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The Oxford Heart Centre

Information for patients

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Contents

Introduction 3

OxfordHeartCentrecontacts 3

Informationaboutyouroutpatientappointment 4

Getreadyforsurgery 6

Eatingforahealthyheart 6

Preparingtoleavehome 10

Consentingtotreatment 13

Settlingintotheward 14

Yourhealthcareteam 15

Family,friendsandvisitinghours 16

Beforetheoperation 17

YourstayinCardiothoracicCriticalCare(CTCC) 18

Recoveryaftertheoperation 21

Goinghomefromhospital 23

Homeactivityprogramme 26

Exerciseschedule 28

Activitiesguide 30

Aftercareandrehabilitation 34

Driving 36

Sexualrelations 36

Howfamilyandfriendscanhelp 37

Contactnumbersforcardiacrehabilitation 38

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IntroductionIfyouarecomingintotheOxfordHeartCentreforanoperationyoumayhaveanumberofquestionsaboutwhatwillhappenwhileyouarehere.Thisbookletisdesignedtoansweryourquestionsandprovideinformationaboutwhattoexpectandhowtolookafteryourhealthwhenyougohome.

Ouraimistoprovideahigh-qualityservicetoourpatients.Wethereforewelcomeanysuggestionsyoumayhave.Helpustoimprovebyfillingoutapatientsatisfactionsurveyorbyspeakingtoamemberoftheseniornursingteam.YouwillfindcopiesofthesurveyinsidetheinformationfolderskeptbyeverybedontheCardiothoracicWard.

Thisbookletisdesignedtocomplementthemanyotherpublicationsavailabletoyou.Furtherinformationcanbeobtainedfrom:

• TheBritishHeartFoundationTel:02079350185/www.bhf.org.uk

• Thehospitalwebsite:www.oxfordradcliffe.nhs.uk/heartcentre

OxfordHeartCentrecontactsPre-admission and Discharge Liaison NursesForadviceandsupportwhileyouwaitforyouradmissionandalsoafterdischargespeaktothePre-admissionandDischargeLiaisonNurses.Theyarethefirstpointofcontactifyouhaveanyquestionsorconcerns.

Tel:01865220274

Ward clerksForhelpwithclaimformsanddetailsofaccommodationavailablelocallyaskoneofthewardclerks.

Tel:01865572635/572663

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Senior Nursing TeamTheSeniorNursingTeamcomprisesamatronandwardsister,allofwhomcanbecontactedviatheward.

Tel:01865572662/572661orviathehospitalswitchboard:01865741166.

InformationaboutyouroutpatientappointmentWhenyouarereferredforcardiacsurgerywewillsendyouanoutpatientappointment.Atthatappointmentyouwillseeadoctorwhowillexplain:• whattheoperationinvolves• anyassociatedrisks.

Tips• Makealistofthequestionsyouhaveandbringthemalongto

theappointment.• Bringarelativeorfriendalongtosupportyou.

AppointmentsIfyouandthesurgeonagreetogoaheadwithsurgery,youwillbegivenaplaceonawaitinglist.Wewilltellyouwhentoexpecttoreceiveanadmissiondate.

Pre-admission ClinicYouwillneedtoattendthePre-admissionClinic(PAC)beforeyouareadmittedforyouroperation.Ifyouroutpatientappointmentisinthemorning,youmaybeofferedtheopportunitytostayandattendthePAConthesameday.Alternatively,youwillbesentanappointmenttoattendthePACafewweeksafteryouhavebeenaddedtothewaitinglist.

AtthePACyouwill:• seethePre-admissionandDischargeLiaisonNurse,adoctor

andthephysiotherapist

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• receiveinformationaboutyoursurgery• havesomemedicalcheck-ups• discussplansforyourdischargeaftersurgery.

YouwillalsohaveachestX-rayandanECGtracingofyourheart,andbloodsampleswillbetaken.Itisagoodideatobringsomeonewithyou.NoneofthetestsyouwillneedtotakeatthePACwillaffectyourabilitytodrivehomeafterwards.APre-admissionClinicappointmentusuallytakesthreetofourhoursintotal.

Ifyouarehavingheartvalvesurgeryyouwillbegivenaletterforyourdentisttosigntosayyourmouthisfreefromsignsofinfection.Ifyouarehavingheartvalvesurgeryanddonothaveadentist,werecommendyoucontactyourGPsurgeryforadviceonhowtofindanNHSdentistinyourareaassoonaspossible.Ifyouareunabletoprovideconfirmationthatthereisnoactiveinfectioninyourgums,youroperationmayhavetobepostponed.

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GetreadyforsurgeryThe right foodOneofthebestwaystoprepareforyouroperationistogetyourdietright.Beingwell-nourishedandatagoodweightforyourheightwill:• promotewoundhealing• giveyoustrengthtomakeaspeedyrecovery.

WhenyouattendyourPre-admissionClinicappointmentthenursewillbeabletotellyouifyouareunderweight,atahealthyweightforyourheightoroverweight.Ifyouareunderweight,thenursewillgiveyouadviceandmayreferyoutothedietitian.Ifyouareoverweight,losingafewpoundsbeforetheoperationwillbehelpful.

Losing weightAimtoloseamaximumof2lbsperweek.Crashdietsmaycauserapidweightlossbutdon’tprovidethevitaminsandnutrientsyouneedtobeinthebeststateofhealthforyouroperation.Preparingforheartsurgeryisoftenatimetotakestock.Manypeopleusethischancetothinkabouttheirdiet,andtomakeplansforkeepinghealthyinfuture.

EatingforahealthyheartWhat matters the most?• Eatagoodintakeofoilyfisheachweek.• Eatatleastfiveportionsoffruitandvegetableseachday.• Reduceyourintakeoffat,particularlysaturatedfat.• Reducethesaltyoueat.

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Oily fish Eattwotothreeportionsofoilyfisheachweek.Ifyouhavediabetes,orareawomanofchildbearingage,keeptoonetotwoportionsofoilyfishaweek.• Oneportionis140gofcookedfish.

Oilyfishisagoodsourceofomega3fattyacids.Theycanmakethebloodlesslikelytoclotandpromotearegularheartrhythm.Examplesofoilyfishincludeherring,kippers,mackerel,pilchards,sardines,sild,salmon,troutandfreshtuna.

Warning• Smokedfishisquitesaltysokeepitfortreats.• Tinnedtunadoesn’tcount,unfortunately,astheomega3oils

arelostinprocessing(freshtunaisfine).

