What is Coronary Artery Bypass Surgery?
Coronary artery bypass surgery is a common procedure for reestablishing blood flow to heart muscle.
But before we get ahead of ourselves, it’s important to know that coronary artery disease is merely a fancy term for clogged plumbing in the arteries that deliver blood to your heart muscle (not to be confused with heart valve problems).
It’s possible to have up to a 75% blockage without any symptoms.
Usually anything higher than this will tend to elicit symptoms (i.e., chest pain or tightness, shortness of breath) and may potentially require medical intervention to open the artery and reestablish blood flow.
If left unchecked, it can result in a heart attack.
If you’re a visual learner, please check out this short video which will give you an overview of the procedure and what to expect.
Common Treatments for Coronary Artery Disease
The two most common procedures are:
- Percutaneous transluminal coronary angioplasty (PTCA), also referred to as percutaneous coronary intervention (PCI) in some countries; and
- Coronary artery bypass surgery
PTCA For Clogged Cardiac Plumbing
PTCA entails inserting a catheter through the femoral artery in your groin, threading it up to the heart into the clogged coronary artery, and inflating a balloon to press the plaque up against the vessel wall to reestablish blood flow.
It is often accompanied by placement of a supportive wire mesh called a stent.
This option is usually suitable for individuals with mild arterial plaque in one or two vessels.
Coronary Artery Bypass Surgery for Heart Disease
If multiple vessels are blocked or the interventional cardiologist deems angioplasty too risky, then coronary artery bypass grafting may be required.
Coronary artery bypass surgery is an open-heart surgical procedure performed when the disease is too diffuse and widespread to accommodate a simple angioplasty procedure.
This operation generally entails the surgical removal of the saphenous vein from your leg and segments of it are then sewn from the aorta of your heart to the opposite side of the blocked arteries, effectively creating a bridge over the plaque.
In some instances, the internal mammary artery which feeds blood to the chest wall is detached and redirected to the other side of the blockage.
Coronary artery bypass surgery is merely a more advanced plumbing job than its comparatively simpler angioplasty/stent cousin.
Newer technologies and surgical techniques are being developed which minimize the trauma to the body. Ask your surgeon which options are best for you.
Recovery Time After Bypass Surgery
As with heart valve repair or replacement, you can expect at least six to eight weeks of recovery time after coronary artery bypass surgery. While rest is important for healing, so is regular physical activity.
Regular aerobic exercise helps offset the deleterious effects of surgery and bed rest, such as muscle atrophy, muscle and joint stiffness, and balance and coordination.
Early mobilisation should begin about one to two days after surgery including several short duration walks per day around the nurse’s station.
Most coronary artery bypass patients return home after a four to six day hospitalisation.
Resuming activities after bypass surgery
Returning to your activities of daily living (ADLs) can be a challenge upon release from the hospital.
It’s normal to feel tired and exhausted as if you were run over by a bus.
But rest assured this is expected and you will progressively regain your energy over the next couple months.
Before you get stuck into any heavy structured exercise, it’s important to work through your daily tasks as safely as possible to minimise any complications.
Overhead lifting after coronary artery bypass surgery can be a challenge.
Your sternum is going to be sore and tender, so be careful when lifting your arms to shoulder height and above.
You can place dishes in the cupboard or brush your teeth, but try to minimise how long your arms are in the elevated position.
Avoid any heavy overhead lifting until you are cleared to do so by your doctor.
Climbing stairs and steps
Climbing stairs and steps after bypass surgery can be tiring, so you should assume a graduated approach.
You may want to start with climbing one flight of stairs and see how you feel. If you become short of breath, then you should stop and rest.
As you return to health and feel stronger, you can gradually increase the number of stairs and steps you climb, while reducing the number of rests you take.
Lifting during household chores
You can perform most domestic tasks after your surgery, but try not to lift much more than 2 to 4.5 kg (5 to 10 lbs) during the first several weeks after discharge.
You can prepare meals, wash cloths and dishes, do light cleaning, and go shopping.
