter100RandolphRoad(860)344-0353
WadsworthGlenHealthCareCenter30BostonRoad(860)346-9299
Water’sEdgeCenterforHealth&Rehab111ChurchStreet(860)347-7286
moodusChestelmHealthCare534TownStreet(860)873-1455
oldSaybrookAppleRehabSaybrook1175BostonPostRoad(860)399-6216
GladeviewHealthCareCenter60BostonPostRoad(860)388-6696
PortlandPortlandCare&RehabilitationCenter333MainStreet(860)342-0370
NeWHAVeNcoUNTY
AnsoniaHilltopHealthCnter126FordStreet(203)736-1100
BranfordBranfordHillsHealthCareCenter189AlpsRoad(203)481-6221
cheshireElimParkBaptistHome140CookHillRoad(203)272-3547
TheHighlandsHealthCareCenter745HighlandsAvenue(203)272-7285
DerbyBirminghamHealthCenter210ChatfieldStreet(203)735-7401
eastHavenAppleRehabLaurelWoods451NorthHighStreet(203)466-6850
TalmadgeParkHealthCare38TalmadgeAvenue(203)469-2316
GuilfordAppleRehabGuilford10BostonPostRoad(203)453-3725
TheGuilfordHouse109WestLakeAvenue(203)488-9142
HamdenArdenHouse850MixAvenue(203)281-3500HamdenHealthCareCenter1270ShermanLane(203)281-7555
WhitneyCenter200LeederHillDrive(203)281-6745
WhitneyManorConvalescentCenter2798WhitneyAvenue(203)288-6230
madisonMadisonHouse34WildwoodAvenue(203)245-8008
WatrousNursingCenter9NeckRoad(203)245-9483
meridenAppleRehabCoccomo33ConeAvenue(203)238-1606
ConnecticutBaptistHome292ThorpeAvenue(203)237-1206
CurtisHome–St.ElizabethCenter380CrownStreet(203)237-4338
MeridenCenter845PaddockAvenue(203)238-2645
MillerMemorialCommunity360BroadStreet(203)237-8815
SilverSpringsCareCenter33RoyStreet(203)237-8457WestfieldManorHealthCareCenter65WestfieldRoad(203)238-1291
milfordGoldenHillHealthCareCenter2028BridgeportAvenue(203)877-0371
MilfordHealthCareCenter195PlattStreet(203)878-5958
The Henry Low Heart Center at Hartford Hospital 8-5
SkIlleDNURSINGFAcIlITIeS
WestRiverHealthCareCenter245OrangeAvenue(203)876-5123
middleburyMiddleburyConvalescentHome778MiddleburyRoad(203)758-2471
NaugatuckBeaconBrookHealthCenter89WeidDrive(203)729-9889
GlendaleCenter4HazelAvenue(203)723-1456NewHavenJewishHomefortheAged169DavenportAvenue(203)789-1650
Leeway40AlbertStreet(203)865-0068
MaryWadeHome118ClintonAvenue(203)562-7222ParadigmHealthcareCenterofNewHaven181CliftonStreet(203)467-1666
SisterAnneVirginieGrimesHealthCenter1354ChapelStreet(203)867-8300
UniversityCenterSkilledNursing&Rehab915EllaT.GrassoBoulevard(203)865-5155
WestRockHealthCareFacility34LevelStreet(203)389-9744
NorthBranfordEvergreenWoodsHealthCenter88NotchHillRoad(203)488-8000
NorthHavenMontoweseHealth&RehabilitationCenter163QuinnipiacAvenue(203)624-3303ProspectParadigmHealthcareofProspect64SummitRoad(203)758-4431
SeymourShadyKnoll41SkokoratStreet(203)881-2555
SouthburyLutheranHomeofSouthbury990MainStreetNorth(203)264-9135
PomperaugWoodsHealthCenter80HeritageRoad(203)262-6555
RiverGlenHealthCareCenter162SouthBritainRoad(203)264-9600
WallingfordMasonicHealthCareCenter22MasonicAvenue(203)679-5900
RegencyHouseofWallingford181EastMainStreet(203)265-1661
SkyviewCenter35MarcDrive(203)265-0981