White fishWhitefishisstillahealthychoicebutcontainsonlysmallamountsofomega3comparedwithoilyfish.

How to increase oily fish intake easily• Puttinnedfish(intomatosauceifpreferred)ontoastasa

quicksnack.• Chopupsomemackerelorsalmonandaddtoasaladorpizza.• Grillorbarbecuewholetrout,mackerel,herring,kippersor

sardines.• Havepoachedkippersforbreakfast.• Tryrollmops(pickledherring)asalightsnack.• Trymackerel/salmonpâté(buyormakeyourown).

Fruit and vegetablesThesecanbefresh,tinned,frozen,driedorasjuice,butonlycountjuiceandmushroomsasoneportiondaily.

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Rough guide to portion sizes

Vegetablesraw,cooked,frozenorcanned 2fulltablespoonsSalad 1dessertbowlDriedfruit ½-1tablespoonGrapefruit/avocadopear ½fruitApples,bananas,orangesandothercitrusfruit 1fruitPlumsandsimilarsizedfruit 2fruitsGrapes,cherriesandberries 1cupfulFreshfruitsalad,stewedorcanned 2-3tablespoonsFruitjuice 1smallglass(150ml)

Easy ways to eat five fruits and vegetables in a dayBreakfast• Havegrilledorcannedtomatoesormushroomsontoast.• Addslicedbanana,strawberriesordriedfruittocereal.• Haveapieceoffruitorcartonofjuicewitharoll.

Lunch• Dipfingersofrawvegetablese.g.carrots,celery,cucumber

andsweetpeppersintolow-fatsoftcheese,salsaornaturalyoghurt.

• Addfresh,driedortinnedfruittopackedlunches.• Fillsandwiches,pittabreadorbaguettesfullofsalade.g.sliced

tomato,gratedcarrot,lettuce,cucumber,sweetcorn,coleslaw.• Addcookedortinnedvegetablestocannedsoupsormake

yourown.

Dinner• Addmixedvegetables,sweetcornorpeastocookedpastaor

rice.• Cookpotatoeswithcarrot,sweetcorn,swedeorcabbageand

mashtogether.

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• Quicklystirfryfreshorfrozenvegetableswithchicken,meatorquornandspices.

• Addextravegetablestoboughtsauces,curries,pizzaetc.• Stuffanappleorstonedpeachwithcurrantsordates,bakeit

intheovenormicrowaveandservewithcustardoryoghurt.

Tip:alltypesoffruitmakeanidealsnackatanytimeofday.

Reduce your fat intakeWhicheverfatyouuse,useitsparingly.

Somefat,likethatinoilyfish,isgoodforyourheart.Otherfat,likethehardersaturatedfats,cancausehealthproblems.Thesefatsarefoundin:• animalfatsuchasbutter/lard/dripping• fatinmeatandmeatproductse.g.pâté,pies,sausagesetc.• fatindairyproductsincludingcheese,milkandcream:choose

lowfatvarieties• fatincakes,biscuits,piesandconfectionery.

Choosespreadsandcookingoilshighinmonounsaturatedfattyacids(e.g.olive,rapeseed)orpolyunsaturatedfattyacids(e.g.sunflower).Avoidthosehighinsaturatedfat(e.g.butter,lard)ortrans-fattyacids(e.g.hydrogenatedvegetableoil).

Eat less salt• Trytoreduceyourintakeofconvenienceandverysaltyfoods

e.g.cook-insauces,processedmeats,packetmixesetc.• Avoidaddingsalttofoodwherepossible.Betteralternatives

includepepper,garlic,herbs,spicesandlemon.

Keep your alcohol consumption low• Menshouldnotdrinkmorethan21unitsperweek.• Womenandanyonetakingwarfarinshouldnotdrinkmore

than14unitsperweek.

Ifyouwouldlikemorespecificadviceaboutfoodandyour

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heart,orwouldlikealittlemoresupport,pleasecalltheDieteticDepartment.

DieteticDepartment:01865221702/3

Other useful resources

BritishHeartFoundation14FitzhardingeStreetLondonW1H6DHwww.bhf.org.uk

FoodStandardsAgencywww.eatwell.gov.uk

BritishDieteticAssociationwww.bda.uk.com

PreparingtoleavehomeBelongingsTheOxfordRadcliffeHospitalsNHSTrustacceptsnoresponsibilityforthedamageortheftofpersonalitemsunlesstheyhavebeenhandedoverforsafekeeping.

BenefitsIfyourstayisprolongedyouwillneedtotelltheDepartmentofSocialSecurity,listedinYellowPages,ifyouarereceivingIncomeSupportoraSocialSecuritypensionorbenefit.Somebenefitsmayhavetobereducedduringyourstay.

Ifyoucontributetoaninsurance/pensionscheme,whichallowsclaimstobemadewhenyouareapatientinhospital,theTrustwillmakeanadministrativechargetocompletetherelevantforms.

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Give somebody your contact detailsLetyournextofkinorclosefriendknowyourtelephonenumberandaddresswhileyouareinhospital:

CardiothoracicWardLevel2JohnRadcliffeHospitalOxfordOX39DU

Tel:01865572663

What to bring with youPackabagforyourstay.Pleasebringcomfortableclothestowearduringthedaye.g.tracksuit;loosefittingnightclothes;dressinggownandslippers;toiletrybag;towel;readingmaterialandstationery.Weaskthatladiesbringinanon-wiredsupportivebratowearaftertheirsurgery.

Current medicationsPleasefollowtheinstructionsonthegreenleafletgiventoyouatthePre-admissionClinicandbringinallofyourmedication,intheoriginalcontainers,inthegreenbag.

ValuablesPleasedonotbringinalotofmoneyorcreditcards.Wealsoaskthatyoudon’tbringanyothervaluableswithyouunlessyouabsolutelyneedthem.TheTrustcannotacceptliabilityforanylossordamagetoanythingyoubringwithyou,unlessithasbeenhandedoverforsafekeepingandyouhaveareceipt.

Going homePlanyourreturnhome.Youwillbegiveninformationabouthowlongyoucanexpecttostayinhospitalatyourpre-admissionappointment,orwhenyouaretransferredbacktotheward.Youwillneedtomakearrangementsforsomeonetotakeyouhomeondischargeandforsomeonetostaywithyouforoneweekafteryougohome.Wewillaimtogetyouhomeintimeforlunch.

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Pleaseencourageyourcarertoreadthisbookletbeforeyouareadmitted.Wewillgladlyansweranyquestionsfrombothpatientsandcarers.PleasecontactthePre-admissionandDischargeLiaisonNursesifyouneedanyadvice.