Once you’ve received clearance from your doctor, you will be able to perform more heavy pushing and pulling activities that load the sternum.
Sex after coronary artery bypass surgery
One of the main concerns with sex after surgery is pressure on the sternum.
You may need to experiment with different positions in order to find the one that least aggravates your incision site.
You should speak with your doctor to discuss when is the best time to return to sex after your operation (usually a few weeks).
Return to driving
You can usually return to driving about a month after your surgery.
You may feel groggy and tired due to the influence of your medications so it may not be advisable from a safety standpoint.
Moreover, your sternum is going to be sore and turning the steering wheel might aggravate it.
There is nothing wrong with being a passenger, but you might want to try putting a soft pillow or cushion between the seatbelt and your chest.
You might also opt to sit in the back seat since an airbag deployed during an accident could cause damage to your already weakened sternum.
Travel is fun but after bypass surgery it can be downright exhausting.
Speak to your doctor about your impending trip and if it’s appropriate for you to take the trip or wait a bit longer.
It is advisable to be geographically close to your doctor should you have any complications.
Bottom line: you might need to hold off on your trip until you are deemed medically stable and feeling well enough to travel.
Going back to work
Going back to work can be both physically and mentally exhausting.
It may take one to two months before you are fully able to engage in your regular duties.
If you are performing a physical job that requires heavy lifting, you should speak with your doctor to determine the best time to return to work.
If you work in an office setting, then it may be appropriate to return sooner.
No matter what your job, it may be advisable to start with a half-day and gradually work up to a full shift.
Healthy eating for coronary artery disease
For more information on diet for people with coronary artery disease, please read Gabby Maston’s article on the paleo diet vs. the Mediterranean diet.
Aerobic Activity Guidelines Post-Surgery
Obtain your surgeon or cardiologist’s approval before engaging in any vigorous exercise.
Low level walking during recovery is usually prescribed, but previously active individuals tend to overdo it with too much too soon.
Perform aerobic exercises that activate the large muscles of the lower body (i.e., legs and hips), are rhythmic in nature, and can be done continuously for an extended period of time.
Be sure to choose exercises you enjoy. You’re much more likely to stick with your program if it’s fun.
It is normal to feel quite tired the first few weeks after surgery, but this will go away in time—give yourself permission to be human.
Start off with multiple short-duration (i.e. three to five minutes) exercise sessions per day, gradually working up to longer durations fewer times per day.
Set a target of walking 45 to 60 minutes non-stop at a comfortable pace as you progress through the recovery period.
Use the following generic graduated exercise plan as a guide. Notice the objective is to “ween” yourself from the shorter exercise bouts more times per day to the longer, continuous bouts less times per day.
Exercise at least three days per week and as many as seven. Three days in the beginning should be more than enough.
Graduated Post-CABG Surgery Exercise Regimen
|Recovery Week||Minutes||Times per day|
|1||3 – 5||6 – 8|
|2||5 – 10||4 – 5|
|3||10 – 15||3 – 4|
|4||15 – 20||3|
|5||25 – 30||2|
|6||30 – 45||2|
Add extra days when you can comfortably perform three days without any ill effects or undue residual fatigue.
Because medications such as beta-blockers blunt your heart rate response to exercise, your pulse may not be considered an accurate marker of your exercise intensity.
Even so, it’s still not a bad idea to keep tabs on your exercise heart rate so you know what your individual response is under the effects of your medication regime.
If you have a hard time finding your pulse, get yourself a heart rate monitor or a Fitbit (which also tracks your non-exercise movement habits).
In this case, focus on a moderate to somewhat hard pace where you’re breathing just hard enough to perform the activity and carry on a conversation with an exercise partner.
Exercise physiologists call this the talk test.
Aerobic Exercise Caution
- Be sure to provide yourself with a 5 to 10 minute warm up and cool down phase before and after each session. It will help reduce your risk of injury or other post-surgery complications.
