Worried about post-op "pumphead"

[mrichardson]

I understand that during open heart procedures the individual is put on a heart-lung machine. I've heard one of the side effects of this is something nicknamed "pumphead", or more commonly known as "Postperfusion Syndrome"

https://en.wikipedia.org/wiki/Postperfusion_syndrome

I have real concerns about this, because I've heard it can be a long-term issue for people. I'm a software engineer by trade, so I have to constantly be able to learn new programming languages, techniques, and technologies. I also have to be able to think clearly about the problem at hand to be able to design an effective solution. In other words, in my line of work, thinking is critical. I read somewhere recently that this condition can last months, and in some cases years.

This concerns me, obviously.

Has anyone else experienced this, and how long did it last?

 

[Paleowoman]

I never had what's known as "pumphead" but I have had visual disturbances which are a neurological side effect of the heart lung machine. I get migraine auras without headache, double vision and sparkles of light crossing my vision from time to time. They started the day after surgery. They happen much less often now, two years later, but I still get them. It seems visual problems like that are something a few of us get, here's a thread about it: http://www.valvereplacement.org/for...964-visual-problems-following-cardiac-surgery

I'm glad to say that my cognitive and thinking skills, memory and suchlike did not suffer one jot as a result of the heart lung machine

 

[neil]

hi, for me I had trouble concentrating for awhile after, couldn't watch telly or read for long, also I became withdrawn and wouldn't answer the phone, stupid I know but that's how I was, It slowly went over time and then vanished, I guess it effects everbody in different ways,

 

[mrichardson]

Thanks for the responses. My understanding of what neil is saying is that withdrawal and depression are also some side effects, and usually they're temporary. Hopefully it won't be too hard on my wife and son when that happens.

 

[cldlhd]

I also get the migraine auras without the headache. Before surgery I would get them with the headache. I occasionally have trouble remembering things but it's tough to say if it's from the surgery because it doesn't seem markedly worse than before. I certainly don't feel any more intellectually challenged then before but that might not be saying much....

 

[Paleowoman]

Certainly depression is very common, but temporary, after AVR, also pain and weakness, gosh yes, but those are effects of the surgery, I don't think they're due to the heart lung machine or "pump head" which is what you were asking about. If you asked me about other effects of heart surgery - I wasn't back to how I was prior to surgery for nearly a year ! But my cognitive skills and memory were fine but with visual problems still going, though less, two years post.

 

[mrichardson]

Paleogirl...your last statement about being back to how you were prior to surgery is something I think I asked about in another thread. It labeled me as "Guest". It's the one about pulmonic valve replacement.

Anyway, I'm hoping that my energy level, at some point, is actually higher than it is now. I'm not necessarily lethargic or anything, but my congenital cardiologist said that I should have more energy at some point after the surgery because my heart will be pumping blood more efficiently.

 

[Paleowoman]

Yes I remember that question about how one is prior to surgery you posted as Guest - didn't realise it was you. I think you'll find that if you have symptoms and low energy now due to your heart not pumping well that post surgery you will notice a very positive difference as your cardiologist says !

 

[mrichardson]

Yes I remember that question about how one is prior to surgery you posted as Guest - didn't realise it was you. I think you'll find that if you have symptoms and low energy now due to your heart not pumping well that post surgery you will notice a very positive difference as your cardiologist says !

Well, what got me to the doctor in the first place was a weird set of symptoms. I had an episode where my heartbeat felt like it slowed down to basically nothing. I was still breathing normally, and didn't experience any sort of chest pain or numbness. Just got a little lightheaded. This lasted 30 seconds or a minute, then my heartbeat would resume like normal.

Except for the regurgitation, I don't seem to have any real symptoms. The cardiologist said since the regurgitation is in the neighborhood of 30-40 percent (maybe a little higher), my heart obviously isn't pumping as efficiently as it could. That makes me think that afterward I'd be able to have more endurance and energy. I'm hoping so, anyway. It'll be good for my exercise program, and my overall health.

 

[Paleowoman]

Well, what got me to the doctor in the first place was a weird set of symptoms. I had an episode where my heartbeat felt like it slowed down to basically nothing. I was still breathing normally, and didn't experience any sort of chest pain or numbness. Just got a little lightheaded. This lasted 30 seconds or a minute, then my heartbeat would resume like normal..

I didn't have any symptoms prior to surgery - my bicuspid aortic valve had been heard (murmur) years before, first time it was heard was when I'd had a bad cough due to a chest infection. The cardiologist had been keeping an eye on it for several years prior to surgery so I had surgery before symptoms developed but when the echo showed things were at severe or critical stenosis.