Travel arrangementsPleasemakeyourownarrangementsforcomingintohospitalandgoinghome.

Informationontraveltothehospitalandparkingcanbefoundonthehospitalwebsitewww.oxfordradcliffe.nhs.ukinthe‘Findus/contactus’sectionandinpatientinformationbooklets.

Personal problemsSocialworkersformpartofthecaringteamandareavailabletohelpyouoryourrelativeswithproblemsthatariseasaresultofyourillnessandstayinhospital.Yournursewillhelpyoucontactthem.

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ConsentingtotreatmentBeforeyouhavesurgeryadoctorwillaskyoutosignaconsentform.Youshouldhaveagoodunderstandingoftheproposedprocedureandtheriskofcomplications,asexplainedtoyoubyyourdoctor.Ifyouhaveanyquestionsorconcerns,beforeoraftersigningtheconsentform,thenpleasefeelfreetoraisethesewithyourmedicalteam.

HaveyoureadthePatientConsentLeaflet?Ifnotpleaseaskyournurseforacopy.

Youcanalwaysrefusetreatment.Ifyouhavesignedaconsentform,butafterwardschangeyourmind,youcanstillwithdrawyourconsent.Thisdoesnotaffectyourrighttoalternativeformsoftreatment.

Ifyouareunhappyaboutyourtreatmentandwishtoleave,tellanurseoradoctor.Youcanusuallyleavewheneveryouwantbutthedoctormayaskyoutosignaformtakingresponsibilityforleavingifheorshedoesnotthinkyoushouldgo.

Allmembersofstaffarerequiredtowearidentificationbadges.Ifyouareunsureaboutsomeone,pleaseasktoseetheirbadge.

Resuscitation policyRarelyapatientmayunexpectedlycollapseiftheirheartstopsbeating(cardiacarrest).Itisournormalpolicytoattempttorevive(resuscitate)patientsinsuchsituations.Ifyouareinanywayunsureaboutthis,orwishtodiscussthispolicy,pleasefeelfreetodosowithyournurseordoctor.

Helping staff to learn – clinical teachingTheOxfordRadcliffeHospitalsisateachingtrust,thereforestudentsmaybepresentwhenyouseethedoctor:ifyouwouldpreferstudentsnottobepresent,pleasetellthenurseordoctor.

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SettlingintothewardThe thoughtof anadmissionmay to somepeople seem ratherfrightening.Weareallheretohelpyouwithanyworriesorproblemsandwillansweranyquestionsyoumayhaveduringyourstay.

Don’t compare yourself to other people!Itistemptingtocompareyourownprogressandrecoverytootherpatientsontheward,butthiscancauseworryifyourtreatmentisnotthesame.Everybodyisdifferent;youwillhavethetreatmentthathasbeenplannedspecificallyforyou,sodonotworryifitisdifferentfromyourneighbour’s.

Privacy and dignityWeareproudtoconfirmthatduringyourstayontheCardiothoracicWardyouwillhaveyourownbedroomwithen-suitefacilities.

Your detailsWhileyouarestayingontheward,yournamewillbedisplayedonawhiteboard(noticeboard)forthemedicalandnursingstaff.Theboardwillnotdetailyourmedicalinformationbutwillbevisibletostaff,patientsandvisitors.Inordertoprotectyourconfidentialityandinlinewithdataprotectionlegislation,wewouldliketoaskforyourconsenttoyournamebeingshowninthisway.Ifyouhaveanyquestionsaboutthisorwouldpreferthatyournameisnotshown,pleaseinformyournurseonadmissionorassoonaspossible.

Wewillaskyoutowearanidentitybraceletatalltimeswhileyouareapatientinthehospital.Thisidentifiesyouandalsocontainsabarcodewithinformationusedtoidentifyyouifyouneedabloodtransfusion.

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YourhealthcareteamThepeopleyoumaymeetduringyourstay:

DoctorsThesurgicalteamisleadbyaconsultantsurgeon.Therestoftheteamincludesspecialistregistrarsandseniorhouseofficers(SHOs).Doctorscometothewardtoseepatientsfirstthinginthemorningand/ortheevening.

Nurses and healthcare assistants

Duringyourstayyouwillbelookedafterbyspecialistnursesandhealthcareassistants.Studentnursesalsotrainontheunitandmaycareforyouwithsupervisionfromatrainednurse.

PhysiotherapistsThephysiotherapistwillmeetwithyoubeforeyoursurgeryandgetyouonthemoveagainafterwards.

DietitiansAdietitianisavailableifnecessarytoprovidespecificdietaryadviceandtocareforyourindividualdietaryneeds.

Pharmacist

Thepharmacistsvisitthewarddailyandgiveadviceaboutyourmedicationaswellasmakingsureyouhavethecorrectdrugstotakehome.

RadiographersRadiographersmaytakeanX-raypicturewhennecessary,eitheronthewardorintheX-rayDepartment.

Ward clerks

Wardclerksprovideusefuladviceandinformationaboutadministrativedetails,e.g.workrelatedmedicalcertificates.

PhlebotomistsPhlebotomistsaretrainedprofessionalswhovisitthewardtocarryoutbloodtestsasrequestedbyyourdoctors.

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HousekeeperThehousekeepermakessurethewardiskeptclean,overseesthecateringneedsofpatientsandhelpswithnon-nursingtasks.

PortersPorterstransferyoufromthewardtotheatreorotherdepartmentswithinthehospital.

Family,friendsandvisitinghoursFamilyandfriendsareimportanttoyouwhenyouareinhospital.Whileweencouragepeopletovisit,youwillprobablyfindthatyouareverytiredimmediatelyafteryouroperation.

Preferred visiting hours: Cardiothoracic Ward• 3.00pm-8.00pmeveryday.• Restperiod1.00pm-3.00pm–allvisitingisdiscouraged

duringthistime.

Ifthisisdifficultforyourrelatives,thenpleasespeaktothenursingstafftodiscussalternativearrangements.

Preferred visiting hours: Cardiothoracic Critical Care (CTCC)• Open.• Restperiod1.00pm-3.00pm–allvisitingisdiscouraged

duringthistime.

Twopeopleareallowedatthebedsideatanyonetime.Itisnotanappropriateenvironmentforyoungchildrenbutspecialarrangementscanbemade.Visitorsmaybeaskedtowaitinthewaitingroomiftheunitisparticularlybusy.

Wearenotabletoaccommodateflowersorplants.

