“What About Dementia and Delirium After Heart Valve Surgery?” Asks a Concerned Wife
By Adam Pick on February 11, 2013
As many patients will tell you… Waking up in an intensive care unit (ICU) after heart valve surgery can be a very dislocating experience. Personally, I remember thinking, “Holy moly! What the heck just happened? What are all those noises? And, why is this massive tube stuck down my throat?”
For that reason, I am always incredibly sensitive to patient questions that address time spent in the ICU. As you will read below, I recently received a question from a Concerned Wife about dementia and delirium after cardiac surgery.
In her note, a Concerned Wife asks:
Dear Adam, My husband and I were both reading your book before he had his aortic valve replacement surgery in late November. It was the only place where we could find a lot of easily understandable information. There were some twists-and-turns in my husband’s procedure — he needed an external pacemaker for a few days before an internal pacemaker could be put in. What I wanted to ask you about was whether any of your readers had written about dementia or delirium over dementia which seemed to have started pretty much right after the valve replacement — while my husband was in ICU. The nurses referred to ICU psychosis and said it would go away, but it has not. I am worried whether I could even handle my husband’s care at home, because he’s big and pretty strong and does what the nurses call “impulsive behaviors.” A psych evaluation has been ordered for him about 10 days ago, but it hasn’t occurred yet. I was totally not prepared for this and just wondered if you or your readers might have any insights. — A Concerned wife.
To provide a Concerned Wife with an expert opinion, I contacted Doctor Rawn Salenger, Director of the Heart Valve Program at Good Samaritan Hospital in Suffern, New York. In his response, Dr. Salenger writes:
Hi Adam and “Concerned Wife” – To answer your question it may be helpful to briefly distinguish delirium from dementia. Dementia is a progressive decline in cognitive/mental ability which can lead to memory loss, confusion, and disorientation. There is a full spectrum of severity and the disease tends to have an insidious onset and progress in severity over a course of years. Most causes of dementia are irreversible and, so far, not able to be cured. In contrast, delirium tends to have an abrupt onset. Delirium may be precipitated by numerous factors in the hospital including surgery, infection, drugs, sleep deprivation, and more. This is one of the most common mental disturbances in elderly hospitalized patients. Similar to dementia, patients may be confused, detached from reality, paranoid, hostile, and impulsive. Often patients suffer from hallucinations. The onset of these changes, however, is much quicker than in dementia. There can be fluctuations throughout the day, often with worse symptoms at night. Usually the symptoms subside over a period of days to months. There are some experts that believe there can be more persistent symptoms over the long-term but this is debatable.
Dr. Salenger – Heart Surgeon
Dr. Salenger than addressed several other interesting points about delirium and dementia after cardiac surgery:
Often there is overlap between the two syndromes. The patients that are most susceptible to delirium are elderly patients with some underlying brain disorder, such as dementia, Parkinson’s, or prior stroke. Sometimes a patient’s mild, unrecognized dementia will be unmasked by a stressful illness or surgery. These patients may or may not develop super-imposed delirium. When the delirium resolves they are left with their chronic brain disease. I would recommend a thorough neurologic evaluation for your husband. This will rule out any (unlikely) reversible causes of brain dysfunction and help distinguish sub-acute from chronic disease. Also, regardless of the diagnosis, you can make sure your husband is getting aggressive physical therapy and occupational therapy to improve his daily functioning. This therapy can be done as an inpatient at a rehab facility or as an outpatient. Hope this is helpful! — Rawn Salenger, M.D.
I really hope this helped a Concerned Wife (and potentially you) learn more about delirium and dementia after heart valve surgery. I would also like to extend a special thanks to Rawn Salenger, MD for his continuing support of our patient and caregiver community.
Keep on tickin!
