Pumphead And Cardiac Depression… What Should Patients Know?

By Adam Pick on August 21, 2007

I’ll never forget the first time I heard the phrase “Pumphead”. I was interviewing a former patient about her heart valve surgery experience for my book.

She was discussing the short-term mental impact of open heart bypass surgery. Specifically, she was remembering a challenging time during her recovery when she suffered from cardiac depression.

 

 

The former patient ended the discussion by saying, “Oh well. I guess I was just a pumphead.”

I did a double-take… “Pumphead?” I thought to myself, “What is pump head?”

It was easy for me to relate to the concept of cardiac depression. Following open heart surgery, I had my own, tough bout with the cardiac depression.

I immediately wondered, “Could it be that cardiac depression is caused by the heart-lung machine? Is that the pumphead stimulant?”

I did some research.

It turns out that researchers from Duke University were the first to document the existence of the post-operative condition, known as pumphead. The clinical term for pumphead is cognitive impairment after coronary artery bypass grafting (CABG).

According to the Duke researchers, symptoms of pumphead include:

  • difficulty in concentrating
  • increased depression
  • other noticeable changes in mental capabilities.

Can Pumphead be prevented?

Duke researchers have found that some elements of pumphead can be prevented using rewarming techniques.

According to the researchers, “Rewarming” is necessary because, during the surgery, while the patient is on cardiopulmonary bypass machine, the body is cooled significantly to help preserve the heart and brain.

Toward the end of the surgical procedure, the patient is rewarmed. It now appears possible that, if rewarmed too quickly, the brain’s need for oxygen temporarily outstrips the supply, leading to post-operative cognitive difficulties.

I hope this helps you better understand pumphead and cardiac depression.

Keep on tickin!
Adam


Written by Adam Pick
- Patient & Website Founder

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.


David says on April 16th, 2008 at 4:12 am

Its worth noting that the Duke study found that the cognitive impacts lasted at least five years. 42% of patients scored 20% lower on tests of cognitive function after five years. A new study (2008) using MRI finds brain damage in 51% of patients right after surgery, and in 31% after 3 years. All this to say that “short-term” is relative at best, and misleading at worst. Of course, most patients don’t have much choice in the matter, but it is worth knowing about and planning for (as we were not able to do, since our surgeon didn’t mention this “short-term” side effect”).



Bill says on April 16th, 2008 at 2:45 pm

Many thanks for the information about “pumphead”…It almost sounds funny, but that is pretty serious stuff. AS I approach my surgery in three weeks, I will keep this in mind and warn my friends and family….
Bill



Al says on May 13th, 2008 at 3:26 pm

Hi Everyone,

I had quad bypass in January and thought it was just me going through all this memory loss and depression.

I swear they gave me some kind of drug prior to surgery to cope with it all while in ICU.

The depression etc. did not kick in until month later, I felt better first week after surgery.

Al



Debbie Jones says on January 11th, 2009 at 11:19 am

I am the daughter of a heart surgery patient. My mother had her heart surgery (bypass & valve replacement) back on March 21st 2007. Months after her surgery she began crying a lot and just feeling like the surgeons had “done something” to her heart and dealing with the changes was very hard. We sought medical attention from her PCP and then also from a psychologist. Honestly neither helped. No one talks about this depression. It’s almost as if it’s non-existant in the world. Why aren’t there more people talking about this instead of chalking it up as something that’s just part of the healing process. My mother isn’t herself. As a matter of fact she’s in her bedroom crying her eyes out as I type this and I feel as though my hands are tied. I need to get her some help but I don’t know where to turn. Her memory has gotten much worse lately and her PCP thinks she might be having “mini strokes”. I feel just about as helpless as my mother except I can function and attempt to get her some help. I just need good resources. If anyone knows of practitioners that specialize in these cases I would be most grateful for your input.



Kathleen Draskoczy says on February 12th, 2009 at 11:23 am

I am the wife of a cardiologist, who just had an AV replacement last Thursday. His mental condition has changed to the point that he cannot remember much of the surgery, nor how we arrived home, nor what day it is, when I give him medication, he asks for the same medication 5 minutes later. His surgery was performed at the Cleveland clinic and mental changes started to occur there 3 days post-op, but they attributed it to the Percocet, which we discontinued. No one spoke of mental changes as a by product of this surgery. I am so depressed myself!! Will take him tomorrow to our local cardiologist for an eveal.