OnadmissionyouwillbegiventelephonenumbersforthewardandCTCC.Pleasenominateonememberofyourfamilytophoneintoaskafteryourprogressandtellallotherfamilyandfriendstocontactthatpersonforupdates.

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BeforetheoperationOn the day of admissionBeforesettingoutonthemorningofyouradmissionpleaseremembertotelephonethewardtoconfirmthatthereisabedavailableforyouandaskwhattimeyoushouldarrive.Ifthereisnotabedavailable,wewillrescheduleyouradmissionassoonaspossible.

Pleasebringwithyouitemslistedonpage11andallyourcurrentmedication.Whenyouarriveontheward,youmaybeaskedtotakeaseatinthewaitingareawhileweprepareyourbed.

Ananaesthetistwillseeyoubeforeyouroperationtodiscussyouranaesthetic,andwillbehappytoansweranyquestionsthatyoumayhave.Heorshewillprescribesomemedicationthatrelaxesyoubeforegoingtotheoperatingtheatre.Moreinformationaboutyouranaestheticiscontainedintheleaflet‘Youandyouranaesthetic’whichyouwillbegivenatPre-admissionClinicorontransfertoCardiothoracicWard.

Ifyoudidnotseethephysiotherapistatpre-admissiontheywillseeyoubeforetheoperationtoexplainsomeoftheexercisesthatwillhelpyoubreathemoreeasilyafteryoursurgery.

Youroperationwillnormallybescheduledtotakeplacewithin48hoursofyouradmission.Occasionallyitmaybenecessarytopostponeyouroperationbecauseofanemergency.Youroperationwillthenberescheduledforthenextavailableoperatingslot.

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YourstayinCardiothoracicCriticalCare(CTCC)Afteryouroperation,youwillbetransferredintotheCardiothoracicCriticalCareUnit(CTCC).Thisunitisdesignedtoprovideintensivemedicalandnursingcareafteryouroperation.Onadmissiontotheunityouwillhaveanursecaringonlyforyouonaone-to-onebasis.Asyourconditionimprovesyouwillbemovedtothehighdependencyareawhereonenursecaresfortwoorthreepatients.

Breathing Duetotheanaestheticyouwillbeunabletobreatheunaidedstraightaway,soyouwillneedsomehelpforashorttime.Whenyouareasleepintheanaestheticroom,asmalltubewillbepassedthroughyourmouthintoyourairway.Thisallowstheanaesthetisttouseamachinethatwilldoyourbreathingforyou.Asyoubegintowakeupyoumaybeawareofthistube.Trytorelaxandlistentothenurse’sadvicetotakedeepbreaths.

Thetubewillberemovedassoonasyouareawakeenoughtobreatheonyourown.However,youwillneedtowearanoxygenmaskforabout24hours.

Afterthetubeisremoved,yourthroatmaybealittlesore,andyourvoicealittlehoarse,butthiswillgetbetter.Rememberthisisonlytemporaryandispartofyourrecovery.

Whenthebreathingtubeisinplaceyouwillbeunabletotalk.Therewillbeanursewithyouthewholetimewhowillhelpyoucommunicatebyaskingyoushortquestionsrequiringanodorshakeofyourhead.

Eating and drinkingAllofyourfluidsandmedicationswillbegiventhroughnarrowtubesinyourveins,calleddrips,butyoucannormallydrinkafterthebreathingtubeisremoved.Youmayfeelsickattimesandifthishappensyournursewillgiveyousomemedicationtorelieve

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thefeeling.Whileyouarenotdrinkingoreatingyoumayfeelthirsty.Mouthwashesandicecubesareavailableasoftenasyouliketohelpwiththis.

Chest drainsTubescalleddrainsareusedtoremoveanyexcessblood,fluidorairremaininginyourchestaftersurgery.Youwillhaveoneortwogoingthroughyourskinintoyourchest.Thesearenormallyremovedwithin24hoursofyouroperation.

Removalofchestdrainscancausepain,butyouwillbegivenpainreliefbeforetheprocedure.

Heart monitorYouwillbeconnectedtoaheartmonitortocontinuouslyassessyourheartrateandrhythm.ThismaycontinueafteryouaretransferredtotheCardiothoracicWard.

Youwillalsohaveasmallplastictubeputintoanarteryonyourwrist.Thisiscalledanarteriallineanditwillmeasureyourbloodpressureveryaccurately,everysecond.ThislinewillberemovedbeforeyouleaveCTCCtoreturntotheward.

Youmayalsohaveasmallwirethroughyourskin,whichcanbeattachedtoapacemakerifrequired.Thiswillberemovedbeforeyouleavehospital.

Toilet facilitiesWhenyouareasleepfortheoperation,acatheter(finetube)willbepassedintoyourbladdertodrainurinewhileyouaretoodrowsytogotothetoilet.Itmayfeelalittlestrangebutitisusuallyremovedthedayafteryouroperation.Thisdoesnothurt.Youmayalsobeconstipatedafteryouroperation.Youshouldletyournurseknowifthishappens.

SleepingImmediatelyafteryouroperationyoumayfinditdifficulttosleep.Ifyoudohaveproblemssleepingpleaseletyournurseknowasthedoctorcanoftenprescribemedicinestohelp.

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Occasionallysomepatientsexperienceveryvividdreams;thesecanbedistressingbutareperfectlynormalandwillpass.Ifyoudoexperiencethese,letyourdoctorornurseknowsothattheycanreassureyou.Yoursleeppatternmaybedisturbedforafewweeksbutitusuallyresolveswithoutmedication.

Pain reliefWhenyouwakeupyoushouldnotbeinalotofpain,asyouwillhavebeengivenaverystrongpainkiller.Ifyoudosufferanypainatallpleaseletthenursesknowandtheycanthengiveyoumorepainkillers.

Patient-controlled analgesia (PCA)APCApumpallowsyoutomaintainaconstantlevelofpainreliefbydeliveringaprescribeddoseofpainmedicationasandwhenyouneedit.

ThePCApump,containingmorphine,isconnectedtoadripthatisplacedinavein.Youaregivenabuttontopresswhenyouareinpainandmorphineisthengivendirectlyintothevein.Sometimesmorphinecancausenauseabutwecangiveyouanti-sicknessmedicationtoreducethis.

Asasafetyprecaution,thePCApumpwillonlyallowmedicationtobedeliveredeveryfiveminutes.Youcangetanotherdoseofmedicationwhenthegreenbuttonisilluminated.Ifyouhaveanyquestionsregardingpatient-controlledanalgesiapleasespeaktoamemberofstaff.

