cagb

[heidi58129]

My husband had heart attack in dec 2008 a bare metal stent was fitted. Everything fine until 3 weeks later had second stent fitted in January 2009. In february 2009 was admitted in hospital with fluid retention. April 2009 was giving angiogram which showed ostial lad lesion and severe instent retenosis.  He had triple bypass April 2009.  2 weeks after bypass had fluid retention which has got steadily worse.  Gets breathless on exertion,and sometimes gets chest pain, even getting dressed is an effort.  We think it is heart failure but drs wont commit we are waiting for a heart scan are we wrong.

[heidi58129]

Thank you for you comments my husband is feeling better knowing that this is not all in his head.  Before his bypass the consultant thought my husbands symptoms were phychological as all his tests came back negitive but the consultant relialised the test were wrong.  Thank you again.

[ed34]

When I was in hospital recovering from my Cabgx3 I was shocked at how many
patients had just had further attempts. Some had received their 4th attempt at making
the bypass successful and I made up my mind then that if it didn't work first time, they
would have to try a different option. I had assumed that due to bypass surgery being used for so many years it would be almost 100% successful but this isn't the case.
They are still unsure as to why vein grafts in many patients close up. They used to
expect veins to last 10-15 years but now claim prior to surgery that they last much
longer. This is why they now try to use to Lima/Rima arteries from the chest. These
do seem to last the life of the patient.

[kenkeith]

The probability of a successful outcome of a cabg and stent is very good, but there are factors that make it difficult to determine an individual's  prognosis.  The doctor's have history and current condition so it would be difficult to second quess, but it seems to me from reading your post an echo should have already been done.  

[heidi58129]

My husband has been booked in for an echocardiogram on 15th August so we will see from there what is going on, hopefully.  You think after bypass surgery everything would be alrite again.  Looks like this is not always so.

[kenkeith]

I experienced a similar condition years ago.  It is a known fact (based on history) your husband has ischemia (lack of blood flow to heart cells due to vessel lesions).  When the heart cells are deprived of blood/oxygen the heart cells begin to die or become dormant (medically termed hibernating cell...can be revitalized with sufficient blood flow).  When this occurs heart contractions a weaker than normal and cardiac output is decreased.

Decreased cardiac output would explain your husband's symptoms.  If the heart contraction do not pump adequately, the blood received from the lungs backs up and fluids leak into the pulmonary tissues (pumonary edema), and that would be heart failure mode.

A better test would be an echocardiogram.  The echo is able to measure cardiac output and there is a visual representation of the heart wall  movement in real time.  Also, chamber dimensions is an important evaluation provided by an echo.

[ed34]

I'm actually confused about this because heart failure in the left side of the heart is related to shortness of breath on any exertion, but is usually accompanied by a build up
of fluid in the lungs. I assume you are referring to fluid retention as in the body in general
and this is associated with the right side of the heart which doesn't normally give shortness of breath problems. As the condition in the left side of the heart worsens, a
bad cough is normally developed where lots of sputum is produced. As the right side of
the heart worsens, the legs normally swell as does the liver. Doctors should have taken
an Xray, a mri or similar scan and ecg. Blood tests should also be taken to see if the
liver has problems and if there is a virus causing the problem.

[ed34]

heart failure is when the heart cannot efficiently pump blood around the body but I assumed this was a condition which appeared whether at rest or not.
Is there fluid in the lungs? this normally shows a problem with the left side of the heart.
A build up of fluid in the body usually relates to a problem with the right side of the heart.

[heidi58129]

He has excess fluid aswell which i forgot to mention he is on 120mg of furosemide and there is still a lot of swelling.  I understand that heart failure sounds worse than it is.  Even when my husband was at his worst the tests all came back normal he had to go on a treadmill to prove that he was ill and nearly killed himself doing it. I just hope he doesnt have to do this again to prove a point.

[ed34]

I always though heart failure meant that the heart failed, / ceased to function.
If anything it seems that the heart is not receiving enough oxygen. I know several
people who have had bypass surgery and it hasn't gone right the first time, including
myself. My bypasses collapsed after three months and I certainly knew about it. One
minute I was walking on a flat surface, the next I was on my knees gasping for air.
Sometimes the area where the bypasses are grafted become inflamed and can
restrict blood flow. This usually settles down with time/medication. A scan is a move
in the right direction and doctors need to run tests to see what is going wrong. If he is
getting breathless on exertion then this can be a good sign because his heart is coping
under relaxed/normal conditions (i.e. receiving enough oxygen). Doctors will soon get to
the bottom of the problem and come up with the best plan. In my case both veins failed
but the artery which was grafted from the chest has remained healthy. It was just that the surgeon grafted it directly onto a large piece of plaque, rendering the feed useless.
I have been in the same condition as your husband since January 2008 and am still here.
If he starts to feel chest pains when resting then get to the hospital asap but it is unlikely
to progress to that point very quickly.