Learning to live with the effects of a heart attack: long-term drug therapy: anticoagulant drugs


For the operation the patient is of course anaesthetized, with the heart-lung machine standing by ready to take over during the critical phase of the grafting. A non-essential vein is removed from the patient's own leg (no rejection problems here) and one end of it is stitched into position in front of the blockage (i. e., on the side farthest away from the heart). The other end of the vein is then sewn directly into the aorta, thus producing a bypass around the blockage and allowing blood to flow freely from the aorta into the heart. Not just one, but several bypasses can be fashioned in a single operation. In order to perform the delicate stitching, the surgeon needs a quiet heart (i. e., one that is not beating), and so a cold, heart-paralyzing solution is injected into the coronary system after the patient has been put on the heart-lung machine. To start the heart again after the work has been completed, warm blood is allowed to flow back into the coronary system. Usually the heart begins to beat spontaneously, but sometimes it needs artificial electrical stimulation to nudge it back to life.

As for results, more than nine out of ten people get some relief from symptoms with a bypass operation and six out of ten get total relief. There is no doubt that the quality of life of the patient is enhanced by the operation, which allows a chance to return to a level of physical activity that previously had been out of the question.

After the operation a few rules and regulations are to be expected. Your doctor will probably put you on a course of drugs. Physical exercise must be taken carefully to start with, so that you build up your levels of exertion very gradually, and, if you feel like it, punctuate your day with a rest in bed. You may get a few aches and pains in your chest and leg - after all, your chest has been opened up for the operation and this will take time to heal, as will the vein wound in your leg.

At night you may sweat a little. Driving is out for the immediate post-op period but can be resumed after about six weeks. Sex is all right, but be sensible and avoid ultra-strenuous activity until your general level of exertion is around normal again. As for work, research shows that more than half of all bypass patients are back on the treadmill within 12 weeks of their operation, and more than eight out of ten by the end of one year. Take advice from your doctor if you are in one of those trades - like driving heavy vehicles -where stresses are known to be severe.