Heart Failure - blockage?

[Husbandndshlp]

My wife, 45 yr old, insulin diabetic, many stents, 4x cabg, more stents, 1 mi that changed an ekg 2 others that changed just blood work. EF 45.  Last few months has had on/off swelling and has always complained of heavy metal plate feeling in chest after cabg. Last mos, swelling very bad, not responding to oral meds she is hospitalized with bnp over 400 and heart failure - diastolic?  IV diuretics worked and edema gone. Then potassium dropped to 2.4 and she was in for IV potassium. 2 weeks later her skipped beats are back and she says they hurt they come so fast and the edema is  coming back and hard to breathe again. She is also complaining of a chest pressure (she has it with exertion) but now without exertion and she takes nitro regularly. Could there be an underlying blockage in an artery that is making this edema come/go?

[Cleveland Clinic]

Yes I think that it is very likely that she has occluded a stent or lost a graft. I don't know the state of her renal function, but if OK she should proceed at once to a LHC and stenting or repeat bypass surgery depending on the findings. She should also be on maximal medical therapy including aspirin, plavix, Ace inhibitor or ARB and a statin, if she can tolerate these medications. And of course a long acting nitrate such as isordil or imdur.

[Husbandndshlp]

I also forgot to mention her heartrate is fast now adays 90-102. BP avgs 120/70-140/70.  The fast heart rate can't be too good for her grafts though right?