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Angina a year after CABGx3
mijmalu posted:
I had CABGx3 in early January 2012 and then had surgery to relieve fluid buildup in the pericardium three weeks later. I went to cardiac rehab for about 3 mos with no problems. After rehab was done I was walking anywhere from 2 to 4 miles three times a week with no angina or breathlessness. I twisted my knee on one of my walks and that put my walking on hold for a number of months. About two months ago I went back to walking and couldn't make it more than a few blocks when I started getting chest pains. I went into my cardiologist and he ordered a nuclear stress test which came back showing ischemia over the front of my heart. He thought there was probably a problem with one or more of the grafts so he ordered an angiogram. When he did that, the angio showed that all three grafts were in perfect condition. On my follow-up visit he prescribed Imdur and nitro tablets to take as needed. He didn't seem very concerned and just said to take the nitro if I have pain. I'm very frustrated and want to be sure there is no real danger if I start exercising again. If there isn't, then I can deal with the angina (knowing it's not life threatening). Anyone else have these type of symptoms after bypass surgery? I thought successful bypass surgery was supposed to relieve chest pain. BTW, I only have it when I walk and it is worse faster if I walk after a meal. Also, when I stop the pain goes away within 30 seconds or so (definitely no more than a minute). If the stress test didn't show ischemia I'd think it was acid reflux. Anyway, any comments from knowledgeable folks are welcome.
cardiostarusa1 responded:

"I thought successful bypass surgery was supposed to relieve chest pain."

Technically it is, as is with angioplasty with or without

......"nuclear stress test which came back showing ischemia over the front of my heart."

......"angio showed that all three grafts were in perfect condition. "

As applicable to the patient, there is coronary artery spasm (CAS), a transient constriction or a transient total closure of a coronary artery, which typically, but not 100% always, causes symptoms (usually angina) at rest. While CAS may or may not respond to nitro, it is typically treated (if/when 100% confirmed) with calcium channel blockers.

There is also, as applicable, microvascular disease, aka Cardiac Syndrome X (CSX), a problem going on in the heart's bed of capillaries, which may or may not respond to nitro. Microvascular disease may/can be present without coronary artery disease or with it.

"If the stress test didn't show ischemia I'd think it was acid reflux."

Beyond acid reflux/heartburn/GERD, noteworthy, as applicable, there is a non-cardiac condition known as esophageal spasm (ES), which can mimic angina-like chest pain and sometimes discomfort. In some cases, even radiating to the arm, neck, jaw, and back. ES may/can respond to nitro. The definitve test for ES is esophageal manometry.

Coronary artery bypass graft (CABG) surgery is just a clever way to temporarily circumvent the problem (atherosclerosis), as it does not address the underlying disease process and what drives the progression.

Most important, coronary artery disease (CAD) is a life-long unpredictable (which can exhibit periods of stabilization, acceleration and even some regression) condition, requiring a continuum of care, as well as good doctor/patient-patient/doctor communication and understanding at ALL times.

Best of luck down the road of life.

Take care,


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Living with Heart Disease

Coronary Artery Disease (CAD)

CAD is a chronic disease with no cure. When you have coronary artery disease, it is important to take......

This is especially true if you have had an interventional procedure or surgery to improve blood flow to the heart....../It is up to you to take steps...

Recognize the symptoms......

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Take your medications......

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Coronary artery anatomy

Starting with the left anterior descending (LAD), the most critical, next to the ultra-critical left main (LM).

_ . _

Good to know, for the primary and secondary prevention of heart attack and brain attack/stroke

Epidemiologic studies (EDS) have revealed risk factors (encompasses some new, novel or emerging) for atherosclerosis, which includes age, gender, genetics (gene deletion, malfunction or mutation) , diabetes (considered as being the highest risk factor), smoking (includes second/thirdhand), inactivity, obesity (a global epidemic, "globesity"), high blood pressure (hypertension), Low HDL (now questionable, according to recent studies) high LDL, small, dense LDL, RLP (remnant lipoprotein), high Lp(a), high ApoB, high Lp-PLA2, high triglycerides, HDL2b, high homocysteine (now questionable), and high C-reactive protein (CRP/hs-CRP).



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