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You do not have to have drink to excess or be dependent on alcohol to benefit from a significant reduction, or a complete stop, in your drinking.
Whether you drink occasionally or regularly, consuming alcohol in the days and weeks before the intervention can greatly increase your risk of complications.
The risks from alcohol
Even small amounts of alcohol affect your body’s reaction to the procedure, and make it more likely that you will have problems either during or after your operation.
Alcohol increases your risk of heart muscle injury, lung infection, and bleeding and reacting badly to the anaesthetic drugs.
To give your body the best chance of a successful recovery, avoiding alcohol both before and after your heart procedure is strongly recommended.
If you regularly drink more than three alcoholic drinks per day, tell your care team or doctors before your operation.
They will not judge you; they need to know because the effects of alcohol withdrawal are also dangerous and increase your risk of complications from your procedure.
The benefits of not drinking alcohol
All reductions in alcohol intake in the weeks prior to intervention will improve the outcome and results of your procedure.
Tips to help you stop drinking alcohol
Stopping anything that has become a habit is difficult, even if it’s only for a few weeks.
Here are some tips to help you stay motivated:
- Set a date to stop. Write this date down to make it more ‘official’.
- Think about why you are stopping. You could write this down too. For example, “I will stop drinking next Tuesday before my operation at the end of the month so I can get better faster.”
- If you find that habits, places, times or behaviours trigger your desire to have a drink, plan how you can avoid those situations and what you can do instead to distract yourself.
- You could do an activity like going for a walk, doing something else or calling a friend for a chat and to get support.
- Set small but achievable milestones, such as a day, then a week, without drinking. Reward yourself when you reach these targets.
LOCAL INPUT REQUIRE Talk to your general practitioner or hospital care team for help and advice about resources and support groups that are available to you.
Smoking is an unhealthy habit that significantly increases your risk of developing coronary artery disease, heart disease, stroke, and blood clots.
In addition, smoking also affects your body’s ability to recover after the procedure.
Cigarette smoke directly affects the healing process: smoking increases the time taken for wounds to heal, increase the chances of wounds becoming infected and can lead to scars becoming more prominent.
Research has shown that smoking increases the risk of developing lung infections, having a heart attack or a stroke after surgery.
This risk is even bigger if you already had angina in the past or have a condition like diabetes or high blood pressure.
Even just stopping smoking for a few weeks around the time of your operation will improve your chances of healing successfully.
When should you stop smoking?
Giving up smoking entirely as soon as possible is always the best option, but if you can stop smoking in the 6-8 weeks before your operation this will really help your lungs to clear. This not only reduces your risk of lung infections after the
TAVI procedure but it also improves the transfer of oxygen to your blood and this will help your heart and blood vessels to heal more quickly.
Even stopping smoking for 2-3 days before your planned procedure will increase the amount of oxygen that your body can absorb and this will help to stabilise your heart rate and improve the success of your operation.
It is very important that you do not smoke anything in the 24 hours before your operation.
LOCAL INPUT REQUIRE Talk to your general practitioner or hospital care team for help and advice about resources, support groups and nicotine replacement therapies that are available to you to help you quit.
How can you quit smoking?
Motivation and goal setting are key to changing any habit. Many people find that it has helped them to set a clear date to quit; you can mark it on your calendar.
You could also add the exact reasons why you want or need to stop smoking.
Suggestions include: to be able to return to a normal routine as quickly as possible after the procedure or so that you can stay healthy throughout your treatment and help to stay healthy in the future.
Use these reasons to motivate you when things get hard and your willpower is weak. When things are especially difficult, do not hesitate to ask for help from people you trust to help you quit and to keep you motivated.
Tell them how you are feeling. The distraction of the conversation, along with their support, will help to ease your cravings and keep you on track.
You should also try to notice habits, places, or even people that trigger your desire to smoke. If you can, avoid or minimise these triggers while you are trying to quit.
Replace these habits with things like going for a walk, an alternative activity, seeing friends, doing crossword puzzles, reading … anything non-smoking related to help distract you!