Itisveryimportantthatyouhaveminimalpainsothatyoucanperformyourdeepbreathingandcoughingexerciseseffectively.Thisisbestdonebyhavingsmallbutregularamountsofpainrelief.

Itiseasiertokeeppainawaythantogetridofitonceyouhaveit.Donottrytogowithoutpainkillers.Youwillprobablyneedthemregularlyforatleasttwotothreeweeksafteryouroperation,andsomepeoplewillrequirethemforlonger.Everyoneisdifferent.

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RecoveryaftertheoperationWhenyouarestableandthedoctorsarehappywithyourconditionyouwillbetransferredfromCTCCtotheCardiothoracicWardtocompleteyourrecovery.Thisisapositivemovetowardsrecoveryanddischargehome.Onthiswardonenursecaresforagroupoffiveorsixpatients.Atstaffchangeovertimesthenursewhowillcareforyouforthemorning/afternoon/nightwillcomeandintroducethemselvestoyou.

Mobility / washingOnceyouarewellenoughyouwillbeabletogetoutofbed,sitinthechairandinduecoursetakeashortwalk.Veryquicklyyourmobilitywillimproveandyouwillgainconfidence.Thenurseswilllookatyourwoundseverydayandgiveyouanypainkillersyouneed.Assoonasyouarereadywewillhelpyoutohaveashower.

Eating againMostpeoplehavenoproblemeatingaftersurgery,butitisperfectlynormaltoloseyourappetiteforawhile.Youwillusuallyhaveyourfirstmeal(evenifitisonlysouporicecream)withinadayofyouroperation.Yourappetiteshouldimprovegraduallysothatbythetimeyouleavehospitalitisclosetonormal.Howevereverybodyisdifferentanditmaytakesomepeoplelongertoregaintheirappetitethanothers.

Meals in hospitalMostpatientsreceivethreemealsadaywhiletheyareinhospital:breakfast,lunchandaneveningmeal.Drinksareservedthen,andatothertimesduringtheday;ahotdrinkisavailablebeforebedtimetohelpyousettledown.Mealsareservedinthewardsataboutthefollowingtimes: Breakfast7.30am-8.00am Lunch12noon-12.30pm Supper6.00pm-6.30pm

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Youmaychoosefromaselectionofmealsbroughttothewardandservedbyamemberofthecateringteam.Youwillbegivenamenutomakeyourchoices–theseareusuallyhandedoutatbreakfasttime.Ifyouwouldliketoraiseanypointsaboutthecateringserviceatanytimeduringyourstaywithus,pleaseasktospeaktothewardhousekeeperwhowillpassonyourcomments.

Ifyouhaveparticulardietaryrequirements,foreithermedicalorreligiousreasons,pleasetellyournursesothatappropriatearrangementscanbemade.Somepeoplemaybeindividuallyreferredtothedietitianforadviceregardingspecificdietaryproblemsoriftheirappetiteispoorforaprolongedperiod.

Pleaserememberthatalthoughwerecommendalow-fat,high-fibredietinthelongterm,youwillbeundergoingmajorsurgeryso‘healthyeating’guidelinesarenotreallyapplicableduringyourhospitalstay.Ifyoufindthefoodinhospitalisnotaslowinfatandhighinfibreasyournormaldietpleasedonotworry.Trytoenjoyyourfoodwhileyouareinhospitalandresumeyournormalhealthyeatinghabitswhenyouarefullyrecovered.

Improve your breathingSoonafteryouroperationyoumaybeabitworriedabouttakingdeepbreathsandcoughing.Thephysiotherapistwilltakeyouthroughbreathingexercises.Itwillbeimportanttorepeattheseexercisesfrequentlythroughouttheday.Itwillalsobenecessaryforyoutocoughinordertoclearphlegmfromyourchest.Althoughthismaybeuncomfortableitisvitaltodothistopreventachestinfection.

Thephysiotherapistwillguideyouthroughtheseexercisesandassistyouwithashortwalkassoonaspossible.Beforeyougohomewewouldexpectyoutobewellenoughtoclimbtwoflightsofstairswiththephysiotherapist.

Wearealwayskeentoensurethatallaspectsofthecareyoureceivemeetyourexpectations.Ifyouhaveanyconcernsorsuggestionsaboutthecareyouhavereceivedpleasespeaktoyournurseorthewardsister.

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GoinghomefromhospitalThelengthofyourstayinhospitalwillnormallybeaboutfivetosevendaysaftertheoperation.Donotworryifyouaresenthomebeforeorafterthistime;peopletakevaryingperiodstorecoverfromsurgery.

Weadvisethatthereissomeoneathome,oryoustaywithsomeonewhocanlookafteryou,forthefirstweekafteryourstayinhospital.Ifthereisnoonetolookafteryou,thenpleasediscussthiswithyourGPorthepre-admissionnursebeforeadmission.

Youwillneedtoarrangeyourowntransportintoandoutofhospital.IfthisisimpossibleforyoupleasediscussthiswithyourGPorpre-admissionnursebeforeadmission.Itisbetteriffriendsorrelativescantakeyouhome.

Yourreturnhomemarksthestartofareturntofitnessandlifeasnormalaspossible.Itisusualtofeelapprehensiveandinsecureaboutleavinghospital.Itwilltakeafewdaystosettledownathome.Manypatientshaveanenormousbuilduptotheirsurgery,andwhenitisovertheymayfeelasenseofanticlimax.Toreachfullrecoveryyoushouldbeginwithasmallamountofphysicalactivityandincreaseitgradually.

Duringyourrecoveryyoumayexperiencegoodandbaddays,andarangeofemotionsandphysicalsymptoms.

EmotionsIrritability,milddepression/moodswings,tearfulness,lossofconcentration,vividdreams/sleepdisturbances.

Physical symptomsTiredness,visualdisturbances,sweats(especiallyatnight),palpitations,lossofappetiteandsenseoftasteandaheightenedsenseofsmell.

Allthesesymptomswillpass,butiftheypersistandyoufeel

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unwellyoushouldnothesitatetocontactyourGP,especiallyifyouhaveatemperatureorprolongedpalpitations.Youshouldavoidhavingyoureyestestedforeightweeksaftersurgerytoallowanyvisualdisturbancestosettle.

Pain controlInhospitalyouwillbegivenregularpainkillers.Whenyougohomeyouwillneedtocontinuetakingtheseregularly–theywillhelpwithyourrecoveryandpreventpainfrombuildingupandbecominguncontrollable.Paracetamoltabletscanbetakenonceyourprescribedpainkillersfromhospitalhavefinished.Ifyouhaveanyquestions,orifyourpainisnotcontrolled,pleasespeaktoyourGP.