Adam
Written by Adam Pick
- Patient & Website Founder
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Andrew says on February 12th, 2013 at 11:34 am |
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I had a mitral valve replacement 3 years ago, aged 48. When I woke up in ICU, I couldn’t hold a glass of water, but no hallucinations or any other symptom, other than being very in love with my partner Helen. I spent two days in ICU and only when they moved me did the problems begin: the walls started moving. It then got progressively worse. I didn’t sleep for 4 days and, as the nurses said to Helen, “it’s a good thing we got to know him before the op”. Despite not sleeping, there is one night that was a complete blur: I was totally detached from reality. Everything had a dreamlike quality. I tried to pull the tubes out of my neck. All I remember of the nurses was disembodied voices saying to me: “Andrew, you have had heart surgery, you are in Castle Hill Hospital, go to sleep.” To which I mechanically replied: “@#&^$ off!” Things got only fractionally better the next day, and whilst the nurses and their voices had re merged, I really wasn’t with it for about 4 more days, until they finally gave me a sleeping tablet. I also had hallucinations (floating over a forest floor covered with bluebells, a road through a swamp with flares going off, incredibly bright and brilliant colours and the sick sense that I knew everything was wrong but there was nothing I could do to stop it). It was awful. When they took me out of the High Observation Unit, they had to put me back in the next morning: I was having panic attacks and couldn’t breath. Then, slowly, life came back into focus. I have made a full recovery with only a few negatives: I have an academics stoop, and my neck seems to have been damaged by being on the op table for 5 hours. And I have lost a lot of memory. There is also the issue of a sort of sub clinical depression, a lurking downwards twist to life, lethargy and apathy. But hey, my heart is fine and the negatives are pretty minor (I was, for example, always depressed, so the only “new symptom” is the “tone” of the downtwist to life. It is different. Different, but not that terrible. So on the basis of my experience, I would say that things may well improve. I guess, and I am only guessing, that people are different and some recoveries may be slower than others. The only certainty is that the surgery was needed. My father had the same problem as me. He died aged 63, of heart failure. His cardiologist said to me: If you have a problem, you have to do something about it. You can’t just sit there and deny it. Which is what my Dad did. I hope this helps. Heart surgery is very tough, but, as my cardiologist said to me, it is better than having cancer. I now lead a normal life. And I married Helen after living with her for 18 years. I guess they really did fix my heart. |
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John says on February 13th, 2013 at 4:09 pm |
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Hi Adam, |
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Steve Miller says on February 13th, 2013 at 6:41 pm |
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Hi Adam! |
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Leslie Bartlett says on February 13th, 2013 at 8:37 pm |
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My greatest of many fears was waking up with a tube in my throat and simply going mad. Well it happened, and I distinctly remember starting to fight it, then from somewhere came the thought, “They’re probably not trying to kill me, so maybe if I cooperate with the machine, this will work.” Being a cpap user for some time, I would have liked more air, but that part of recovery went remarkably well. Then there were Martians, followed by a conspiracy to kidnap me. Finally there was the mob of teenage hackers breaking into the ICU trying to take over the telemetry. I really did lose it for the first night, anxiety disorder running at least seven generations back in my family. My body loved morphine, but my brain hated it. So, I was put on something which i think did a bit less to eliminate pain. But from then on I had the experience of feeling in perhaps the safest place I’d been in my life. Two years and a half later, I still take flowers to the nurses stations, and the surgeon (my cardiologist moving shortly after surgery), send letters to the administration, and take goodies to the nurses’ night shift on Christmas eve, so amazing I felt the care to be. I certainly have all my phobias very much alive, but the two years of terror living in denial and dread was vastly greater than the difficulty of the entire procedure. My wife limited access to me to two couples of friends (a wise decision I am quite sure), and all four of them plus my wife used the same words to describe what they saw of me- shocked and amazed, having expected me to be a mean, recalcitrant patient. I was quite the opposite. There was laughter and happiness in my room, with nurses not on my case coming to see me because they wanted to. Doctors were wonderful. I hope I am not making this out to be easy, but as my cardiologist, himself an aortic valve recipient said, “It’s doable.” It is. |
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Mary Binderman says on February 14th, 2013 at 4:09 am |
