Heart Transplant: What to Expect at Home

Your Recovery

A heart transplant is surgery in which your diseased heart is replaced with a healthy donor heart. Your doctor did the surgery through a cut (incision) in your chest.

You will feel tired and sore for several weeks after surgery. You may have some brief, sharp pains on either side of your chest. Your chest, shoulders, and upper back may ache. The incision in your chest may be sore or swollen. These symptoms usually get better after 4 to 6 weeks.

You will probably be able to do many of your usual activities after about 3 months. But for 3 to 4 months, you will not be able to lift heavy objects or do activities that strain your chest or upper arm muscles. At first you may notice that you get tired easily and need to rest often. It may take several months to get your energy back.

Having an organ transplant can bring up many emotions. You may feel grateful and happy. But you also may feel guilty or depressed. Seek out family, friends, and counsellors for support. If you think you are depressed, ask your doctor for help. Treatment can help you feel better.

After a heart transplant, you must follow a strict lifestyle involving daily medicines and regular medical care. This includes regular sampling (biopsies) of the transplanted heart tissue to check for rejection.

You probably started a cardiac rehabilitation (rehab) program in the hospital. You will continue with this rehab program after you go home to help you recover and prevent problems with your heart.

This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible.

How can you care for yourself at home?

Activity

Continue the cardiac rehab program you started in the hospital. Your program has details about your activity level and your diet. Here are some general guidelines:

Rest when you feel tired. Getting enough sleep will help you recover. Try to sleep on your back for 8 to 12 weeks while your breastbone (sternum) heals. This usually takes at least 6 to 8 weeks.
Try to walk each day as directed by your cardiac rehab program. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or heavy aerobic exercise, until your doctor says it is okay.
For 3 months, avoid activities that strain your chest or upper arm muscles. This includes pushing a lawn mower or vacuum, mopping floors, or swinging a golf club or tennis racquet.
For 2 to 3 months, avoid lifting anything that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a child.
Ask your doctor when you can drive again.
You will probably need to take at least 6 weeks off from work. It depends on the type of work you do and how you feel.
Do not swim or use a hot tub until your doctor says it is okay.
Ask your doctor when it is okay for you to have sex.

Diet

Eat a healthy diet. Your doctor can help you learn about healthy eating. You also may want to talk to a dietitian. A dietitian can help you learn about healthy foods.
Drink plenty of fluids (unless your doctor tells you not to).
You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fibre supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if and when to start taking those medicines again. Make sure that you understand exactly what your doctor wants you to do.
Your doctor will give you anti-rejection medicines. He or she may also give you medicines to prevent blood clots, keep your heartbeat steady, and lower your blood pressure and cholesterol. Take your medicines exactly as prescribed. Call your doctor or nurse call line if you think you are having a problem with your medicine.
Take pain medicines exactly as directed.
- If the doctor gave you a prescription medicine for pain, take it as prescribed.
- If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
- Do not take aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), or other non-steroidal anti-inflammatory drugs (NSAIDs) unless your doctor says it is okay.
If you think your pain medicine is making you sick to your stomach:
- Take your medicine after meals (unless your doctor has told you not to).
- Ask your doctor for a different pain medicine.
If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

If you have strips of tape on the cuts (incisions) the doctor made, leave the tape on for a week or until it falls off.
Wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
Keep the area clean and dry.

Other instructions

Hold a pillow firmly over your chest incision when you cough or take deep breaths. This will support your chest and reduce your pain.
Do breathing exercises at home as instructed by your doctor. This will help prevent pneumonia.
You may shower as usual. Pat the incision dry. Do not take a bath for the first 3 weeks, or until your doctor tells you it is okay.
Do not smoke. Smoking can make it harder for you to recover. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
Check with your doctor before you drink alcohol. Alcohol can cause problems with some of the medicines used to prevent organ rejection.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

You passed out (lost consciousness).
You have severe trouble breathing.
You have sudden chest pain and shortness of breath, or you cough up blood.
You have severe pain in your chest.
You have symptoms of a heart attack. These may include:
- Chest pain or pressure, or a strange feeling in the chest.
- Sweating.
- Shortness of breath.
- Nausea or vomiting.
- Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
- Light-headedness or sudden weakness.
- A fast or irregular heartbeat.
After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.

Call your doctor or nurse call line now or seek immediate medical care if:

You have pain that does not get better after you take pain medicine.
You have loose stitches, or your incision comes open.
Bright red blood has soaked through the bandage over your incision.
You have signs of infection, such as:
- Increased pain, swelling, warmth, or redness.
- Red streaks leading from the incision.
- Pus draining from the incision.
- Swollen lymph nodes in your neck, armpits, or groin.
- A fever.
You have signs of a blood clot, such as:
- Pain in your calf, back of the knee, thigh, or groin.
- Redness and swelling in your leg or groin.
Your heartbeat feels very fast or slow, skips beats, or flutters.
You are dizzy or light-headed, or you feel like you may faint.
You have new or increased shortness of breath.

Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if:

You gain weight suddenly, such as 1.5 kilograms or more in 2 to 3 days.
You have increased swelling in your legs, ankles, or feet.
You have any concerns about your incision.
You feel very sad or have other signs of depression, such as trouble sleeping or eating.
You have questions about diet, exercise, quitting smoking, or stress reduction after surgery.