Other ways that may help control pain• Makeyourselfacoughcushionoruseafoldedtowelto

supportyourwoundwhenyoucough.• Useseveralpillowsinbed.Thesewillactasalevertohelpyou

situp.Rollontoyoursidewhengettingoutofbed.• Useahighbackedarmchairwitharmreststominimisethe

effortneededtopullyourselffromalow-lyingunsupportedsetteeorsofa.

• Adailybathorshowerwillhelpreducemusclestiffness.• Informationonrelaxationtechniquescanbeobtainedfrom

yourlocallibraryortheinternet.• Gentlemassageofachingmuscles.

Activity and sleepDuringthefirstweekathome,continuewiththeroutineandlevelofexerciseyoufollowedinhospital.Aimtograduallyincreasethedistancethatyouwalkdaily,sothatbyfourtosixweeksafteryoursurgeryyouareabletowalktwotothreemilesperday.Ifyouhavedifficultieswithwalkingduetootherhealthconcernsyourphysiotherapistcanadviseyouonalternativeformsofexercise.

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Youwillfeeltiredatfirstandarestafterlunchisagoodidea,butdonotsleeptoomuchduringthedayasyoumaynotsleepatnight.Itisoftenagoodideanottohavetoomanyvisitorsintheearlydaysathome.

Don’tliftanythingheavierthantenpoundsinweightforthefirstsixweeksfollowingsurgery,forexamplebagsofshoppingorsmallchildren,asthisputsstrainonyourbreastbone.Aftersixtoeightweekstheboneshouldbehealingwellandyoushouldbeabletodohouseworkandlightgardening.Youcannormallyresumedrivingsixweeksafteryouroperationbutyoushoulddiscussthiswithyourdoctorfirst.Anyheavyliftingormanualworkandanythinginvolvinglargearmmovementsshouldbeavoidedfor12weeks.Thetableonpages31and32outlinestheserestrictionsinmoredetail.

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HomeactivityprogrammeThephysiotherapistshavedevelopedthisprogrammetohelpyou.Theywilldiscussitwithyoubeforeyouleavehospitaltogohome.Thisprogrammeistohelpyoutoreturntoyournormalactivitiessafelyandregainyourfullstrengthaftersurgery.

Itisaguidetohowmuchactivitytodo.However,takenoticeofhowyouarefeelingandadjustyouractivityaccordingly.

Iftherearesomeactivitiesyoudo,whicharenotincludedintheguide,askyourphysiotherapistwhenyoumaystartdoingthese.

Walking• Atfirst,walktwicedailyforfivetotenminutes.• Trytoincreaseyourwalkingbyonetotwominuteseachday.• Walkatacomfortablepace.Youshouldbeabletokeepupa

conversationwhileyouwalk.Ifyoucannot,slowdownalittle.• Walkundercomfortableconditions.• Keepyourselfwarm.• Donottakethedogwithyouinthefirstfewweeks.• Donotwalkifyouareunwell.• Donotwalkimmediatelyaftermeals;waitapproximately45

minutesbeforeexercising.• Trytowalkonlevelground–avoidhills(ifhillsare

unavoidable,paceyourselfmoreslowly).• Builduptoatleast20-30minutesdaily.• Ifpossiblewalkwithsomeone(atyourpace)untilyoufeel

confidenttowalkalone.

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Stopwalkingifyouexperience:• undueshortnessofbreath• chestpain• nausea• headache• inappropriatetiredness• musclecramps• dizziness• persistentpalpitations.

Rest,andifsymptomsreoccurconsultyourdoctor.

PostureYoushouldbeawareofyourpostureatalltimes–whetherlyingdown,sittingorwalking.Youneedtotryandkeepyourheaduprightandyourbackstraight.Ifworkingatadeskorcomputer,beparticularlyvigilantaboutyourposture.

Aftersurgeryyoumayexperienceback,neckorshoulderpain.Ifthispersistsconsultyourdoctor,asphysiotherapymaybehelpful.

Tips• Donotneglectanytypeofseverepain.• Inthefirstweekortwoathomeyoumayfeelverytiredand

findithardtokeepupwiththesuggestedexerciselevel.Donotbecomediscouragedasthisiscommon–persevereandyouwillcontinuetofeelbetterdaybyday.

• Walkingisanimportantformofexercise–itwillhelpyoutomakethemostofyouroperation.

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ExercisescheduleMakesureyouspaceyouractivitiesthroughouttheday.It’simportanttochangeyouractivitylevelsaccordingtohowyoufeel.Herearesomeexamplesofthekindsofactivitiesyoucandoweekbyweekafteryouroperation.

Stage 1 (the week after your operation)• Continuewiththesameexerciselevelyouhavebeendoingin

hospital.• Re-establishyournormalroutinee.g.gettingdressed,meal

times.• Restforanhourintheafternoon.• Restrictvisitorstofamilymembers.• Climbstairsslowly.• Lightactivitiese.g.makingcupsoftea/coffeeandlight

snacks.• Avoidwideorenergeticarmmovements,stoopingand

bending.• Keepitgentle!Forexamplereading,music,TV,cards,chess,

paintingpictures,potteringaroundthehouse.

Stage 2 (second week after leaving hospital)• Lightactivitiese.g.preparinglightmeals,tidyingthehouse,

tidyingupthebedroom(notchangingthesheets).• Washingdishes.• Puttinglaundryintothewashingmachine(notcarryingthe

loadorhangingitoutontheline).• Lightgardenactivitiese.g.handwateringwiththehoseor

lookingafterindoorplants.• Stoopingandbendingoccasionally.• Shortdrivesasapassenger.

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Stage 3 (third week after leaving hospital)• Lightactivitiesinthegardene.g.wateringwithasmall

wateringcan(weighinglessthan10lbswhenfullofwater).• Half-dayoutingstovisitfriends.• Shopping–forshortperiodsonly,avoidbusytimesanddon’t

carryparcelsorpushtrolleys.

Stage 4 (fourth week after leaving hospital)• Householdactivitiese.g.lightironing,hangingoutwashing

(asksomeonetohelpyouwithsheetsandtowels),makingbeds(withhelptochangethem),lightsweeping.

• Lightweeding,diggingwithatrowel,pruning.• Indoorbowls.• Watchingfilmsandsports.