Be realistic about your progress and try to remain positive, despite any setbacks. Set small milestones towards quitting and reward yourself when you reach them.
For example, when you go a full day without smoking, then a full week, then a full month etc. treat yourself to a small reward. This will help you stay on track and motivated.
A sedentary lifestyle is one where you do a lot of sitting (either in chairs or in vehicles), lying down and very little exercise.
According to the World Health Organization (WHO) a sedentary lifestyle has serious health side-effects and it is now considered to be amongst the ten leading causes of death and disability in the world.
It increases your risk of cardiovascular diseases, obesity, diabetes, high blood pressure and anxiety.
To help prevent the onset of these chronic diseases the WHO recommends that everyone should do up to 30 minutes of moderate, physical activity every day.
The WHO also recommend avoiding smoking and eating healthily since smoking, excessive alcohol consumption and a diet that is high fat and sugar has been shown to make the effects of a sedentary lifestyle even worse.
High blood pressure, also known as hypertension, is another condition that can lead to the development of many heart diseases, including arterial stenosis.
The effects of hypertension are not always obvious and so it is important to monitor your blood pressure and, if necessary, take medications to lower it.
The blood pressure result is given as two numbers, one over the other in units called millimetres of mercury (mmHg). The systolic blood pressure is the larger number.
It is measured when your heart muscles contract during a heartbeat to squeeze blood out and around the body.
The second, lower number is the diastolic pressure. It is measured when your heart relaxes, in-between beats, to refill with blood ready for the next pump.
A typical blood pressure for a healthy adult is between 90/60 and 120/80 mmHg.
The higher your systolic blood pressure, the harder your heart is having to squeeze to move blood around your body. The higher your diastolic blood pressure, the less your heart is able to relax.
FOR LOCAL INPUT
For patients with aortic stenosis, the target blood pressure is XX/XXXmmHg.
Both type 1 and type 2 diabetes are independent risk factors for the development of many cardiovascular diseases, including valve stenosis.
his means that researchers have found strong links between diabetes and the development of heart disease.
Pre-type 2 diabetes is also known as ‘metabolic syndrome’. It is called this because the symptoms of metabolic disease are due to poor regulation of key metabolic functions like blood sugar levels or circulating fat levels.
If the control of your blood sugar levels fails, then you will develop diabetes. Type 2 diabetes is not always inevitable, though, especially if lifestyle changes can be made in time so that the body’s control of sugar levels is not lost.
Unlike type 2 diabetes, type 1 diabetes (diabetes mellitus) is an autoimmune condition that occurs at any age. The development of type 1 diabetes is inevitable as the beta cells in your pancreas that produce a hormone called insulin are destroyed by your immune system.
This disease is linked to your genes, rather than your lifestyle, diet or advancing age. It requires treatment with insulin injections as well as careful management of blood sugar levels throughout your life through testing and diet.
However, although they are different diseases, both forms of diabetes can damage blood vessels if their effects are uncontrolled.
This damage will significantly increase your risk of developing all types of heart disease, including problems with the valves in your heart.
The knowledge that that diabetes increases the risk of cardiovascular diseases is a good reason to make lifestyle changes to increase your activity and eat less fat and sugar.
Reducing your weight will also lower your risk of developing either pre- or full type 2 diabetes. It will also help you to manage type 1 diabetes.
Body mass index (BMI) is a measure of body fat based on your weight in relation to your height.
It is calculated by dividing your weight in by the square of your height. You can used either metric units (kilograms and metres) or imperial/US measurements (stones and feet), just don’t mix the unit types.
Although it is not perfect for everyone; BMI is a simple, reasonable indicator of body fat for both adults and children and is calculated the same way for men and women over the age of 20.
Here is the table to classify your BMI
Being overweight or obese can increase your risk of developing heart problems, including aortic valve disease.
If your BMI score indicates that you are overweight, or obese, consider taking measures to get healthier and lose excess weight.
