As much as you may want your return home to be a return to normalcy, it won't be. You'll be tired and your family and friends will be worried. That said, the more normal things you can do, the better:

• Get out of bed and shower. The activity and routine will do you good.
• Eat breakfast. It's not too early to start thinking about healthy eating.
• Take a walk. Walk on level ground for 5 to 10 minutes.

These simple activities will probably tire you out. That's normal. You'll feel weak and won't be able to do all the things you did before.

You've been through a lot and need time to heal. Your body (and mind) need time to recuperate. Here are some of the reasons why you're feeling run down:

• Immobility Even short periods of bed rest and inactivity weaken muscles, the heart and the lungs.
• Anemia It takes the body time to replace blood lost during surgery. Being down a pint or so makes it difficult to supply the muscles and organs with the extra oxygen they need during physical activity.
• Lack of appetite Few people enjoy a hearty appetite after a heart attack or heart procedure. Not eating enough food or drinking enough water can make you feel sluggish.
• Medications Certain prescription drugs can affect how your heart and blood pressure respond to exercise. Beta-blockers, for example, lower your heart rate. Other drugs that can influence the body's response to exercise include calcium channel blockers, digoxin, nitroglycerin and other nitrates, and amiodarone. Drug-related weakness is usually strongest when you start taking a new medication and tends to lessen as your body adjusts to it.

Heart-attack survivors often end up with sections of dead or dying heart muscle. A small amount of damage may have little effect on the heart's ability to pump blood. The greater the damage, the less efficiently the heart can pump blood. Such damage doesn't usually contribute to weakness, although it might lead to other symptoms, especially shortness of breath.

To combat this weariness, budget your energy and plan your day so that rest follows each period of activity.

After heart trouble, every little flutter can trigger worries that your heart is in danger. What should you look out for? Ask yourself these questions:

• Is what I am feeling now whether it is pain in the chest, light-headedness or shortness of breath similar to what I felt just before my heart attack?
• Does the pain in my chest, arm, jaw or lower back continue even after I massage the area or change my position?
• Am I sweating more than I should be, given the intensity of my activity?
• Am I short of breath (without having recently done physical activity)?
• Am I feeling sick to my stomach?
• Am I dizzy, light-headed or feeling faint (without having recently done physical activity)?
• Am I having problems with my post-surgical wounds in my legs, arms or chest?
• Do I feel like my heart is racing or fluttering? (You may be experiencing a rhythm problem if your heart beats more than 100 times per minute or the beats aren't spaced evenly.)

Talk to your doctor about anything unusual.

Your incisions can become infected from bacteria that live on your skin or that come from the environment around you. If this happens, your doctor will prescribe antibiotics to kill the infection. Scarring can result if the infection is not treated early, and early detection of a possible infection is up to you, the visiting nurse, and the medical staff at the rehabilitation facility.

Signs of infection include:

• Increased tenderness There will be some tenderness of the incision for many weeks after surgery, which will get gradually better each week. But when the tenderness suddenly increases, that's a possible sign of infection.
• Redness The lines where the knife cut into the skin (the incision) remain red for many weeks after surgery. That's a normal part of the healing process. When the red line suddenly becomes a much brighter red and the redness seems to be spreading out from the incision, that can be a sign of infection. When the spreading red area is tender, that is especially worrisome.
• Red streaks up your leg or arm Sometimes infections can spread through small tubes under the skin called lymphatic vessels. These infected vessels can look like red streaks under your skin.
• Fever Infections cause fever (usually, a temperature of 99.6 or more).
• Shaking chills Infections can cause chills. This is more than just feeling chilly or cold; it is uncontrollable shaking of the body. If this happens, call your doctor immediately.
• Feeling sick and weak If you suddenly feel sick or weak, like you are no longer making progress in your recovery, you may have an infection.
• Drainage If you notice oozing from incisions, especially thick, yellow drainage this can also be a sign of an infection and you should contact your doctor.

If your surgeon removed blood vessels (veins or arteries) from your legs or arms, you will have incisions that need to heal. (These vessels are used to bypass blocked heart arteries.) By the time you leave the hospital, healing will be well under way, but it will not be complete. There are three things to watch out for:

• Infection Incisions can become infected.
• Injury Until your incisions completely heal, they will be vulnerable to new injuries. Be careful of activities that could cause your arms or legs to strike (or be struck by) hard objects.
• Swelling Some swelling after surgery is normal. While you are in the hospital, your arm may have been suspended in a sling to reduce the swelling. Usually, this swelling is gone by the time you go home. However, your legs may look puffy, and if you push on the skin, it can cause a slight pit.