Pat Pellom says on February 22nd, 2009 at 9:59 pm

My fiance, age 66, underwent quad-ruple by-pass in May, 08. He recuperated nicely. However, I began to notice a change in him around Sept. His personality changed and others noticed it too. He finally broke off with me Jan. 09. He went to a PA and was prescribed Prozac. He said he couldn’t ask me to wait for him, as he doesn’t know if he will ever get back to where he once was. He is so different and doesn’t want to see me alone, I see him out places. Can anything be done for him? He went back to his heart dr. who said he was progressing nicely. No, he isn’t. What is wrong with Dr.’s? I had alerted his dr. to the problem before he went.
His persona;ity where he was once outgoing is now zero.

——————————————————————————–



Tom Sheehy says on October 31st, 2009 at 3:09 pm

I am 7 1/2 weeks post AVR and single bypass. I have suffered moderate to acute depression for the last two weeks. My Cardiologists and surgeon could not have been better, but…………..There was absolutely no mention of pumphead before the surgery. I was not well prepared by two very competent technical physicinans? Routine?

Tom Sheehy



Claire White says on November 1st, 2009 at 12:25 pm

I am only 41 and had AVR & a bypass 3 years ago. I have suffered depression ever since and have now found that I need further surgery as my valve has started to deteriorate already. No-one told me about the depression and not sure how I’ll cope after a further bout of surgery. I\’m in the UK and certainly here, it seems that no-one likes talking about that side of the surgery and it made me not talk about it either. I wish I had sought help much earlier and insisted that someone listen to me but I think I thought I was the only one. It\’s good to see on this site that i’m not alone.



Larry Ward says on November 19th, 2009 at 9:15 pm

I am pursuing the answer(s) as to whether the heart lung equipment use is the actual cause of pumphead..and very possible subsequent CD..cardiac depression. What damage to the brain really occurs because of the microemboli …tiny blood clots pileup and delivered to brain cells….purportedly caused by the heart lung equipment and maybe also the inadequate oxygen supplied to the brain? Could the clots pile up in the grey or white brain tissue stroking and killing cells from a lack of oxygenated blood? This seems enough to cause short/long term memory loss along with the terrible CD that I read offen occurs after AVR. Just had the op done at Duke and experienced the problems to some extent. Seems that Cardiologist and Shrinks do not want to talk much about this problem..I wonder why the blank look from them when CD and Pumphead symptoms are mentioned…..Is it that they do not really know or maybe the subsequent liability that could be possible by recent ongoing studies. These miladies are not minor things to brush aside.



Jason Trevethan says on January 30th, 2010 at 11:47 pm

Hi, I had my AVR in 2002 aged 36. I to suffered depression ( still do), and short term memory loss. No one at the hospital or my Doctors informed me of the memory loss/depression. To this day I still suffer. Only my family and close friend have been told. I was made redundant from my Job. and can no longer work in that field. I to forget if I have taken my warfrin, people names etc. My wife is very understanding ( sometimes) I wish these Doctors understood we are more than just items to perform surgery on. And I wish they was some form of duty to disclose post operative problems. I worked for 18 months after my operation and for that time thought I was going mad as I kept forgetting things. Until one day I was speaking to a lady who had the same operation, we compared ops, she told me about her memory loss, I went home that day with the weight of the world removed ( and cried all night). For 18 months I had no idea what was going on with me….I thought I was having a mental break down.



oleo says on August 6th, 2010 at 2:16 pm

My 15 year daughter, born with heart disease, had her second surgery 1m ago. I felt like we were past the stage of experiencing any depression, I was wrong. We have tears, sadness, feeling of worthlessness etc. I spoke with her cardiologist who said it was from the pump and would go away in time. It is very difficult to see family members struggle with the emotional challenges- the surgery and all that goes along with it. I’ve worked at keeping her engaged in some normal things-going to mall, movies, sleep-overs at our house- it helps. She does tire more quickly, which will g
et better. The sadness is what concerns me.I’ve read that anti-deppresants can help, but she’s so young and I’d rather see that as the last solution. Given that the cardiologist stated it would pass, I’m going to try some alternative methods in addition to walks on beach, music, massage we are trying accupuncture. Any shared experiences with accupuncture would be helpful. We’ll see!



goldrush says on September 25th, 2010 at 7:22 am

I have a friend that just went through bypass & valve replacement a few months ago, she was an active, relatively healthy woman and it was suggested to go ahead & do this surgery while she was in such good health for a better recovery. After surgery her vision and speech was impaired, she was told it would go away and given some anti depressant and was told it was all in her head. Now months later after visits to 2 neuroligists (sp) she has been told that it was a complication from the heart and lung machine, a rare complication that only less than 10 people in the world have had occur. They have told her that she will not get any better and may get worse. This has completely changed her whole life, she will not be able to drive a car or function normally in her life as she had before. All of this for a surgery that could have been put off for a while longer. I am not sure that these risks were pointed out to her and personally I would think long and hard before having any surgery performed, DRs today just want to process you through and keep the accounts recievables coming in. I would get a lot of 2nd opinions and try to talk with people going through my issue before allowing a DR. to do anything to me. Its all about the money these days and the medical field is at the top of the list.



