congestive heart failure

[preston74]

My father is 74 and has CHF, he has had 2 open heart surgeries, 9 bypasses, 2 stints, 1 stint thru his groin , numerour heart attacks throughout the years and kidney problems.  We have been told he cannot have any more heart surgeries or any other type of surgeries.  He fell this past June and broke his hip, the doctor told us putting him to sleep damaged his heart even more. His ejection fraction is 24%, my question is the doctor told us he would not be with us by the end of the year. Can you give a date like that and how can you come up with a time frame when it comes to the heart? He can barely walk without being winded, his blood pressure was bottoming out and seems to be stable now, his feet are swelling and  he has lots of mucous from coughing. This is a very confusing disease. I will see him one day and he looks awful, then a couple of days later he looks pretty good, although he always is very winded. His skin is extremely dry, he says his feet feel numb often. Just trying to understand and be prepared for what is happening. thanks

[ed34]

you're welcome and thank you :)

[kenkeith]

Thanks for the information.  It is very difficult for a patient to get much information from their doctor, and input such as this is very helpful.

[ed34]

I have to say I have not heard of 9. There does seem to be a contradiction in terminology with some hospitals. I was told I have received a triple bypass, (2 veins + Lima) but only one vessel was actually 'fixed' , the LAD. The Lima AND one vein bypassed one occlusion while the other vein was fed into the proximal LAD via a diagonal. So, in effect, ALL three vessels bypassed ONE blockage. So is this really a single bypass because one coronary artery was treated, a single bypass because one blockage was bypassed, or a triple bypass because three grafts were used. All my records state CABGx3. I would have thought with CABG, the 'G' meaning GRAFT would make it clearer to call it a triple.
Maybe experts should just have one name and one meaning.
Just as a matter of interest to some people reading this...
There are several vessels which can be used for grafting and first there are the arteries.
RITA/LITA which are difficult to harvest from the stomach, and the artery is removed by cutting both ends.
LIMA/RIMA which are in the chest, and only one end is cut, so it can hang down to be connected to a coronary artery.
RADIAL which are in the arms. Both ends are cut and the vessel is then attached to the Aorta and Coronary artery.
Great Saphenous Veins from legs. Veins can take much less abuse than arteries and have a much lower lifespan when grafted. They can also contain valves, to help fight against the effects of gravity in the legs. So the surgeon has to either destroy these, or make sure the vessel is the right way round to allow blood flow when grafted to the heart.
Problems....
Due to the Radials/Lita/Rita being totally harvested from both ends, they tend to suffer severe spasms if over handled by the surgeon which can cause problems.

[kenkeith]

When the heart isn't pumping adequately, there is a backup of fluids in the lungs that causes dry cough especially when lying down. One can drown in their own fluids, and it appears your father does not have that problem at the time you posted unles there is a concomitant condition that causes muccous coughing.  An ejection fraction of 24% can be adequate if the demand for blood/oxygen is reduced (reduce activity, etc.) and the resistance for blood flow is low (reduce blood pressure). The inability to walk normally may also strain the heart and as the hip heals there may be a positive effect.  

Sometimes with heart failure (EF below 29%) the heart  will enlarge and that may compromise and obstruct the electrical pathways through heart muscle and cause an irregular heart rate and then cardiac arrest may be the expectation.

There are many success stories of recovery that is worse than your father's present condition. More than 6 years ago I had an EF below 29%, an enlarged heart, moderate to severe mitral valve regurgitation, a totally blocked LAD, RCA artery 98% occluded, etc.  Today my heart size and EF are normal, and I feel very well each and every day.

There must some mistake because I don't believe 9 bypasses are possible unless you mean several occlusions were bypassed with each operation. It seems the number of bypassses are limited due to the number of veins that can be harvested.

Sorry to hear of your father's medical condition and thanks for sharing.  You are welcome to follow-up if you have any further questions.  Take care.