VillageGreenofWallingford55KondrackiLane(203)265-6771WaterburyAbbottTerraceHealthCenter44AbbottTerrace(203)755-4870
Buck’sHillNursing&RehabilitationCenter2017NorthMainStreet(203)757-0731
CheshireHouseHealthCareFacility3396WestMainStreet(203)754-2161
CrescentManor1243WestMainStreet(203)757-0561GroveManorNursingHome145GroveStreet(203)753-7205
MeridianManor1132MeridenRoad(203)757-1228
ParadigmHealthcareofWaterbury177WhitewoodRoad(203)757-9491
RoseGardenHealth&RehabilitationCenter3584EastMainStreet(203)754-4181
VillageGreenofWaterbury128CedarAvenue(203)757-9271
WestHavenAppleRehabofWestHaven308SavinAvenue(203)932-6411
ParadigmHealthcareofWestHaven310TerraceAvenue(203)932-2247SoundviewHealthcare&RehabilitationCenter1CareLane(203)934-7955
WoodbridgeTheWillowsCare&RehabilitationCenter225AmityRoad(203)387-0076WolcottWolcottViewManor50BeachRoad(203)879-4987
NeWloNDoNcoUNTY
colchesterAppleRehabColchester36Broadway(860)537-4606
HarringtonCourt59HarringtonCourt(860)537-2339GrotonFairview7218StarrHillRoad(860)445-7478
GrotonRegencyCenter1145PoquonockRoad(860)446-9960
SkIlleDNURSINGFAcIlITIeS
8-6 The Henry Low Heart Center at Hartford Hospital
mysticAppleRehabMystic28Broadway(860)536-9655
AvalonHealthCareCenteratStoneridge186JerryBrowneRoad(860)536-9700
MysticHealthcare&RehabilitationCenter475HighStreet(860)536-6070
PendletonHealth&RehabilitationCenter44MaritimeDrive(860)572-1700
NewlondonBeechwood31VauxhallStreet(860)442-4363
TheCrossingsEastCampus78VietsStreetExtension(860)447-1416
TheCrossingsWestCampus89VietsStreetExtension(860)447-1471NianticBridebrookHealth&RehabilitationCenter23LibertyWay(860)739-4007
NorwichNorwichtownRehabilitation&CareCenter93WestTownRoad(860)889-2614
RegencyHeightsofNorwich60CrouchAvenue(860)889-2631
UncasvilleOrchardGroveSpecialtyCareCenter5RichardBrownDrive(860)848-8466
WaterfordBayviewHealthCareCenter301RopeFerryRoad(860)444-1175
FountainviewCareCenter88ClarkLane(860)442-0471GreentreeManorNursing&RehabilitationCenter4GreentreeDrive(860)442-0647
TollANDcoUNTY
RockvilleFoxHillCenter22SouthStreet(860)875-0771
StaffordSpringsEvergreenHealthCareCenter205ChestnutHillRoad(860)684-6341
StorrsMansfieldCenterforNursing&Rehabilitation100WarrenCircle(860)487-2300
TollandWoodlakeatTolland26ShenipsitLakeRoad(860)872-2999
VernonVernonManorHealthCareCenter180ReganRoad(860)871-0385
WINDHAmcoUNTY
BrooklynPierceMemorialBaptistHome44CanterburyRoad(860)774-9050
DayvilleWestviewNursingCare&RehabilitationCenter130WareRoad(860)774-8574DanielsonRegencyHeightsofDanielson111WestcottRoad(860)774-9540
PlainfieldVillaMariaConvalescentHome20BabcockAvenue(860)564-3387
VillageManorHealthCare16WindsorAvenue(860)564-4081
PutnamHolySpiritHealthCare72ChurchStreet(860)928-0891
MatulaitisNursingHome10ThurberRoad(860)928-7976
WillimanticRegencyHeightsofWindham595WalleyStreet(860)450-7060
WindhamDouglasManor103NorthRoad(860)423-4636
St.Joseph’sLivingCenter14ClubRoad(860)456-1107