 

[mrichardson]

I didn't have any symptoms prior to surgery - my bicuspid aortic valve had been heard (murmur) years before, first time it was heard was when I'd had a bad cough due to a chest infection. The cardiologist had been keeping an eye on it for several years prior to surgery so I had surgery before symptoms developed but when the echo showed things were at severe or critical stenosis.

I had the murmur, I think, since my original surgery when I was 22 months old. I was athletic as a kid, though. I played sports like American Football, baseball, and I even did some power lifting for one season. My doctor told me that my regurgitation caused my right atrium to enlarge, but the surgery should correct that.

Have you been asymptomatic since your surgery? I don't know what sort of job you have, but how long was it before you were able to return to work? What sort of exercises did they have you doing post-op?

Thank you for all the replies.

 

[Paleowoman]

Have you been asymptomatic since your surgery? I don't know what sort of job you have, but how long was it before you were able to return to work? What sort of exercises did they have you doing post-op?

Hi - yes I've continued asymptomatic since surgery, and, of course, now the echoes show no stenosis or problems (got my annual on Friday).

Immediately post op they are very keen that you do walking as it helps the heart and body recover. At the hospital I was doing laps of the hospital corridor every day, then stairs and so on. At home I continued that.

I'm a housewife so I returned to work when hubby decided to stop doing it ! Seriously though, I didn't do much in the way of 'work' for the first couple of months and then slowly got back into it.

Post op exercises: apart from walking, I started cardiac rehab at seven weeks post op. Because I'd been fit prior to surgery my cardiologist didn't want me going to the usual rehab as he said that was for people who weren't so fit beforehand, mostly for heart attack patients at the hospital I was at, so I had one to one rehab. I was doing well at that and then I injured my foot so the cardiac rehab nurse got me doing weight lifting instead which I much preferred - he got me doing light weights with fast reps and very short rests between so that the heart gets used to speeding up and slowing down which is apparently good exercise for it. Prior to surgery I was doing SuperSlow weight lifting and I was keen to resume that which I did after a few months.

I'm sure there are lots of different ways that cardiac rehab is done - it's invaluable.

 

[pellicle]

Hi

I believe that many of the symptoms mentioned here (which I also had) are also associated with any longer General Anaesthetic. I assume you've read the wikipedia page on it (here).

The thing is that its variable across people so you just can't be sure what you'll get. Its like you know what the possibilities are for a dice roll (1~6) but you just don't know what you will get till you roll them. That's (annoyingly) life.

In terms of managing outcomes I think that you're streets ahead even knowing that these things are likely. So your wife and son can be expecting this before it crops up. You can be too.

Myself I had no such knowledge prior to my sugery as (perhaps some will not believe this) I did not throw myself at google reading up on things (though my wife did). I'd already had 2 surgeries before my last one, so I already knew that recovery was tough but I could do it. I already knew that "putting my shoulder behind it" was my job post operatively.

I believe that the most important thing in post operative recovery is attitude. The desire to get better by sheer will if needed - rather than the await recovery to patiently method.

I know I'll be weakened (physically and mentally) and work towards getting better.

Cognitive issues and depression seemed to plague me more this time than the 2nd operation (perhaps it was that I was 48 no 28 that made the difference), I was unhappy and felt myself to be better off dead if it wasn't for the fact that would not be what I wanted to thrust my wife into (being a widow that is). By about 6 months I was more or less back to normal (and its a slow progression that you realise has happened without you noticing).

I wish you well for your surgery and a smooth recovery

 

[cldlhd]

I agree it's a slow progression. I would say it's like a set of shocks ( dampers ) wearing out , its gradual so you don't notice it day to day. Although it's obviously the opposite in that you'll be getting gradually better. FWIW I'll be a year out on the 7th and I feel back to normal .

 

[mrichardson]

So what about getting back to my normal workout routine, and/or adding to it? As I've mentioned previously, I'm doing a sort of "power yoga" (DDP Yoga). The congenital cardiologist I've been speaking to told me that I wouldn't be able to do any type of "arm supported" exercises (think push-ups) for at least a month.

I also wouldn't mind incorporating some light, "toning" weight lifting into my routine.

 

[mrichardson]

Hi - yes I've continued asymptomatic since surgery, and, of course, now the echoes show no stenosis or problems (got my annual on Friday).

Immediately post op they are very keen that you do walking as it helps the heart and body recover. At the hospital I was doing laps of the hospital corridor every day, then stairs and so on. At home I continued that.

I'm a housewife so I returned to work when hubby decided to stop doing it ! Seriously though, I didn't do much in the way of 'work' for the first couple of months and then slowly got back into it.

