Pain 10 months after bypass

[drm2]

I had a heart quadruple bypass last December, I have diabetes and am 51. After getting over the procedure I experienced a pain around the heart area when I took a 2 mile walk in the evenings about every third or fourth time. 10 months after the operation I'm experiencing the problem every third of a mile now. I'm not out of breath and if I rest for a few minutes I can continue and get my two miles in. I've had a stess test (6 months ago), CT scan (1 month ago) and a catherization all of which came up negative, all the grafts are ok and the bypasses are clear. The Cardiologist that did the catherization (done 2 weeks ago) said that I had blockages of some of the smaller arteries/veins that were not involved in the bypass and that they could be causing the pain. He said that my heart was getting about 90% of the flow needed with the bypasses and that it was not worth going in to mess with these other blockages and the pain should go away. Do you have any opinions or questions I should ask when I go back to my regular Cardiologist in December as this problem seems to be getting worse. How long should this pain continue.

[CCF-M.D.-MJM]

Hello,

This is a common situation. It is sometimes difficult to get a complete revascularization.  Sometimes there may be a small branch taht is too small to bypass and to small to stent but still causes symptoms.  It is difficult to say how long the symptoms will last.   Sometimes these areas will revascularize with small collateral vessels, but it is difficult to say.  One option is to take your cath films to another cardiologist or center and ask for a second opinion.  I would make sure this is a reputable center -- like a teaching center.  If the symptoms are limiting, there may be additional options for medical management or perhaps just angioplasty without stent would treat the symptoms.  It is difficult to say without seeing the cath films.

I can't think of additional questions to ask the same doctor, but I would consider asking another doctor for their opinion.

I hope this helps.  Good luck and thanks for posting.

[save]

I would like your opinion on this if you can.  I have e-mailed you in the past and find your answers very intelligent.  I just had the aortic valve replaced and bypass surgery about 8 weeks ago.  I started getting jaw pain and fullness in the chest around 3 weeks ago and it has increased.  They want me to do more tests to see if the bypasses failed and to see if the LAD is worse.  It was 60% and they decided not to bypass it.  I have turned down tests for now, and he is letting me try medicines which he does not think will work.  They will not let me start any rehab until I find out what is causing the jaw and chest fullness again.  You mentioned that you had angina after stenting, it went away.  I did try the nitro again and it helped.  I just do not want to start tests again.  I need a rest at this point.  Could I have you ideas on this.

[save]

I had a branch off the LAD that was 85% or more blocked that could not be stented.  He said that the LAD may be blocked more, and I will probably need a cath.  He mentioned a CT (I think) that slices to see if the stents failed.  He said it can show blood flow, but if I still have symptoms I will still need a cath.  I wonder what happens if one does not get failed grafts fixed.  He agreed to let me go back on the patch (Nitro) and more Toprol XL ( my heart rate is around 104) to let me see what happens.  He does not think it will work. I am suppose to call him in 2 weeks.  I have 6 blockages in all.  The LAD, 2 branches off the LAD, RAD, 3 laterals.  They fixed 2 of them - one of the brances off the LAD and the RAD.  The right one is behind the heart.  I am not sure my letters are correct.  His parting words to me were not to let this go like I did the surgery.  I blue coded in the hospital.  I think that was what he was talking about.  I did not do the surgery when they told me to.  I hope that I am not repeating myself.  Thanks again.

[504dp]

I had CABG x4 in late 2004 and have had left chest wall and what has felt like upper heart pain every since.  Tests last July discovered x2 Ramus blockages that the first & second caths missed.  I am being told now that it is best to live with it.  Sometimes it is hard to deal with it mentally.