- While in the early recovery phase, avoid overexerting yourself with strenuous/vigorous exercise (unless advised to do so by your cardiologist or surgeon). This can cause a sharp spike in your heart rate and blood pressure which might aggravate the bypass grafts. Use the ol’ KISS acronym: Keep It Slow and Steady.
- Walk or cycle on level surfaces to establish your fitness foundation. You’ll be able to handle the hills in due time. If you find yourself huffing and puffing, that should be an indicator to ease up on the accelerator!
- Limit your exposure to environmental stressors such as extreme cold, heat, or strong winds. Any of these can make your usual exercise pace seem much more difficult.
- Pay attention to any signs or symptoms associated with exercise. If you experience chest pain or discomfort, slow down or stop exercising. If it does not resolve by itself or continues to get worse during rest, seek emergency medical attention.
Can I Go to the Gym After Coronary Artery Bypass Surgery?
If exercising at a gym, ask the staff what credentials or experience they have in working with heart patients.
They should understand your condition as well as any medications you may be taking.
They should also have an emergency response protocol in place (i.e. dial 911 (000, 111 in some countries), on-site defibrillator, etc).
Strength Training Guidelines Post-Surgery
While it may seem counter-intuitive to lift weights after bypass surgery, quite the opposite is true.
If judiciously applied, resistance training can hasten your healing and recovery and help you get back to your regular way of life quickly and efficiently.
However, you shouldn’t lift much more than four to five kilos (10 pounds) during the first 4 to 6 weeks of recovery, or until clearance by your surgeon.
After that, keep your progression slow to avoid any debilitating muscle soreness.
Always perform resistance movements with proper form and breathing technique. Always remember to exhale on the exertion (lifting) phase. As a rule, never hold your breath or strain during a lift.
You may want to consult a qualified fitness professional for additional guidance on form and technique.
For general conditioning, work all major muscle groups from largest to smallest.
You don’t want to pre-fatigue your small muscles first since they work as assisting muscles during larger movements.
For example, your triceps are assisting muscles during the chest press.
If you work your triceps first, they’ll be too fatigued to assist during the chest exercise.
Begin with short duration sessions as this will allow your body to safely adapt.
Start off with 15 to 20 minute sessions and work up from there.
Marathon training sessions may leave you tired and sore and potentially discourage you from continuing with your regimen.
Use light resistance in the beginning.
It is far better to use light weights and learn proper form up front than start off with heavy weights and sloppy form.
Begin with a weight that allows you to perform 10 to 15 repetitions.
When you can do 15 without any undue fatigue, increase the weight by 3 to 5 percent.
Don’t overdo it.
Perform resistance training two to three times per week.
The in-between days are for proper recovery and recuperation.
After you receive final clearance from your surgeon and/or cardiologist, then you may progress to heavier weights and more sets and repetitions.
Strength Training Caution
- As with aerobic training, obtain physician clearance before starting any strength training program.
- Numbness in the chest area is normal. Coronary artery bypass surgery entails cutting nerves in your chest but the feeling usually returns within one year.
- If signs or symptoms occur during resistance training, stop training immediately. If symptoms do not improve, or if they worsen during rest, seek immediate medical attention.
Take Home Message
While coronary artery bypass surgery can be very hard on the body, you will be served far better by engaging in regular physical activity during the recovery period.
The immediate post-surgery phase is the most difficult but after you break through the first two to three weeks, you’ll be amazed at how well you feel.
The previously blocked arteries that were causing you shortness of breath and chest pain will no longer be limiting factors in your ability to carry out your daily tasks.
Most people who’ve had bypass surgery go on to live very fruitful and active lives, sometimes even better than before! But be forewarned, surgery is not a cure for artery disease.
If you previously lived an unhealthy lifestyle and return to your old ways, there is the possibility that your arteries will block up again, potentially leaving you in line for a follow-up coronary artery bypass procedure.
In short, adopt healthy lifestyle changes and make it a part of your daily routine!
