Post-Bypass Surgery: Why Am I Still Experiencing Chest Pain and Breathlessness?

Q: Post-Bypass Surgery: Why Am I Still Experiencing Chest Pain and Breathlessness?

Hello： Coronary artery bypass grafting (CABG) is, as the name suggests, a procedure that bridges a vessel from the aorta to the distal end of the coronary artery, "bypassing" the obstructed lesion to ensure adequate blood supply to the myocardium downstream. <br>The standard prac

After coronary bypass surgery, I still feel chest tightness and have difficulty breathing, worse than before the surgery?

Hello, Dr.
Huang! (I apologize for not providing enough details in my previous message, so I am resending it.) My brother underwent a coronary angiogram due to chest tightness, which revealed 50% blockage in the left main (LM) coronary artery, 70% blockage in the mid-left anterior descending (LAD) artery (the most severe), 50% blockage in the proximal right coronary artery (RCA), and additional blockages in the distal RCA and proximal left circumflex (LCx) artery.
He underwent bypass surgery at FE Hospital's cardiac surgery department, utilizing both internal mammary arteries and saphenous vein grafts.
Upon discharge, the surgical report stated OPCAB x4 (LIMA to LAD; RIMA to GSV to DX to PDA to distal RCA).
However, there was no mention of the LM or LCx.
(The accompanying diagram shows that while the LIMA is connected to the LAD, it appears to be connected to the proximal area near the LM rather than the distal area beyond the blockage, which raises concerns about the LAD.
Additionally, there is no record or diagram indicating a connection for the LCx.)
It has been four weeks post-surgery, yet he still frequently experiences chest tightness and shortness of breath (which improves with sublingual nitroglycerin).
He becomes breathless after walking for 20 minutes (compared to being able to walk for an hour pre-surgery).
His condition seems worse than before, with occasional arrhythmias (as indicated by his blood pressure monitor) and an increased heart rate, along with dizziness.
I have spoken to several fellow patients who have undergone bypass surgery (including those I know from the ward and clinic, as well as three friends), and they all reported feeling comfortable after discharge without experiencing the symptoms mentioned above, nor did they need sublingual nitroglycerin.
(I have also been diligently using a lung function improvement device and participating in walking rehabilitation.)
When I asked my doctor during a follow-up visit whether my grafts were connected properly, he replied that he couldn't recall the details and suggested that I would need another coronary angiogram for clarification.
I inquired why I am experiencing these symptoms while others are not, and he responded that everyone is different.
I would like to boldly ask the doctor: Based on the information provided, could it be that my bypass grafts were not connected properly, or could there be other factors at play? Why is my experience so different from that of other patients? Thank you.

Peng Ren, 60~69 year old female. Ask Date: 2019/05/08

Dr. Huang Yinghe reply Cardiology

Hello: Coronary artery bypass grafting (CABG) is, as the name suggests, a procedure that bridges a vessel from the aorta to the distal end of the coronary artery, "bypassing" the obstructed lesion to ensure adequate blood supply to the myocardium downstream.
The standard practice is to connect grafts to the distal ends of the three main arteries: the left anterior descending artery (LAD), right coronary artery (RCA), and left circumflex artery (LCX).
However, due to individual variations in vascular anatomy, such as a small myocardial territory supplied by the LCX, it may not be necessary to perform a bypass on the LCX.
The left main coronary artery (LM) branches into the LAD and LCX, so the bypass surgery does not directly address the LM; instead, the grafts to the LAD and LCX can supply blood flow to the anterior wall of the heart.
If you feel that your postoperative symptoms have not improved or have even worsened, it is advisable to first conduct non-invasive tests such as an electrocardiogram (ECG) and echocardiogram to check for signs of deteriorating cardiac function.
If there are indications of worsening function, it may be necessary to perform coronary angiography to assess the status of the grafts (reports indicate that about 15-18% of grafts using the great saphenous vein (GSV) may become occluded within one month post-surgery).
Of course, there are many potential causes for shortness of breath; if the surgical grafts are functioning well, other conditions such as pulmonary diseases, anemia, or endocrine issues may also need to be considered.
Wishing you safety, Chiayi Hospital, Huang Ying-He.

Reply Date: 2019/05/08

More Info

Post-bypass surgery, experiencing persistent chest pain and breathlessness can be concerning and frustrating, especially when you see others who have undergone similar procedures feeling much better. Your situation is complex, and several factors could contribute to your ongoing symptoms.

Firstly, it’s important to understand that coronary artery bypass grafting (CABG) is designed to improve blood flow to the heart by bypassing blocked arteries. However, the surgery does not guarantee an immediate resolution of all symptoms, especially if there are underlying issues that were not addressed during the procedure.