Stage 5 (fifth week after leaving hospital)• Mostroutinehouseholdchores(exceptanythatinvolve

prolongedstoopingandbending),cleaningthebathroom,moppingfloors.

Stage 6 (sixth week after leaving hospital)• Bythistimeyoumaybeabletocarryoutmosthousehold

activitiesasnormalunlesstheyinvolvelargeorenergeticarmmovementse.g.vacuuming,heavygardeningorheavylifting.

• It’sagoodideatobreakuplargertasksintotwoorthreesmallertasksatfirst.

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ActivitiesguideHereisaguidesuggestingwhenyoumaybeabletostartdifferentactivitiesafteryoursurgery.Thetimingwillvaryfromonepersontoanotherdependingoneachperson’sprogress.Thetimingsarefromthedateofyoursurgery.

Initiallyit’sagoodideatobreakuplargertasksintotwotothreesmallerones.

Note:thesetablesareonlyaguideandyourdoctormaygiveyoudifferentadvicethatfitsyoursituation.

Activity Numberofweeks aftersurgerySexual intercourseAvoidweightbearingpositionsorpressureonyourwound 3-4Domestictasks:• Lifting(nothingover10lbse.g.kettle

fullofwater) 0-6• Ironing 4• Washing(light) 4• Rakingleaves 10-12• Lawnmowing 10-12• Vacuuming 10-12• Heavypushingorpulling After12• Heavydigginginthegarden After12• Heavylifting After12Work:• Lightwork 6-8• Manualwork 12

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Activity Numberofweeks aftersurgerySport:• Fishing 12• Swimming Paddling 6 Breaststroke 10 Freestyle 12• Golf Putting 2 Driving 12• Dartsandsimilargamesusing yourarms 6• Lawnbowls 6-7• Cycling Stationary 4-6 Moving 12Car driving 6Youmusttellyourcarinsurersthatyouhavehadcardiacsurgery

Twelve weeks after surgeryAfter12weeksdiscusstheactivitiesbelowwithyourGP,SurgeonorCardiacRehabilitationNursebeforestarting.Remembertoincludeawarmup/coolingdownperiod.• Jogging• Squash• Tennis• Badminton• Circuitwork/aerobics• Rowing• Canoeing• Hiking

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FoodIfyourappetiteforfoodhasnotcompletelyreturnedtonormalbythetimeyouleavehospital,itwillalmostcertainlyrecoverquicklywhenyougethome.However,ifyourappetitecontinuestobepoorformorethanoneweekafteryouhavelefthospital,youcancontactthedietitianforfurtheradviceandinformation.Tel:01865221702/221703.

Rememberthatduringyourrecuperationperiod(thefirstsixweeksorsoafterdischarge)youshouldeatwhatyoufeellikeandnotrestrictyourself.

Be kind to yourself!Healthyeatingguidelineswhichrecommendlessfat,sugarandsaltandmorestarchyfoodsandfruit/vegetablesareverysensiblerecommendationsforhealthypeople.Theyarenotidealfollowingmajorsurgery.Youneedtocontinuetoeatavarieddietafteryouroperation,but‘alittleofwhatyoufancy’maydoyougoodintheshortterm.

Startfollowinghealthyeatingguidelinesonceyouarerecoveredfromyouroperation(probablyaboutsixweeksafteryouroperation).

Mostcardiacrehabilitationprogrammesincludesessionsoneatingforahealthyheart;theseareagoodopportunitytogetmoredetailedinformationaboutthistopic.

WoundsYourchestandpossiblylegorarmwoundsmaytakeseveralweekstoheal.Thewoundswillfeeltenderandyoumayfeelbruised,numbor‘tight’indifferentareas.Youshouldcheckyourwoundsathome,lookingfor:• increasedrednessaroundthewound• oozingfromthewound• swellingorwarmth.

Ifyouareworried,tellyourGP.Anytendernesscanbereduced

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bywearinglooseclothing.Womenareadvisedtowearanon-wiredsupportivebra.Boxershortsmaybehelpfulformenwhohavehadaveinremovedfromtheirthigh.

StitchesUsuallyweusestitchesthatjustdissolve.Ifyourstitchesneedtoberemovedwewillarrangeanappointmentforyourdistrictnursetoremovethemforyou.

Dental and medical careIfyouhavehadvalvesurgery,orifyouhavecongenitalheartdisease,properdentalcarewillbeveryimportantfollowingsurgery.Bacteriafromteethandgumscanenterthebloodstreamandinfecttheheart.• Tellyourdentistwhattypeofsurgeryyouhavehad.Youwill

needtotakeantibioticsbeforeanydentaltreatment.• Tellyourdentist,doctororpharmacistifyouaretaking

warfarin.

Themedicationsyoutakemaychangeafteryoursurgery.Thenurseand/orpharmacistwillmakesurethatyouunderstandaboutanynewmedicationsbeforeyouleavehospital.Wewillgiveyoua‘medicationrecord’toremindyouwhatyouneed.

Whenyouleavehospital,wewillgiveyouaonemonthsupplyofmedicines.It’simportanttomakesureyouhaverepeatprescriptionsbeforetheonemonthsupplyisfinished.

WewillsendadischargelettertoyourGP,explainingthereasonforyourhospitalstay,andgivingdetailsofyourmedication.IfyouhaveanydetailedquestionsaboutyourmedicationpleaseaskyourpharmacistorGP.

Follow-up visitsYouwillhaveafollow-upappointmentapproximatelysixtoeightweeksafteryoursurgery.ThismaybeattheJohnRadcliffeorbackatyourlocalhospital.Wewilltellyouabouttheplansforyourfollow-upbeforeyougohome.Atthisappointmentyou

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canaskforadviceaboutmedication,workoranyothermattersthatconcernyou.Ifyouhaveaproblembeforethen,itcanbediscussedwithyourGPoryoucancontactthePre-admissionandDischargeLiaisonNurseson01865220274.

AftercareandrehabilitationAfteryourcardiacsurgeryyoumaybeinvitedtoattendacardiacrehabilitationprogramme.

Cardiacrehabilitationisaservicethatsupportsandguidespatientstomakeanynecessarychangestotheirlifestyle.Ouraimistohelppeoplereturntothequalityoflifetheyhadbeforesurgery.Inmanycasesthiscanmeanamuchimprovedqualityoflife.

What is cardiac rehabilitation?Cardiacrehabilitation:• providesadviceandsupporttopatients• helpspeopleavoidfurtherproblemsandgetbackontheirfeet

again• helpspatientstolookattheirlifestyleandmakeanynecessary

changes• istheretosupportpeoplebothphysicallyandemotionallyas

theyadapttotheirnewlife.