Here's how to prevent and treat swelling:

• Keep your legs propped up when you sit, so that your toes are above your chest. A footrest with some pillows on top will do the trick. It is also important to walk around frequently and not sit for prolonged periods.
• Don't stand on your feet for more than 20 to 30 minutes at a time in one place for the first month after surgery.
• If you have had a vein removed from your leg, you will be sent home with special support stockings that help squeeze the swelling out of your feet and legs.
• If you had surgery to remove an artery from your arm and there is still swelling, your doctor may ask you to prop your arm up on a pillow at night and when you are sitting in a chair.

If swelling appears in a leg that was not operated on, this can be a sign of either heart failure or blood clots in the leg, complications that can follow surgery. Contact your doctor right away.

If both legs were operated on, but swelling seems much greater in one leg, and the swelling does not go down when you prop that leg up, this could be a sign of blood clots. Contact your doctor.

Your chest is a cage of bones. Inside this cage is your heart, lungs and other important structures. Open-heart surgery requires that your breastbone (called the sternum) be cut in half, so that surgeons can see and operate on your heart. When the operation is complete, your breastbone is pulled back together, usually with stainless steel wire. (These wires remain in your chest for the rest of your life, and show up on X-rays.) Your skin is also sewn back together. There are two things to watch out for:

• Infection Incisions can become infected.
• Injury The breastbone returns to full strength only after the bone heals by growing new bone where the bone was cut. It takes six to 12 weeks for the bone to heal. During that time you may feel a clicking or movement between the two halves when you take a deep breath or turn your chest. Until your breastbone heals, it will be vulnerable to new injuries, and can be injured by activities that normally would cause no damage.

Here's how to avoid injury that can delay healing of the breastbone:

• Avoid any activity that could cause your chest to strike (or be struck by) hard objects. Doctors usually ask you not to drive (because the steering wheel could strike your chest in an accident) for at least four weeks after surgery.
• Do not lift objects heavier than 10 pounds until your doctor says it's OK, usually 3 months from the date of surgery.
• Do not do sit-ups or push-ups.
• Lie flat on your back when you sleep: Avoid sleeping on your side or stomach. It may help to lie flat if you wedge pillows under each side of your butt.

Not that long ago, rest was what the doctor ordered after a heart attack or heart trouble. Taking it easy, so the thinking went, wouldn't stress the heart and would help it heal more quickly. Today we know that inactivity is bad for the heart and the rest of the body.

Exercise strengthens the heart. And by helping muscles use oxygen more efficiently, exercise eases the heart's workload. Exercise has many other benefits, including:

• Lowering your chances of developing diabetes (or controlling diabetes if you have it)
• Controlling your weight
• Lessening the threat of some cancers
• Strengthening your bones and muscles, and so decreasing your chances of falling and breaking a bone
• Improving mood, and possibly preventing or controlling depression

Although the emphasis throughout your recovery is on strengthening your heart, your heart's safety is an even higher priority. So you'll be encouraged to do things that exercise your heart without stressing it too much.

How can you tell what's safe and what's not?

• Pace yourself. Walking on level ground at a pace of about 100 steps a minute is safe for almost everyone.
• Monitor your heart rate. If you like gadgets, you can buy a wristwatch-like device to keep tabs on your heart rate. Exercise hard enough to get your heart beating faster than it does when you are sitting, but not so hard that it's going faster than 10 to 20 beats above its rate at rest.
• Use the talk test. You should be able to carry on a normal conversation while you are exercising, and not have to stop to catch your breath.

Many people fear having sex after a heart attack or heart procedure. While it may be true that love can break your heart, sex barely stresses your pumping muscle. Most sexual activity affects the heart about as much as a brisk walk around the block.

The short answer is any exercise that you enjoy (or will at least tolerate)! Pick an exercise that you dislike and you probably won't do it often enough to reap any benefits. Aside from that, choose an exercise that:

• Will give you an aerobic workout. That means an activity that will get your heart and lungs working harder than they do when you are sitting. Walking, swimming and bicycling are common aerobic exercises.
• You can do without pain or discomfort.

Drug prescriptions commonly say something like take one tablet every four hours for seven days. Cardiac rehabilitation experts use a similar strategy to emphasize the importance of exercise and to personalize exercise programs. Many exercise prescriptions follow the FIT format: frequency, intensity and time.

Once you feel OK walking for five to 10 minutes on level ground, increase your time by four to five minutes every four to five days until you're walking comfortably for 30 minutes a day. Every so often, try climbing an extra set of stairs — slowly.

How fast should you walk? At first, not very fast: Walk briskly enough so you feel you're getting a workout, but not so fast that you get out of breath. For most people, that means taking about 100 steps a minute. (If you can't carry on a normal conversation while you are walking, you're moving too fast.) You can also monitor the intensity of your workout by selecting an activity with a particular intensity, by using a scale that gauges how hard you are working, by measuring your pulse or by using a monitor to check your heart rate.