Monday 13th of June 2022
Hi Dr. Bill I have a quadruple CABG 6 weeks ago and I have maintained a solid regular walking regime at pace over that time period. Is it possible to know when it may be appropriate to include some short jog or running with a view to returning to the routine exercise level I undertook prior to the surgery - twenty minute slow jog on 5 to 6 days a week ? Any view greatly accepted. (PS. Levels of pain/discomfort since surgery have reduced excepting some variable frequency of pain on one side of one's neck)
Dr Bill Sukala
Monday 20th of June 2022
Hi Ed, If you're 6 weeks post-op and you're already tolerating that level of exercise, provided there are no objections from your doc and/or are given full clearance to return to exercise, you would likely be safe to introduce a little more intensity into your workout.
Regarding the pain, it's not unusual to have a bit of residual discomfort after open heart surgery. It's definitely a stress on the body so, heart healing aside, it takes a while for the sternum to heal and the pain to subside.
Hope this helps! Kind regards, Bill
Friday 22nd of October 2021
My Aunt had open heart surgery (double bypass) in March this is October and she feels some better but is having these huffing and puffing things happen like she has been crying hard and it only happens a few times and stops and that happens a few times a day everyday. She is going tomorrow to have a defibrillator put in since the day she came out of surgery she has been having afib attacks a lot. But this is awesome information for anyone.
Dr Bill Sukala
Friday 22nd of October 2021
Thanks for sharing Tiff. Most appreciated. I like for these comments to be a useful resource for visitors so I appreciate your contribution.
Thursday 7th of October 2021
Good information-I am in my 4th week.
Monday 13th of September 2021
This is one of the best written articles I have seen. Thank you. I am post CABG (now 4 months). I am a (long time) Strength and Conditioning Coach. So I know my way round exercise pretty well. Your comment about previous high level of activity is spot on! I was always a high achiever and always competitive. Mentally it’s been tough. Even though 4 months post, I’m frustrated because I was achieving less than just prior to surgery. I have been bike riding, slowly biting off chunks of a long hill. My Surgeon just chewed me out! Saying I should have been at 120bpm. My previous max was 173-176… guess I’ve been close! Kindest regards, Clive Rodell (.com)
Wednesday 10th of February 2021
Hello Dr. Bill, First off, thanks for all the great advice and counsel you offer to all who write. Just reading through has provided lots of info ( and comfort) for those of us traveling the journey of recovery.
I'm 4 weeks out of a CABG x 5. Everything has gone well, with the exception of a PE event about a week after surgery. Slowed recovery a bit but now on track again.
I am a long time race car driver and now participate in vintage racing. Assuming a full recovery , do you have any thoughts about returning to racing. Main concern is being tightly restrained with racing harness and the occasional possibility of a racing incident (crash) and the effect on the sternum.
I am in otherwise good health and at 68 was lucky to have the intervention before there was damage. Thanks.
Dr Bill Sukala
Wednesday 10th of February 2021
G'day Gordy, Thanks for taking the time to leave a comment. Sometimes those little hiccups occur during recovery and I'm happy to hear you're doing well and on the up and up.
Moving forward, as you will see me mention in most of my responses, the most important thing is working closely with your medical management team to get specific recommendations for your unique circumstances (based on your full medical history etc).
I think once your sternum fully heals (about 6 to 12 months and beyond), that will probably not be an issue. Otherwise, it would be good to discuss with your doctors the effects any meds might have on your driving abilities, response times, or any impact on your blood pressure. Also, depending on how fast you're driving, I wonder if that might also impact your circulation (plus being tightly strapped in).
Bottom line: I'd talk to your cardiologist and perhaps even see about getting a treadmill stress test done before you go back to racing (just as a safety precaution). The thing to remember is that you are just trying to minimise risk. There are always going to be risks in everything you do, but if you can sort of preempt those risks by covering your bases in advance, then you at least give yourself and others some peace of mind.
Hope this helps and best wishes to you in your racing endeavours! Cheers Bill