Judy Sanderson says on November 19th, 2010 at 8:14 pm

Four years ago, I had quadruple by-pass surgery. I have an 80% blockage again in the rt. coronary artery. I am currently being treated with nitrates. My husband complains that I say something, but later I cannot remember what exactly was said! Not only is it distressing to him, but very distressing for me! I was on an anti-depressant for several years before my surgery, but I am concerned over the change I see in myself, and close family members are seeing. I am not sure this is an after-effect from the surgery, my age,or from long-term use of anti-depressant, but after reading others comments, I am convinced it is the side effect of my heart surgery!



Gesiggie says on February 23rd, 2011 at 9:29 am

March 2008 I had open heart surgery to repair my Mitral valve (Annuluplasty ring). I was 32 at the time. No one told me pre-op that depression is a side effect of the op. I struggled with depression – crying for no reason, almost divorced my hubby as I was so sure that he was making me unhappy, until we went for Marriage councelling. Then the Councellor told me that I have pump head depression! I am now on anti depros and sleeping tabs and my memory is very very bad. I forget things all the time and I do things and can not remember doing them!



Terry Howington says on April 1st, 2011 at 12:47 pm

my husband had aortic valve replacement june 2009. he has always kept things to himself so until the last few months I didn’t know there was a major problem until he began acting not like himself. He’s now wanting to be “free” leaving all he’s known behind, feels he’s not worth being around. can’t handle the mental and physical changes as he was so strong and healthy other than an inherited valve problem that took 69 years to manifest. He, at 69, had the strength and body and stamina of a 25 year old. Talked to doctor, who said “he’ll be fine” and just changed his medicine. He’s been to counselor, where he shut up, wouln’t talk, feels he has to fix this on his own. Been told it’s an neurologial problem, depression problem, but he won’t believe me. I’ve tried everything, talking, researching, I’m afraid. He’ system matically erasing our entire life together bit by bit, moving all his stuff (awards, photos, etc.) out, changing our accounts to his accounts, etc. help anyone.



Joe1950 says on June 16th, 2011 at 9:54 am

In 2008 I had a triple by-pass & had similar problems after the surgery Depression and Cognitive problems (still do).. At first I thought I was going crazy.. the cardiologist laughed and called it pump-head like it was a minor thing and said it would go away. I was lucky to be in the military stationed in a Medical Research community. My PCM reluctantly referred me to a neurologist and he was a godsend. After a lot of tests and research he concluded that I indeed had suffered a neurological incident during the surgery and put me on some meds that a study indicated would help (currently prescribed for Alzheimer’s). It helps, not great, but better. The depression is ongoing, but managed with meds and counseling on most days.. At least I don’t think I have lost my mind anymore. So here I am retired at 62 skills obsolete and about 3/4 of my former mental ability (I think), wondering what I am I going to next… I am so lucky to have the best wife and family in the world… I would suggest that you actively seek out and others in your area and share your experiences you never know you might save them and their families a great deal of anguish. Just remember never quit on yourself or the ones you love because like a shark if you are not moving forward you are dead.
good luck and god bless, Joe



Kim says on October 8th, 2012 at 10:48 pm

My 78 Year old mother had open heart surgery to repair my Mitral valve (Annuluplasty ring) two months ago. She was a very healthy independent women prior to the procedure. As we get farther out from the surgery her memory is getting worse. She has started to accuse me of not telling her the truth about her surgery, she tells my aunt that she had lung surgery (not heart surgery), and she can’t find the way to the lab that is a mile from her house in the area she has lived in for 40 years?!?!?! Is this “pump head”?



Sherry Bradford says on December 6th, 2012 at 10:42 pm

Had AVR 10/23/2012. This is first I have heard about this issue and came across it while searching on memory loss. For first few weeks following surgery, I could not remember the names of people I know and had difficulty finding words to express common things. That scared me. Some of that is fading, but this posting and what I read in the Duke and subsequent studies is very frightening. Wish this had been discussed prior to surgery. Are there any more recent updates on this issue?



