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

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Post-Coronary Artery Bypass Grafting (CABG) complications can be complex and multifactorial. In your father's case, despite symptomatic improvement following the surgery, persistent issues with Left Ventricular Ejection Fraction (LVEF), Mitral Regurgitation (MR), and Tricuspid Regurgitation (TR) raise important clinical questions. Let's address your queries systematically.

1. Presence of Myocardial Ischemia Post-CABG: The electrocardiogram (ECG) taken the day after CABG may still show signs of myocardial ischemia. This can occur due to several reasons, including incomplete revascularization, residual coronary artery disease, or even new ischemic events. The heart muscle may still be recovering from the stress of surgery, and transient ischemic changes can be observed. It is crucial to correlate these findings with clinical symptoms and possibly conduct further imaging studies, such as a stress test or myocardial perfusion scan, to assess for ongoing ischemia.

2. New Symptoms and ECG Findings: The development of shortness of breath (dyspnea) in March, coupled with the ECG findings, should be evaluated carefully. If the ECG shows new signs of ischemia or a complete Left Bundle Branch Block (LBBB), it could indicate new or worsening coronary artery disease or other cardiac issues. LBBB can complicate the interpretation of ischemic changes on an ECG, as it can mask or mimic ischemic patterns. Therefore, a thorough assessment, including echocardiography and possibly a cardiac catheterization, may be warranted to determine the underlying cause of these new symptoms.

3. Management of MR vs. LBBB: The echocardiogram indicating worsening MR from moderate to moderate-severe and TR from mild to moderate, along with the emergence of pulmonary hypertension, suggests that the heart is under increased stress. The decision to address MR or LBBB first depends on the clinical context. If the MR is significantly contributing to heart failure symptoms or pulmonary hypertension, it may need to be prioritized. Conversely, if LBBB is causing significant conduction issues or is associated with new ischemic symptoms, it may require attention. A multidisciplinary approach involving a cardiologist and possibly a cardiac surgeon is essential to determine the best course of action.

4. Reasons for Persistent LVEF and MR Issues Post-CABG: The lack of improvement in LVEF and the worsening MR post-CABG can be attributed to several factors. First, the underlying myocardial condition prior to surgery may have led to irreversible damage, affecting the heart's ability to contract effectively. Additionally, functional MR can arise from left ventricular dilation or dysfunction, which may not have been fully addressed during surgery. The presence of new LBBB could also indicate underlying ischemia or structural heart changes that were not corrected. Furthermore, factors such as patient age, comorbidities (like diabetes or hypertension), and overall cardiac health play significant roles in recovery and outcomes post-surgery.

In conclusion, your father's case highlights the importance of ongoing monitoring and management after CABG. It is crucial to maintain open communication with his healthcare team, who can provide tailored recommendations based on his specific clinical situation. Further diagnostic evaluations, including imaging and possibly invasive procedures, may be necessary to clarify the current state of his heart and guide appropriate treatment strategies.