Post-CABG Heart Issues: LVEF, MR, TR, and New Symptoms - Cardiology

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Post-CABG heart issues can be complex, especially when symptoms persist or worsen despite surgical intervention. In your father's case, it is encouraging to hear that his symptoms improved significantly after the CABG surgery, but the lack of improvement in left ventricular ejection fraction (LVEF), mitral regurgitation (MR), and tricuspid regurgitation (TR) raises important questions.

1. Is there still myocardial ischemia present post-CABG?
It is possible that some degree of myocardial ischemia could still be present even after CABG. The heart may take time to heal, and the immediate post-operative period can show changes in the electrocardiogram (ECG) that may not reflect the long-term status of the myocardium. If the ECG shows signs of ischemia, it may indicate that not all areas of the heart are receiving adequate blood supply, or that there are other underlying issues such as microvascular disease.

2. Regarding the ECG from March 1st and the presence of new symptoms:
If your father is experiencing new symptoms such as shortness of breath, it is crucial to evaluate the ECG for any new signs of ischemia or blockages. The presence of a complete left bundle branch block (LBBB) can complicate the interpretation of the ECG, as it can mask underlying ischemic changes. LBBB can also be a sign of underlying heart disease or structural issues, and its development post-CABG may indicate that the heart is under stress or that there are new conduction abnormalities.

3. Management of MR versus LBBB:
The decision to address MR or LBBB first depends on the clinical context. If the MR is functional and related to left ventricular dysfunction, improving the overall heart function may help alleviate the regurgitation. However, if the LBBB is causing significant symptoms or is associated with new ischemic changes, it may require more immediate attention. A thorough evaluation by a cardiologist, possibly including further imaging or catheterization, would be necessary to determine the best course of action.

4. Reasons for unchanged LVEF and worsening MR post-CABG:
Several factors could contribute to the lack of improvement in LVEF and the worsening of MR after CABG. These may include:
- Underlying myocardial damage: If there was significant damage to the heart muscle prior to surgery, it may not recover fully even after revascularization.

- Post-surgical remodeling: The heart may undergo changes in shape and function after surgery, which can affect LVEF and lead to functional MR.

- New or progressive heart disease: The development of new coronary artery disease or other cardiac conditions can occur post-surgery, impacting heart function.

- Diastolic dysfunction: If the heart is unable to relax properly, it can lead to increased pressures in the heart, worsening MR and TR.

In summary, your father's case requires careful monitoring and possibly further evaluation to understand the underlying causes of his symptoms and the lack of improvement in cardiac function. It is essential to maintain open communication with his healthcare team to ensure that all aspects of his heart health are being addressed appropriately. Regular follow-ups, imaging studies, and possibly catheterization may be necessary to guide treatment decisions moving forward.