To start you can read the “Healthy diet” and “Physical activity” modules.
Ask your general practitioner or healthcare team about support and resources that are available to you in your area.
Lipids are a group of molecules with specific properties (e.g. they don’t dissolve in water). Several different lipids are found in your body and blood.
The ones that are measured in routine blood tests to assess heart problems are called cholesterol and triglycerides.
Triglycerides are also commonly known as ‘fat’ (like the white rind on bacon or beef). It is used in your body as fuel to power muscles. It is also stored under the skin and around your internal organs. Too much ‘in storage’ can lead to obesity.
Cholesterol is used in all cell membranes, and for making hormones like oestrogen and testosterone. For most people, about 80% of the cholesterol in their blood is made by their own liver.
The remaining 20% comes from the food that they eat. Food like meat, poultry, eggs, fish and dairy products are very high in cholesterol. Foods that come from plant sources contain very little or no cholesterol.
What is good and bad cholesterol?
Because it does not dissolve easily in water, cholesterol cannot travel freely in blood. Instead, it is carried on special carrier proteins called lipoproteins.
Some of these lipoproteins deposit cholesterol in the blood vessels, and some of them actually ‘mop up’ excess cholesterol in blood vessels.
Too much cholesterol in blood vessels and in heart valves can lead to blockages and blood clots. The lipoprotein that collects the cholesterol and takes it back to liver is often called “good cholesterol”. The lipoprotein that drops off cholesterol is called “bad cholesterol”.
Your health care team will talk to you about your cholesterol and will measure the amounts of these lipoproteins in your blood.
The medical terms used for good and bad cholesterol are:
- Low-density lipoprotein (LDL) (bad cholesterol)
- High-density lipoprotein (HDL) (good cholesterol)
The second main type of lipids measured in your blood are called triglycerides (TG). TG are also used to make cell membranes and they are the type of fat that is stored under the skin, especially around the waist, stomach, buttocks and thighs.
Saturated TG are solid at room temperature and can be seen in meat (e.g. the white layer on bacon). These saturated fats release a lot of TG into your blood when you digest them.
Doctors are interested in the different levels of these lipids in your blood because changes in the ratios of different lipid levels are be associated with a very high risk of arterial stenosis as well as other cardiovascular diseases, and stroke.
Although your body makes most of its own cholesterol and stores TG fat, you can also change the levels of lipids in your blood by what you eat, and how you exercise because TG fats are also used as energy to fuel muscles.
General guidelines for healthy cholesterol levels include: LOCAL INPUT REQUIRE
- Total cholesterol should be less than 200 mg/dL
- Low-density lipoprotein (LDL) or “bad” cholesterol should be less than 100 mg/dL
- High-density lipoprotein (HDL) or “good” cholesterol should be higher than 60 mg/dL
- Triglycerides should be less than 150 mg/dL
There are several ways you can improve your blood lipid levels:
- Get at least 30 minutes of moderate physical activity every day, most days of the week.
- Eat a diet low in saturated fat and cholesterol.
- Choose a diet that is rich in fruit, vegetables and whole grains.
- If you are not already at a healthy weight for your height, lose weight.
- Take cholesterol-lowering medication, such as statins, if you are advised to do so by your doctor.
Your lifestyle has a big effect on your ability to recover quickly from your procedure.
A healthy lifestyle can also help you to avoid coronary artery disease in the future since it reduces the risk of other atherosclerotic (where the blood vessels become damaged and blocked) conditions like stroke, heart failure and aneurysms (when the artery wall is weakened and bulges).
Below is a list of various risk factors for cardiac artery disease whose impact can be reduced by positive changes in lifestyle.
They include:
- Smoking
- Alcohol
- Weight loss and weight management (including obesity)
- A sedentary lifestyle
- Blood Lipids
- Hypertension (high blood pressure)
- Diabetes (type 1 and type 2)
- Obstructive sleep apnoea (OSA)
You can find information about each of these risk factors here in your library.