Doctors Lounge - Cardiology Answers
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Forum Name: Miscellaneous Cardiology Topics
|PastorStudent - Mon Jan 05, 2009 9:02 pm|
On 9-11-08, after my second heart attack and a kidney stone attack that week, I underwent a triple bypass. I actually needed a fourth bypass, but the artery was too small (genetic defect?). After the surgery, I developed an atrial fibrillation with a heart beat of 200. This was eventually controlled by Sotolol (no longer taking as of November 2008). I also developed a plueral effusion around left lung, where 600 ccs of fluid was removed in November. After removing this fluid, the chest x-ray showed that a mininal amount of fluid remained. I was subsequently diagnosed with inflammation of the lungs and put on prednisone. As of Jan. 2009, the fluid is gone according to the chest x-ray. Nonetheless, I am still experiencing what feels like congestion (I thought this was the inflammation). I have no mucus, but my breathing is labored and I whistle/wheeze. I eventually get really hoarse. My chest also has the sensation that I am being crushed. Often, I lift my shirt of my chest, which sometimes allievates the sensation. I also experience a sharp pain in the left shoulder blade. These symptoms come and go, which makes me say I have good days and bad days. In the last three weeks, I've had five bad days. The heart surgeon and the pulmonary specialist have released me. The cardiologist suggested that it might be the onset of allergies. I have been told to buy some over the counter allergy medicine or Mucenix. A nurse's practictioner tells me that I may need up to one year to heal from my bypass surgery. What's up?
|John Kenyon, CNA - Tue Jan 06, 2009 9:58 pm|
Hi there -
Most, if not all, of your symptoms are fairly common ones post coronary artery bypass graft surgery (CABG). Atrial arrhythmias, especially A-fib and flutter, are very common and usually go away, as yours did, in a fairly short time. The pleural effusion, sometimes called Dressler's syndrome, is also extremely common and responds well to the measures used in your situation. Sometimes a little bit of fluid will remain in the pleural space indefinitely.
The wheezing and whistling could be asthma due to allergies that have been awakened by the trauma to your body, or could be due to some other sort of irritation. There are several innocuous prescription antihistamines on the market which won't make you drowsy and may help the wheezing. You may also wind up being prescribed an inhaler if this can be proven to be asthma. Mucinex may be helpful and won't do any harm. It's apparently not cardiac asthma, as you've been seen and released by your cardiologist and surgeon.
There are also musculoskeletal complaints which can continue for some time after CABG, especially if you had the conventional open surgery where the sternum is divided then put back together with steel rings afterward. This isn't the primary cause, but is part of it, along with the ribs having been spread during surgery, which can cause some lingering pains and also some very odd sensations (often described as feeling as though there is "bent sheet metal" in the front of the chest at times). The sensation of your chest being "crushed" can be relieved, at times, by removing your shirt. Therefore the sensation is actually rather superficial. This is one of those really odd things that happens because nerves in the thoracic cavity have been irritated, touched, moved, etc. It takes a while for them to reorient themselves, and in the meantime these odd and troubling sensations may occur off and on. The tend to fade away.
A good rule of thumb for recovery expectations is one year for all the odd things to resolve and to feel completely normal. Getting into a cardiac rehab program is essential to a smooth recovery and is invaluable in terms of social support as well as a structured program of flexibility and aerobic fitness. Some people leave these programs in better condition than they've ever been in their lives. During that year some people seem to recover almost over night while others take a more deliberate course. Your body has been subjected to a major trauma because of this surgery, but your heart is also functioning much more efficiently than before, so the trade off is a very good one, but there are some potentially really strange symptoms to get past before you'll feel like yourself (or better) again. The good news is that most people do feel better than before.
That one anomalous artery is not unusual either. Probably one in 20 patients wind up having this problem with one artery in a group considered for bypass.
All in all your recovery sounds fairly typical. Some are faster and smoother, some are slower and more bumpy. In all cases I would highly recommend cardiac rehab for at least the Phase II (closely monitored) stage, and if possible, enroll in Phase III
(loosely monitored and self-paced). There's probably nothing quite as useful in getting back to feeling "right" again.
I hope this is helpful to you. Good luck with this, and please follow up with us here as needed.
|PastorStudent - Thu Feb 26, 2009 5:19 pm|
Thanks for your help. I was actually improving until one of my grafts recently closed off because of scar tissue. It was stentable. By the way, I was recently diagnosed with pericarditis. It seems to be the same symptoms that I had reported earlier; however, I am not certain as the recent pain actually was more intense.
|John Kenyon, CNA - Fri Feb 27, 2009 12:04 pm|
I'm glad you're doing well in general and that the one scarred artery was stentable. Pericarditis is fairly common after bypass surgery but usually is described as sharp, stabbing pain on breathing or while lying supine, and relieved by sitting up and leaning forward. Still, there's a huge spectrum of perception of pain (and its description as well), so it may have been what was going on all along.
Keep up the good work!
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