One possibility is that the grafts used in your surgery may not be functioning optimally. While your medical team has indicated that the surgery was successful, it’s worth noting that grafts can sometimes become narrowed or blocked over time, leading to symptoms similar to those experienced before surgery. This phenomenon is known as graft failure, and it can occur for various reasons, including the development of atherosclerosis in the grafts themselves.

Additionally, your ongoing symptoms could be related to the heart's ability to pump effectively. Even with successful bypass surgery, some patients may experience heart failure or reduced cardiac output, which can lead to symptoms like breathlessness and fatigue. It’s crucial to monitor your heart function post-surgery, and tests such as echocardiograms or stress tests can provide valuable insights into how well your heart is performing.

Another factor to consider is the potential for anxiety or depression following major surgery. Many patients experience emotional challenges after undergoing significant medical procedures, which can manifest as physical symptoms, including chest pain and breathlessness. It’s essential to address these psychological aspects, as they can significantly impact your recovery and overall well-being.

You mentioned experiencing palpitations and dizziness, which could indicate arrhythmias or other cardiac issues. It’s essential to communicate these symptoms to your healthcare provider, as they may require further investigation, such as Holter monitoring or an electrophysiological study, to assess the heart's rhythm and electrical activity.

Furthermore, your description of needing sublingual nitroglycerin suggests that you may still be experiencing angina, which is chest pain due to reduced blood flow to the heart muscle. This could indicate that there are still areas of the heart that are not receiving adequate blood supply, possibly due to residual blockages or issues with the grafts.

Lastly, it’s worth considering non-cardiac causes of your symptoms. Conditions such as pulmonary issues, gastrointestinal problems, or musculoskeletal pain can also lead to chest discomfort and breathlessness. A comprehensive evaluation, including pulmonary function tests and imaging studies, may be necessary to rule out these possibilities.

In summary, while your surgery may have been technically successful, ongoing symptoms can arise from various factors, including graft function, heart performance, psychological impacts, and potential non-cardiac issues. It’s crucial to maintain open communication with your healthcare team, advocate for further testing if necessary, and consider a multidisciplinary approach to your recovery that includes cardiology, rehabilitation, and mental health support. Your experience is unique, and addressing all potential contributing factors is vital for your recovery and quality of life.

Similar Q&A

Post-Bypass Surgery: Why Am I Still Experiencing Chest Pain and Breathlessness?

Hello, Dr. Huang! My brother underwent a cardiac catheterization due to chest tightness, which revealed 50% blockage at the ostium of the left main coronary artery (LM), 70% blockage in the mid-segment of the left anterior descending artery (LAD) (the most severe), 50% blockage a...

Dr. Huang Yinghe reply Cardiology
Hello: Coronary artery bypass grafting (CABG) is, as the name suggests, a procedure that bridges a blood vessel from the aorta to the distal end of the coronary artery, "bypassing" the obstructed lesion to ensure adequate blood supply to the myocardium downstream. Typic...

Post-Stent Surgery: Understanding Symptoms and Potential Risks

Hello doctor, it has been 2 months since I underwent stent surgery. Recently, I have been experiencing intermittent shortness of breath, as well as chest pain, back pain, and stomach pain (which can be relieved by pressing). Last week, I had a resting electrocardiogram, and the r...

Dr. Cai Guiqin reply Cardiology
We recommend that you discuss the above situation further with your attending physician. Wishing you good health. Thank you!

Understanding Chest Pain: Post-Surgery Symptoms or Heart Issues?

I underwent a fibroma surgery on my left chest in February 2022. Postoperatively, I did not experience any significant pain, only occasional discomfort. Recently, I have been experiencing two unusual sensations in my left chest. First, there is a feeling of being enveloped inside...

Dr. Wu Xueming reply Cardiology
Due to your young age and the absence of chronic diseases, your risk of developing heart disease is low. Many factors in daily life can contribute to this situation, such as emotions, stress, irregular sleep patterns, or excessive consumption of caffeinated beverages. It is advis...

Post-Thoracoscopic Surgery Symptoms: Understanding Breathlessness and Discomfort

Hello, Doctor: I would like to ask about my condition. A year ago, I underwent a single-port thoracoscopic surgery due to severe empyema. It has been over a year since my discharge, and I have been experiencing persistent shortness of breath, chest tightness, and a pulling sensat...

Dr. Cai Dongqi reply Family Medicine
Hello: Most major lung issues (such as pneumonia, COVID-19, lung surgery, or drainage of pleural effusion) can affect lung function. Engaging in exercise to improve lung function is important, and autonomic nervous system dysregulation is one of the contributing factors. It is ad...