Post op exercises: apart from walking, I started cardiac rehab at seven weeks post op. Because I'd been fit prior to surgery my cardiologist didn't want me going to the usual rehab as he said that was for people who weren't so fit beforehand, mostly for heart attack patients at the hospital I was at, so I had one to one rehab. I was doing well at that and then I injured my foot so the cardiac rehab nurse got me doing weight lifting instead which I much preferred - he got me doing light weights with fast reps and very short rests between so that the heart gets used to speeding up and slowing down which is apparently good exercise for it. Prior to surgery I was doing SuperSlow weight lifting and I was keen to resume that which I did after a few months.

I'm sure there are lots of different ways that cardiac rehab is done - it's invaluable.

Well, I'm glad you're asymptomatic! That's a good thing! I'm quite sure they'll probably have me walking. I'll probably have to walk around my house, too. And when I do return to the office (I have a desk job) I'll have to make sure that I get up every hour or so to walk around.

I'm also looking into doing Tai Chi. I found a wonderful DVD for the Tai Chi short form. So I think I'm going to do that, too.

 

[tsanjose]

wow, im glad i came across this thread. i'm 4 most post op (MV repair) and have been experiencing difficulty concentrating (mostly reading or thinking) and migraines with auras (w/o headaches). for those who are further out, post op, what's been your experiences with recovery and getting these things to subside? for me, i have only experienced 3 episodes of the auras but the sparkly lights racing across my vision i get more often. thoughts?

 

[Zoltania]

No "pump-head" for me, and I was on the heart-lung bypass machine for nearly three hours. My ability to write computer programs and to play orchestral music on the clarinet seems unchanged since the surgery; I haven't noticed any cognitive issues at all.

I do get optical migraines (sparkly visual disturbance but no pain) more often than I used to, but I started getting those many years before my surgery.

Cardiac rehab was not offered to me and would have been prohibitively expensive on my own, so I'm getting back to cardio (anything more vigorous than brisk walking) carefully and with trepidation. From what others have said here, I think cardiac rehab would have been very reassuring for me. I'll go back to weight training later on but don't want to push myself too much yet. I just hate it when I feel my heart beating quickly or notice PVCs, though intellectually I know this is all nothing to worry about.

As for going back to work, my surgeon told me to take three months off and I was glad to do so. My energy levels were definitely not up to par after two months (and even after three months I wasn't at 100%). My employer's disability claims administrator disagreed with my surgeon and thought I could have gone back to work sooner, so they denied the last four weeks of my claim.

 

[pellicle]

Hi

So what about getting back to my normal workout routine, and/or adding to it? As I've mentioned previously, I'm doing a sort of "power yoga" (DDP Yoga). The congenital cardiologist I've been speaking to told me that I wouldn't be able to do any type of "arm supported" exercises (think push-ups) for at least a month....

remember you've just had the "key stone" bone of your chest broken. its a slender and delicate bone. Let it heal or you WILL suffer for it. I have absolutely no idea at all reading your post what is your "normal workout" routine.

However I followed strictly the no lifting guidances of my surgeon and did nothing strenuous for 8 weeks. When my surgeon was satisfied with my sternum being healed I started back doing light weights / high reps.

I did pretty much everything I did before but dialed it down in weight. I'd also had an aneurysm repaired. The key factor is to not put too much pressure on the cardio vascular system ... think pressure in terms of hydraulic pressure. So keep your blood pressures low. I bench pressed no more than 20Kg (would do 40 before) and focused on careful breathing. Do not hold your breath and pressurise your chest cavity.

Aside from that, pay attention to your body ... don't press hard and just focus on a slow and gradual improvement.

Remember: you aren't 18 anymore and you have just had a massive injury.

My motto is: small steps forward no steps backwards ... if you hurt yourself the setbacks could be months. So steady steady ... its better than being dead or crippled right?

 

[almost_hectic]

I'm sure pump head is very real but I am inclined to think its more rare than common. I'm sure it all depends on the individual situation, patient, and how long you're under. I think most of us would probably say the more common experience of cognitive abilities affected are from the anasthesia, pain meds and other drugs after surgery. They cloud and confuse the brain and combine with emotions that surface with such a traumatic experience event. But it is temporary I think most of us would tell you. Don be surprised if they linger for a few months or even longer. My thinking is clear and sharp again as I near the six month mark. Although I do still find my emotions easily stirred and I can still get rather choked up if I sit and dwell on the whole experience of my surgery and recovery. I don't necessarily think that's a bad thing though. I think it's healthy to reflect on the gravity of the situation and appreciate what it means to have survived it all.

Here's some posts on the emotional issues right after surgery
http://www.valvereplacement.org/for.../857625-dgaf-levels-immediately-after-surgery