Robin Williams says on December 30th, 2012 at 2:38 pm

I had Mitral Valve Repair at University of Maryland Medical Center in October 2006, almost exactly 6 years later; I had the same valve replaced at the Cleveland Clinic in October 2012. I strongly agree that this is a very important “side effect” that should have been discussed with me by the many medical professionals I interacted with pre and post surgery(s). After all, I did go to two of the best hospitals in this country. Since my initial diagnosis of having a Rheumatic Heart and Valve Disease at 44 years of age, I did a lot of research on valve disease and heart surgery procedures. I never read anything that mentioned cognitive problems following heart surgery or maybe it is that I just don’t remember… being the Pump head that I am. On a more serious note, I did experience post surgical depression in 2006, following the MV Repair, but this time things are very different. The depression is horrible and the cognitive difficulties, AKA Pump Head, is making day to day living very difficult. It is very problematic for me and it is effecting many life areas; such as, my ability to concentrate on tasks; my ability to manage my finances; to grocery shop; my relationships with others are suffering severely; my ability to multi-task and maintain organizational skills are almost nonexistent. I also don’t feel any joy or happiness and I have every reason to be happy. I recently returned to work and my job as a Psychiatric Social Worker is being affected to the point where I may be let go. One would think that I would have all of the tools to help me manage the symptoms and deficits, but I am finding that it just isn’t that easy. For the millions of people that live with heart disease, you would think that we would be more informed about this so we and the people in our lives can be better prepared for this roller coaster ride. If anyone has any information or suggestions, please let me know. Thank you.



Sherry Bradford says on January 7th, 2013 at 5:04 pm

Robin – I am so sorry to hear of your serious symptoms. I don’t know this for certain, but I think part of the issue is that depression itself can lead to some of the cognitive disconnects and there is already an awareness that many folks experience depression are impacted by depression. So I think often we are brushed off as “just” having depression. It is obvious that something else is happening and it can be debilitating. My organizational skills (something for which I was hired and for which I have always been considered expert) are much different than prior to surgery. I find it hard to “finish”, if that makes sense. I can categorize, but that is not the same. At any rate, it is what it is and now I have to find a way to deal with it. I know that those who are hit with other cognitive issues (like stroke victims) go through various stages of recovery and learning/relearning. I’m hoping that the same will be true of the skills that I can see are very different than I had prior to surgery. I hope that you will not lose your job but will also find a way to incorporate methods that will help you stay at the top of your game. The surgeons are so wonderful and so happy that they can offer this tremendous life-saving surgery – and so am I. But there has to be awareness that we are complex beings and SOMETHING is happening that needs to be addressed. I hope it is the rewarming situation and that will show better results for many people. It may be why my own symptoms are much less than those who have gone through this a few years ago. I hope you will connect with a neurologist or even someone in a rehab facility who can help you find ways to cope and that time will be kind and allow you and many others to retrain the brain to compensate for these issues.



Diane says on February 18th, 2014 at 11:59 am

My 74 year old father recently had a bypass, maise proceedure for Afib and a valve replacement. He was an independent man that lived on his own prior to the surgery. After 1 week in the hospital he was moved to skilled nursing facility to help with his rehab. He has been very combative, verbally abusive to my sister and I and staff around him. One minute he is yelling, the next he is hysterically laughing. He forgets and then repeats the same thing over, he is swearing constantly. Then comes back into focus and is apologetic for how he is treating all around him. He is refusing any form of medication, he took Xanix which gave him nightmares. He is not sleeping well due to the nursing home facility and unrest. It is going into the 3rd week and seems to be getting worse. Will this subside or is this something longterm we will be faced with. Or once he is home in normal surroundings will it help him get back into perspective?



Sherry Bradford says on February 22nd, 2014 at 11:38 pm

My mother went through something very similar after having a seizure and it was ultimately determined that her electrolytes and especially potassium were very messed up. Be sure they are testing him for appropriate balances in his potassium. It is not unusual for it to take time to get this correct after heart surgery. If he is on ANY medication, he may also be suffering a reaction. Chantrix, for example, can cause exactly this type of wild emotional swing – even if it was tolerated prior to this event.

Since I last posted, all my symptoms of memory issues, managing sequential process thoughts, problem solving, etc., have returned to pre-surgery levels. I am forgetful sometimes, but no more so than prior to surgery and usually because I am tired or distracted. I found that reading, doing puzzles, and just forcing myself to think through memory lapses to the answer helped tremendously. The loving encouragement and support of my family was also a huge help. I think any form of isolation would have made it much more difficult to recover. No surprise this is seen more in the elderly as many are often isolated.

My thoughts and prayers are with you and your family. You may have to force your Dad’s case out of the rehab and back to a gerontologist as well as the surgeon. There is often huge age bias that this type of “behavior” is a normal reaction for an elderly patient. But if he was fine mentally prior to surgery, look to a medical reason for this current situation. It is no more normal for him in that case than it is for a sixty or even a fifty year old. It might be more normal for him to suffer greater fatigue or sleep issues -but not mental issues.


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