Any advice appreciated

[Clive-Higs]

  I'm a 45-year old diabetic who had a double bypass in March 1997. The
  angina stopped but after the operation the (until then normal) blood
  pressure "rocketed". The cardiologist prescribed amlodipine for the BP
  and aspirin. This reduced the BP to ~145/85 in the morning rising to
  ~170/90 in the evening. Moderate exercise was ok for up to 2 hours but
  even gentle exercise longer than this caused tiredness and breathlessness.
  In November 97 I cycled 27 miles but.that evening about 2 hours after
  dinner I was very relaxed watching TV when there started extreme
  breathlessness, exhaustion, dizziness and very cold legs despite sitting
  by a log fire in a warm room. The feet were slightly swollen and the
  blood glucose was ok but the breathlessness came and went in waves for
  about 10 hours. The pulse was weak but I think it was about 72. After
  this I was tired, cold, hyperglycemic, sometimes slightly breathless and
  had a poor exercise ability for about a week.
  There were another 2 episodes like this but the last in January  had
  severe breathlessness, blood pressure of 184/91 and an irregular pulse of
  ~98. My GP changed my BP medication to lisinopril which lowered the BP,
  stopped the previous palpitations during the day,  and reduced evening
  symptoms to slightly heavy breathing after meals or after bedtime
  sometimes. The resting pulse is regular and about 54 now and there's
  very mild angina if I try something energetic when tired. I contacted my
  cardiologist who said he would arrange an appointment for June but
  nothing's happened. Having had no diagnosis I've tried to reduce blood
  pressure by taking extra lisinopril when it goes above ~155/88 but
  there's quite a delayed response. I've gradually increased exercise to
  almost the November level. Is there anything else I can do to prevent
  future trouble besides this and the low fat diet & strictly controlled
  diabetes? Do you think the heart was failing after I exercised with high
  BP?.
  Clive

[CCF CARDIO MD APS]

Dear Clive,  I commend you on how well you have taken care of yourself both
before and after your bypass surgery.  It is obvious that exercise is very
important to you, and as you know it is one of the most important factors in
maintaining health(including slowing the progression of coronary artery disease.)
Any symptoms that develop new or recur following a surgery such as bypass warrant
investigation; in other words you do need an evaluation by a physician soon.  As for
the breathlessness type symptoms that you are having, there are a myriad of potential
causes, including but not limited to the heart failing due to uncontrolled high
blood pressures while exercising, pulmonary emboli(blood clots to the lung), chronic lung disease
as a result of any history of cigarette smoking(I assume you do not smoke now), and
allergic type reactions to food, environment, or medications.  The concern about angina
that appears after bypass surgery often requires another stress test and or catheterization.
The drug Lisinopril or any in it's class require checks of the kidney function (blood test)
with any new symptoms.  It would be of great benefit to you to keep a diary of your
symptoms with details regarding time of day and what activity you were doing or not soing when they occurred.
You are absolutely on target when you stress the need for good blood pressure control as no one's heart is happy
in the face of continued high blood pressure.  Good Luck.  Information provided in the Heart Forum is intended
for general informational purposes only, actual diagnosis and treatment can only be made by your physician(s).