Once in the ICU, you will be connected to monitors that will constantly display your EKG tracing, blood pressure, other pressure readings, your breathing rate, and your oxygen level. You will have drains in your bladder, chest, and stomach. You will still be sedated. Your skin will be cool and pale, and your face and hands may be swollen due to fluid from the surgery.

You will be placed in a special isolation room in the ICU to help prevent the spread of infection. Everyone who enters your room will wash his/her hands and put on a mask and gloves before entering the room. This is done to protect you from infection, which is serious risk due to the anti-rejection medication you will be receiving to help keep your body from rejecting your new heart.

The nurse will check your vital signs and assess your condition thoroughly when you arrive. Blood will be drawn and sent to the lab. An EKG will be done. A chest x-ray will be done as you lie in your bed.

Once all of the admission work has been completed and your condition is stable, your family will be allowed to visit you for a few minutes. You most likely will not be aware of this first visit, as you will still be sedated from the anesthesia.

As you start to wake up, you will hear strange noises and people talking. The noises will come from the ventilator (which will still breathe for you until you are awake enough to breathe on your own), a warming blanket device used to help keep you warm after the surgery, and other equipment. Your nurse will be checking on your status very frequently for the first several hours after you arrive in the ICU. The respiratory therapist will make adjustments to the ventilator as you wake up more and start to breathe on your own. Your physician and other physicians working with him/her will be checking on your status, as well.

While the breathing tube is in your throat, you will not be able to speak. Your nurse and the other people in the ICU are very experienced in taking care of patients in this situation, and will ask you questions that you can answer by nodding or shaking your head to find out what you need. Your wrists will be lightly tied to the side of the bed as a reminder to keep you from accidentally knocking out the breathing tube before you can breathe well enough by yourself. Your nurse will occasionally clean out the breathing tube to keep mucus from collecting in your lungs. This procedure may make you cough and may make you feel short of breath for a brief time.

Your nurse will turn you from side to side about every two hours to relieve pressure on your skin and prevent bedsores.

As you wake up from the anesthesia more and start to breathe by yourself, the breathing machine will be adjusted to allow you to take over more of the breathing.

You may be on special IV drips to help your blood pressure and your heart. As your condition stabilizes, these drips will be gradually turned down and then turned off as tolerated.

You may feel like your bladder is full and that you need to urinate. However, the catheter (tube) will still be in your bladder, and you can relax and let the catheter continue to drain the urine.

Your family will be allowed to visit according to the ICU visiting policy. It is important to rest after your surgery, so visits may be limited to short periods several times a day.

When you are awake enough to breathe completely by yourself and are able to cough, the breathing tube will be removed. The stomach tube will be removed at this time, also. You will be given oxygen by a face mask for a while. The mist from the face mask will help your throat and breathing passages to feel better. Your throat will probably be sore from the tube, but the soreness will go away in a day or two. You may also be hoarse because of the tube, but the hoarseness will also go away soon.

After the breathing tube is out, your nurse will assist you to cough and take deep breaths every two hours. This will be uncomfortable due to soreness, but it is extremely important that you do this in order to keep mucus from collecting in your lungs and possibly causing pneumonia. You may have pain medication if you are hurting, and you should ask for the medication before you become extremely uncomfortable. Your nurse will show you how to hug a pillow tightly against your chest while coughing to help ease the discomfort.

Because of the medication you received before surgery, your mouth will feel dry. Once the breathing tube is out, your nurse may give you a few ice chips periodically. However, until your stomach and intestines resume proper functioning (the surgery makes your stomach and intestines slow down markedly), you should take only small amounts of ice and fluid at a time, no matter how dry your mouth may feel. If you take too much fluid too soon, you may become sick to your stomach and vomit. Your nurse will give you moisturizer for your lips to help the dryness.

Once the breathing tube is out and your condition is stable enough that IV medication drips for blood pressure and heart function have been weaned off, your nurse will assist you to sit on the side of the bed - this is called "dangling," because your legs and feet dangle over the side of the bed. If you tolerate this well, you may even stand up for a moment at the side of the bed with assistance.

You may take clear liquid fluids, such as water, broth, apple juice, and gelatin as tolerated. Once you are tolerating the clear liquids without difficulty, you will begin to receive full liquids, such as milk, ice cream, pudding, cream soup, etc.

Your nurse will assist you to sit up in a chair. You will need to remember to not cross your legs while sitting up, so that the circulation in your legs will not be compromised. You may get tired very quickly once you are in the chair. Your nurse will leave the call bell with you, so that you can call for assistance in getting back to bed. You should not try to get up without assistance. In order to help keep your legs from swelling and to improve the circulation in your legs, you will wear a pair of elastic stockings during the day.

You will continue to cough and perform deep breathing exercises about every two hours while you are awake. You will also use a device called an incentive spirometer, which helps you to take deeper and deeper breaths so that you can keep your lungs adequately expanded. If you feel you are too sore to do the breathing exercises or to move around, ask your nurse for pain medication. It is very important for you to do your breathing exercises and move around in order to prevent complications, which could slow down your recovery. Also, you will feel better by moving around as soon and as much as possible.

Your nurse will instruct you about transferring out to the acute care unit, which is a step-down unit for the ICU. You will be in a private room, and your family can stay with you for longer periods of time. Once it has been determined that your vital signs and breathing status are stable, the arterial line, chest tubes, and bladder catheter will be removed (not all at once). You can then transfer to the acute care unit.

Your recovery will continue to progress here. You will sit up in a chair for your meals. Your diet will be advanced to solid foods as tolerated, but you may be on a low-salt, low-fat, low-cholesterol diet. Ask to see a dietitian before discharge if you have any questions.

Your heart rhythm may continue to be monitored by telemetry, which is a type of "long-distance" heart monitoring. You will have electrodes on your chest attached to a small box with wires, which you will wear at all times. The small box sends your EKG signal to a central monitoring station on the unit, which is constantly monitored by trained staff. You can get out of bed and move around while you are being monitored by telemetry.

You will begin to walk around, first in your room, then out in the hall for increasing distances. When you go out of your room, you will wear a face mask to help prevent you from getting an infection. Your nurse or an assistant will assist you until you reach the point where you can walk around without assistance. The cardiac rehabilitation team will work with you to help you increase your strength and endurance.

You will continue to cough and perform deep breathing exercises and use the incentive spirometer every two hours or so while awake. You may stop wearing oxygen tubes once it has been determined that your oxygen levels are stable without them.

Your IV line and the pacing wires will be discontinued within a couple of days after you leave the ICU.

One week after the transplant, an endomyocardial biopsy is performed (in the cardiac catheterization laboratory) by inserting a catheter into the heart and removing a tiny piece of heart tissue to assess for rejection of the new heart.

Your nurse and other hospital staff will begin to give you and your family instructions regarding how to take care of yourself when you go home. It is very important that you ask questions if you do not understand something or if you need additional information. When you have reached the following milestones, you will be discharged to go home:

• can ambulate (walk) for about 200 feet without excessive increase in heart rate or heart rhythm changes, shortness of breath, or extreme fatigue
• can maintain stable vital signs (heart rate, blood pressure, temperature, and breathing rate)
• food intake is adequate
• all discharge instructions have been received

Length of stay

In general, patients go home within two weeks of their heart transplant surgery. However, your individual situation will determine how long you will need to stay in the hospital.

Average recuperation time

It may take about six to eight weeks before you feel like yourself again after the surgery. For some people, recovery may take more or less time. The length of your recuperation will depend on your individual situation.