Youcanhavecardiacrehabilitationeitherinhospitalasanoutpatientorinthecommunitysettingsuchasaleisurecentre.CardiacrehabilitationinOxfordshireissuppliedbynursesandexercisephysiologists,withfurthersupportfrompsychologistsanddietitiansifneeded.

Whenyouaredischargedfromhospitalyouwillbereferredtoyourlocalcardiacrehabilitationteam.Thecardiacrehabilitationteamwillusuallycontactyouwithintwotofourweeks,eitherbytelephoneorbyletter.Theywillaskyouvariousquestionsabout

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howyouarefeelingandhowyourrecoveryisprogressing.Ifyoudonothearfromthempleasecontactthemonthenumberlistedonpage39:ifitisnotlistedyoucancontacttheCardiacRehabilitationDepartmentattheJohnRadcliffeHospitalon01865220251andtheywillbeabletogiveyouthetelephonenumberofyourlocalcardiacrehabilitationteam.

IfyouliveinOxfordshireaCardiacRehabilitationNursewillcomeandseeyouonthewardandintroducethelocalservicetoyou.Theywillthencontactyouwithintwoweeksofdischarge,andgiveyouinformation,adviceandtheopportunitytotakepartinourprogrammeofsupervisedexerciseatalocalleisurecentreorhospital.

Steps towards a healthier life Youmayalreadybedoingsomeorallofthese.• ConsiderstoppingsmokingwiththesupportofyourCardiac

RehabilitationNurse,practicenurseorlocalsmokingcessationservice.Therearemanywaystohelpyouwiththis,sopleasedonotbeafraidtoask.Thisisthemostsignificantchangeyoucanmakeinpreventingheartdisease.

• Eatawell-balancedlow-fatdietwithplentyoffruitandvegetablesandoilyfish(seepage7).

• Takeregularphysicalactivity.StartbyfollowingtheguidelinesprovidedbythephysiotherapistattheJohnRadcliffeHospital.

• Trytoreducecircumstancesthatcauseyoustress.• Keepyouralcoholintakewithinrecommendedguidelines.

Menshouldnotdrinkmorethan21unitsperweekandwomenandpeopleonwarfarinshouldnotdrinkmorethan14unitsperweek.

• VisityourGPforregularcheck-upsofyourbloodpressureandcholesterollevels.Wesuggestyouhaveyourbloodpressurecheckedtwotothreeweeksafteryouhavebeendischargedandagainatthreetosixmonths.

• Ifyouarediabeticmakesurethatyourbloodsugarsarewellcontrolled.

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DrivingTheDVLAguidelinesadvisethatyoushouldnotresumedrivinguntilfourtosixweeksafteryouroperation.However,itisadvisabletodiscussthiswithyoursurgeonsixweeksaftersurgery,whenyouhaveyouroutpatientappointment,orwithyourGPifthisappointmentislaterthansixweeks.

IfyouholdaLGV/PCVlicenceyoucannotdriveforthreemonths.TheDVLAmayaskyoutotakeanexercisetestbeforereturningyourlicencetoyou.YouwillneedtocontacttheDVLAtodiscussthis.• 08702411879• www.dvla.gov.uk.

ContacttheDVLAwithinthefirstcoupleofweeksafterdischargefromhospital,asitcantakeawhiletoarrangethetest.

Toensureyourpolicyremainsvalid,youmustinformyourinsurancecompanythatyouhavehadcardiacsurgery.

Seatbeltsmustalwaysbewornbutyoumayfindapadorcushionbetweenyourchestandtheseatbeltmorecomfortable.

SexualrelationsAftercardiacsurgerysometimespeoplefearthattheexertionofsexualintercoursemayplaceaddedstrainontheirheartsorcausethewoundtocomeapart.Thiswillnothappen,althoughthewoundmaybesoreforafewweeks.

Theexertionofintercourseissimilartoclimbingtwoflightsofstairs.So,providingyoucancopewiththisamountofactivityitisunlikelyyouwillexperienceproblems.

Talkthingsoverwithyourpartner;keepitsimpleuntilyourconfidencereturns.

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Ifyouexperienceproblemsonceyouhaverecoveredfromyoursurgery,pleasediscussthemwithyourcardiacrehabilitationorpracticenurse.Donotworry–thereishelpavailable.Anorganisationwhichcanhelpyouis:• SexualAdviceAssociation:08707743571• www.sda.uk.net

Localorganisationsarealsoavailable–yourCardiacRehabilitationNursewillbeabletogiveyoucontactdetails.

HowfamilyandfriendscanhelpCardiacsurgerycanhaveanenormousknock-oneffectforfamily,friendsandcarersaswell.

Youmayexperiencemanyanxietiesandyouremotionsmaybevariable(e.g.‘WillIgetovertheoperation?’;‘WillIgetbacktonormal?’).Thesefeelingswillpassasyourecoverandyoubegintoreturntoyournormaldailyactivities.However,ifnegativefeelingsdon’tgoawayandyoufeeltheyaregettinginthewayofyourrecovery,pleasetalktoyourCardiacRehabilitationNurse,practicenurseorGP.

Yourfamilyandfriendswillalsobeconcernedandfeelanxious.Itmayhelptoshowthemthisbooklet.Cardiacrehabilitationcanalsoofferinformationandsupporttoyourfamily,friendsandcarerifrequired.

Furtherinformationoncardiacsurgery,cardiacrehabilitationandlifestylechangesareavailablefrom:• BritishHeartFoundation• www.bhf.org.uk

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ContactnumbersforcardiacrehabilitationJohnRadcliffeHospital,Oxford 01865220251

TheHortonGeneralHospital,Banbury 01295229753(Part of the Oxford Radcliffe Hospitals NHS Trust)

Cheltenham 08454223535

Gloucester 08454223535

HighWycombe/Aylesbury 01494526161 Ext2025

Luton&Dunstable 01582497469

MiltonKeynes 01908243966

Northampton 01604545345

Reading 01183226638

Swindon 01793646221

Warwick 01926495321 Ext4927

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OMI2597

Ifyouneedaninterpreterorneedadocumentinanotherlanguage,largeprint,Brailleoraudioversion,pleasecall

01865 221473oremailPALSJR@orh.nhs.uk

JennyMitchellPre-admissionandDischargeLiaisonNurse

Version1,April2011ReviewApril2014

OxfordRadcliffeHospitalsNHSTrustOxfordOX39DU

www.oxfordradcliffe.nhs.uk/heartcentre