When you were 15, you could probably decide on the spur of the moment to lace up your sneakers, go for a run and then stop when you'd had enough. Now that your heart is a bit more fragile, it's best to plan an exercise session more carefully. The following example uses walking as the exercise, but the same principles apply to any kind of exercise. Divide your session into three parts: warm-up, aerobic conditioning, and cool-down. You may also want to consider adding strength training to your work out.

A target heart rate is the range within which you want to keep your heart rate when you exercise. To get the full benefit of exercise, you should keep your heart rate within 40 percent to 60 percent of your maximum heart rate.

A simple equation can give a healthy person a fair idea of his or her maximum heart rate. But it isn't precise enough for people with heart disease needs to be more precise. Your doctor or rehabilitation specialist will probably measure your maximum heart rate using an exercise stress test.

If you still have chest pain (angina) or an irregular heart rhythm (an arrhythmia) after your heart attack or heart procedure, your doctor will set the upper range of your target at least 10 beats per minute below the rate at which chest pain or an irregular rhythm begins.

Your doctor or rehabilitation specialist may want you to check your pulse every few minutes after you've entered the aerobic phase of a workout. (You'll need to wear a watch with a second hand or second indicator when you walk.) If you can check your pulse without breaking your stride, great. If you need to stop and check, that's fine too.

Find a pulse point in your wrist or neck. Count the number of beats in 10 seconds and multiply by six. An easier and more accurate way to monitor your heart rate is with an an electronic heart-rate monitor. These devices, which look like wristwatches, cost $50 and up.

If your heart rate is below your target, walk faster. If it's above the target, slow down or stop and rest for a minute, then start again at a slightly slower pace. Try to choreograph your workout so you keep your heart rate in the target zone for the time called for by your exercise prescription.

One of the easiest ways to measure how hard you are working is with a list called the Borg Scale of Perceived Exertion. The scale runs from 6, which means no feeling of exertion to 20, which means you are exercising very, very hard. A safe zone for the early phase of cardiovascular rehabilitation is 11 to 12. You should be able to talk normally without huffing and puffing while doing your activity.

Source: Borg G.A. Psychophysical bases of perceived exertion. Medicine and Science in Sports and Exercise 1982; 14:377-381.

The following questions can help you sort out normal exercise pain from worrisome pain. Answering YES to any of these questions could mean potentially dangerous changes instead of normal ones:

• Is what I'm feeling similar to what I felt just before I had my heart attack?
• Is it taking a long time (more than 10 minutes) for my breathing and heart rate to return to normal after exercise? (This could also mean that you are exercising too hard and need to ease up a bit.)
• Does the pain in my chest, arm, jaw or lower back persist even after I massage the area or change my position?
• Am I dizzy from exercising?
• Did the symptoms come on as I exercised and fade away after I stopped and rested?

Yes. All adults should have their blood pressure checked at least every two years. People at higher risk, including those with a family history of high blood pressure, African-Americans, overweight people, people with diabetes and anyone who has had a heart attack or any heart surgery or procedure, should have their blood pressure checked more often. Your doctor will tell you how often to check your blood pressure.

A blood-pressure reading consists of two measurements, the systolic blood-pressure reading and the diastolic pressure reading. The systolic reading indicates the force the heart must exert to pump blood to the arteries in order to supply blood to the rest of the body. The diastolic reading is the resting pressure inside the arteries when the heart muscle relaxes. High blood pressure usually is defined as a systolic pressure of 140 or more and a diastolic reading of 90 or more.

Your blood pressure will be measured when you visit your doctor, but you can also do it at home. Devices for measuring blood pressure at home are commonly available in drug stores. These devices include a cuff that you put around your upper arm, wrist or finger. Arm monitors are the most reliable of the electronic devices. Avoid using wrist and finger monitors.

The easiest devices work like this:

1. You put the cuff around your arm.
2. You push a button, which inflates the cuff then slowly deflates the cuff.
3. The machine shows you your blood pressure and pulse rate.

Many machines also store the last several blood-pressure and pulse-rate readings, so that you can compare your current readings with readings in the past.

Ask your doctor if he or she has a preference regarding what machine you buy. And always check the accuracy of your monitor by using it in your doctor's office and comparing it to the reading obtained by your doctor or nurse.

There are no set rules, but taking three readings at each sitting works well for many people. Discard the first reading, then record the second and third reading. Take your blood pressure at different times throughout the day and mark the date and time next to each reading. Record any notable circumstances, for example, poor sleep during the previous night or recent return from a brisk walk. Share your records with your doctor.