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I had a mitral valve repair and Maze Procedure on January 9, 2013. The surgery went well; however, my body responded negatively to the lasex, with my liver and pancreatic enzymes rising. I was in the hospital for thirteen days and went home with a lot of fluid still in me. Five days later I was back in the hospital, as I was having a lot of trouble breathing from the fluid overload. Quite a bit of fluid was removed from around my right lung. Different diuretics were tried, and finally the fluid began to be reabsorbed, and my breathing became much easier. I’m back to my preop weight. Still, nights continue to be difficult. My dreams are not necessarily frightening but very real. Sometimes I have to sit up, though I know my breathing is fine. Other “requirements” become my focus if I want to breathe or go back to sleep. My husband, who is a psychologist, has helped me to get through these events. We talk about what I think is happening. If needed, we get up and go downstairs to talk or watch television until I think I can go back to sleep. A nurse practitioner at the surgeon’s office mentioned ‘pump head” to us. I’ve not read anything about it. The N.P. said it will go away after a while, maybe months. Meanwhile, I get little sleep, though I do seem to sleep for two or three hours before waking with another dream. In fact, it’s 4:00 A.M. now, and I’m awake with another dream or hallucination. The good news is, I’m not firghtened, just annoyed. You need your rest if you’re going to return to all your activities. Still, knowing other people experience hallucinations and dreams helps. |
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Joyce Baker says on February 19th, 2013 at 11:41 am |
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Mary, I went through horrible, frightening mental issues after my aortic valve replacement – I am three months postop and they have mostly cleared up, but I still have occasional insecurities that something is still wrong with me and everyone is keeping it from me. I would estimate that I am 90% back to normal after three months. |
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peggyann doak says on February 23rd, 2013 at 12:15 pm |
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After I was home from surgery, I had written on face book about having a hard time recooping. I did not say mentally, but a friend…I guess…told me to look up ‘pump head’. this is a belief that the bypass pump can cause irreversable problems in the brain, including memory loss, loss of intellegent decision making, confusion etc. Is there truth to this? |
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Joyce Baker says on February 23rd, 2013 at 3:59 pm |
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Irreversible? No, that is not true unless u are brain dead to begin with. I am completely clear of those kinds of problems after three months – I was on the bypass machine for a very long time – I think it takes time for the body to flush out the drugs, anesthesia, etc. I even read someplace that they have to keep circulating so much fluid through your body that your brain gets a little waterlogged and has to rid itself of the excess. Is that true, who knows. You will improve with each passing day – hang in there – and surround yourself with upbeat people – my husband got a lot of laughs out of my ramblings. God bless. |
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sherrie bischof says on March 28th, 2013 at 8:09 pm |
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I am fifty years old and suffered from cardiac psychoses five days after my aortic valve replacement. I had my first hallucination and was overwhelmed with paranoia. I attempted to run away from the hospital. A lot more pre-surgical warnings and a lot more post-surgical observation would have helped me. |
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Denise says on October 22nd, 2013 at 7:08 pm |
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My mom, 66, just had Mitral Valve Replacement and Left Atrial Appendage Closure last Wednesday. This was her second open heart surgery. This surgery lasted almost 6 hours. During her first surgery, she had the same issues as she is having this time around; seeing things that aren’t there, not sleeping (going on four days now), talking about how the nurses are trying to put her in a mental hospital, extremely fidgety constantly moving her feet and hands, etc.. (she even told a male nurse she wanted to take him to bed, which is VERY unlike my mom! LOL). I feel SO sorry for her. She looks at us like she’s a child sometimes. |
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sherrie bischof says on October 23rd, 2013 at 7:57 am |
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Okay, this is weird. I had my surgery in February 2013. Here it is at the end of October and I don’t remember the post above from March!!! My God, I may still be off… This is a little frightening. |
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Prayer warrior says on November 27th, 2013 at 5:18 pm |
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My aunt had a quadruple bypass with the maze procedure done for her afib. She was taken on and off the bypass machine 3 times to stop leaks. It is now Wednesday and she hasn’t woken up. She has thrashed around in bed and moans, so they are keeping her sedated most of the time. Has anyone experience or heard of this behavior? |
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Glen Moore says on March 10th, 2015 at 10:09 pm |
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My 81-year-old father-in-law had mitro-valve replacement, double bypass, and A-fib surgery over one month ago. Previously, he’d had minimal health problems, two jobs, and a very active younger wife who kept him busy. The surgery was over 7 hours and went amazingly well. However, in the ICU, he was given heparin and developed a rare allergic reaction. As a result, his blood platelets are too low, he’s very confused and agitated, and is basically exhibiting signs of dementia. His Dr.s say it’s normal and, once his platelets return to normal, the confusion and paranoia will subside. Anyone have experience w/this type of recuperation? We are worried he won’t improve, but the Dr.s are optimistic it’s transient. We are beside ourselves and are preparing for the worst. Any suggestions? Thank you. ( Oh, also he’s not sleeping well, which we’re convinced exacerbates his issues.) |
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