Surgery Journey
Heart, Lungs, Blood Pressure and Sleep Apnea
Heart, Lungs, Blood Pressure and Sleep Apnea: Surgery With Extra Care
Heart attacks, heart failure, abnormal heart rhythms, and lung complications are among the most serious problems that can follow surgery, and they are more likely if you have heart disease, a coronary stent, a pacemaker, high blood pressure, asthma, COPD, or sleep apnea, or if you smoke. Much of this risk can be reduced by preparation before surgery and simple actions afterward. The promise of this guide: we will check your heart and lungs carefully, keep the medicines that protect them, and watch you closely after the operation.
Before Surgery: Checks You Can Expect
- A stepwise heart assessment: the urgency of surgery, any active heart problems, your combined risk, and what you can do physically. If you can climb two flights of stairs without stopping, you often need no further heart testing. Tests are ordered only when the result would change the plan.
- Questions about snoring and sleep: loud snoring, witnessed pauses in breathing, and daytime sleepiness can be signs of sleep apnea, which changes how anesthesia and pain medicines are given.
- A review of your breathing: recent chest infections, asthma or COPD flare-ups, inhaler technique, and oxygen levels. Planned surgery is usually delayed until a chest infection or flare-up has fully resolved.
- Bring all heart medicines, recent heart test results, your pacemaker or defibrillator device card, your inhalers, and your CPAP machine, mask, and tubing.
Surgery After a Heart Stent: Timing Matters
Surgery soon after coronary stenting carries a higher risk of the stent clotting. For planned surgery, the usual minimum waits, based on the 2024 American guideline, are:
Balloon angioplasty without a stent
- Usual minimum before planned surgery
- At least 14 days
Bare-metal stent
- Usual minimum before planned surgery
- At least 30 days
Drug-eluting stent for stable disease
- Usual minimum before planned surgery
- Ideally 6 months, and never within 30 days
Stent placed for a heart attack or unstable angina
- Usual minimum before planned surgery
- Ideally 12 months
Decisions about stent medicines are always made with your cardiologist. Never stop aspirin or other antiplatelet medicines on your own.
Your Heart and Lung Medicines Around Surgery
Beta-blockers
- Usual approach
- Continue, including on the morning of surgery. They are never started for the first time on the day of surgery
Statins
- Usual approach
- Continue
ACE inhibitors and angiotensin receptor blockers
- Usual approach
- May be omitted 24 hours before higher-risk surgery in selected patients with controlled blood pressure, according to protocol; usually continued in heart failure with reduced pumping. Your written plan decides
Diuretics (water tablets)
- Usual approach
- Often omitted on the morning of surgery; restarted when drinking normally
Nitrates and calcium channel blockers
- Usual approach
- Continue
Inhalers
- Usual approach
- Continue, including on the morning of surgery. Bring your reliever inhaler with you
Blood pressure on the day
- Usual approach
- Mild to moderate high readings are not a reason to postpone surgery; very high readings, around 180/110 or above, or high readings with symptoms, need assessment first
Protecting Your Lungs: The I COUGH Steps After Surgery
After the operation, a simple bundle protects your lungs. Remember it as I COUGH:
- Incentive breathing: take 10 slow, deep breaths every hour while you are awake.
- Coughing: cough while holding a pillow over your wound. Tell the team if pain stops you from breathing deeply or coughing; your pain relief can be adjusted.
- Oral care: brush your teeth and rinse your mouth twice a day.
- Understanding: know why each step matters; ask when you are unsure.
- Getting out of bed: sit up in a chair for meals and walk several times a day.
- Head of bed elevated: rest with your head raised.
- If you have sleep apnea, use your CPAP every time you sleep, including naps, and sit up rather than lying flat. Pain medicines that cause drowsiness are used carefully, at the lowest effective dose.
Recovery After Surgery: Watching the Heart
- You may have heart monitoring, and blood tests for heart strain, after surgery. Heart injury after surgery is often silent, without chest pain, so tell the nurse at once about chest pain, breathlessness, or palpitations, whatever the monitors show.
- An irregular heartbeat (atrial fibrillation) can begin after surgery and is treatable; report palpitations.
- Walk as soon as you can, and restart your usual heart medicines as planned.
- Stop smoking, including shisha and vaping: both strain the heart and lungs and slow healing.
Warning Signs: When to Seek Help
Green
- What you notice
- Mild tiredness in the first weeks; ankles slightly swollen after surgery but improving; mild cough and slight breathlessness that improve each day
- What to do
- Expected. Keep taking your heart medicines and doing your breathing steps
Amber
- What you notice
- Palpitations or a fast, irregular pulse; ankle swelling or weight gain of 2 kg in 2 days; breathless with less activity than usual; cough with yellow or green phlegm; temperature of 38 C or more; needing your reliever inhaler more than usual
- What to do
- Call your doctor or the clinic the same day
Red
- What you notice
- Chest pain or pressure lasting more than a few minutes; breathless at rest or when lying flat; fainting; sudden weakness, numbness, or speech problems; breathlessness that is getting worse; coughing blood; blue lips; confusion; a severe asthma attack your inhaler does not help
- What to do
- Call an ambulance or go to the emergency department now
Questions Patients Ask
Do I need heart tests before my operation?
Only if they would change what we do. If you can climb two flights of stairs without stopping, you often need no extra tests.
I had a stent recently. Can I have my operation?
For a planned operation, it is usually safer to wait, ideally 6 months after a stent for stable disease or 12 months after a heart attack. We will decide with your cardiologist.
Why do you ask about my snoring?
Loud snoring and stopping breathing during sleep can be signs of sleep apnea, which affects how we give anesthesia and pain medicines.
Do I need to bring my CPAP machine?
Yes, please. You will use it after the operation and every night in hospital.
I only smoke shisha. Does that count?
Yes. Shisha and vaping also affect your lungs, heart, and healing. Stopping before surgery helps.
Full guide written by Dr. Tamer Elalfy