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Abnormal blood flow after bypass surgery?

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Posted 7/3/2006 5:30 PM (GMT 0)
I had single bypass, mammary to LAD ( the LAD was 100% blocked) 14 months ago. I was told the mammary should last essentially the rest of my life. Well I had a stress test done last week and the cardiologist told me everything looked good while I was on the treadmill.

I then proceeded to getting the pictures taken and he called me on friday saying " I wish I had good news but I don't. You appear to have abnormal blood flow in the same area as where you had your bypass. It's not even borderline, it's definite. We need to go in there with a heart cath asap and see what's going on. Maybe it can be treated with medication, angoplasty and maybe it's ok but we're not seeing it. Hopefully we can fix it"

"Hopefully fix it"?

Told me that it appears that the bypass isn't doing what it's supposed to be doing. I asked about blockage and he said "it could be a blockage". I asked him if it appears that I need another bypass surgery and he said " I didn't say that, I said it appears to be abnormal blood flow and we should go in and see if we can fix it with either medicine or angioplasty".

I asked him if I'm in any imminent danger and he answered the question with a question " Do I think you are in danger of having a heart attack? No. " And I would recommend that you keep walking normally but I would probably recommend against any jogging ( well he KNOWS I can't job having done the lower extremities a week prior to this stress test! )

I see him on wednsday.

Any advice on what to ask, what to look at would be greatly greatly appreciated.

Does it sound like a failed bypass surgery??

Jeeesh confused

 

Posted 7/3/2006 9:48 PM (GMT 0)
Here's what an interventional radiologist customer wrote:

Tom,

I am on vacation and do not have time for the complete analysis and answer.

It is possible that one of the bypass grafts has failed, and it is not unusual for that to be the case. It is also possible that the area is 1) irreparably damaged, explaining the abn nuclear stress test or 2) There is an artifact or misinterpretation of the stress test. If I were you, I would undergo the cath. Little risk, and then, you will have the answer.

Sorry so brief, just do not have the time for more at this point.

sad  

Posted 7/4/2006 5:48 AM (GMT 0)
Hey Tom, are you having any symptoms such as chest pain? Were these stress tests just for yearly exams or did you have chest pain, SOB, severe fatigue and all?

Stress tests are known to sometimes be false positives. I would think that your body would help you to understand developing blockages, or "abnormal blood flow" to your heart. I think I have read where different things can happen to reroute the blood to other than your bypass graft. If the pressure differential is not right, blood won't flow the right artery. This is called stealing, I think. It also happens to some (na for your problem), due to deveoping blockages between the carotid and subclavean artery in the chest. Blood drains from the head and causes fainting, etc.

Could it bee that you have had some coronary artery spasms? If it happened during the test, it would show up in the results. The mammary artery may be in a bind?

I guess your question is whether to have the cath, or not. I have had 8 caths in the past 3 years. That would be the most conservative approach, though. It would also probably give you some peace of mind and stop your worry about another bypass.

Best wishes,

Rj
Posted 7/4/2006 3:07 PM (GMT 0)
Hey RJ,

Thank you for your reply. No symptoms whatsoever. Whereas I was tired a lot, had severe night sweats before the surgery ( which all went away after the surgery ), none of those or any new symptoms have appeared.

You had 8 cath's in 3 years? Wow! Have you had open heart surgery?

Rgrds

Tom

Posted 7/4/2006 3:16 PM (GMT 0)

Oh Hey RJ, It's been 14 months since the bypass surgery and I just thought it was a good enough time to get a check up. Nothing else promted me to do this.

Posted 7/4/2006 4:15 PM (GMT 0)
I guess that does give you a choice with regard to the cath? Once those test(s) turn out wrong....I think they have to cover themselves until proven otherwise, or if you back out. I think that I would sit my doc down, present your current condition (good?), and address the inaccuracy rate of nuclear imaged stress tests. Get his gut feeling....

No I haven't had bypass surgery. They wanted to do the same surgery as yours, but I opted for stents from a better, teaching hospital (UAB). Little did I know that I would have rotoblational arthectomy, along with 2 more stents. I was only told that they would "try to stent" the 95%blockage at the very beginning of my Lad. They had to drill out the plaque and flush the debris on into the cells of my heart muscle. The blockage extended into my "short" L. Main. Stenting, w/o drilling could have caused the plaque to travel to unwanted places (per the docs). The blade (acorn shape diamond) became disconnected from the apparatus when the flushing was going on. The professor took control and retrived it. Rotoblational Arthectomy is rarely used, from what the docs have said, and from what I have read. Most plaque can be pressed into the wall of the artery as the stent is inflated. The stent traps the plaque. Remember, runaway plaque can cause an mi, even on the cath table. I now have 3 overlapping stents in my Lad and 1 in my obtuse marginal. So, I guess you would say that I am waiting on something to happen to these stents...Then go for the bypass as you have already done.

Good luck

Rj
Posted 7/4/2006 6:32 PM (GMT 0)
Sometimes a scar forms where the new vein is stiched in this can cause abnormal blood flow if this is the problem they can put in a stent and that should fix the problem
Posted 7/4/2006 6:54 PM (GMT 0)

Thanks, funny thing is though is I don't FEEL any problem. None. Other than my left leg ( I have a blockage there) I'm like the eveready bunny.

So how much of a problem can abnormal blood flow be? I asked him if I'm in imminent danger and he said " Do I think you are going to have a heart attack? No I don't, but you are definitely showing abnormal blood flow and we don't like seeing that in young guys like you". Endquote.

In retrospect about the open heart surgery. I'm not sure if I would have done it. Probably would but not sure. I think I would have given the chelation a shot as I have with the other blockages and seen what happened before I got up on the gurney. But then I had symptoms. I was dead tired every afternoon. HAD to take naps everyday. At nights I would wake up in a pool of sweat and I was never a night sweater. Interesting point there is when I mentioned that to the surgeon ( night sweats ) he told me "that's a different can of worms, let's deal with the blockage and then we'll talk abolut the nighgt sweats". After the bypass surgery the night sweats essentially disappeared. So he didn't even recognize that as a symptom?

Now, I don't take naps ( well, sometimes but my Wife and I are working till 2AM most of the time), don't have any lack of energy, no chest pains, no night sweats........no symptoms.

Grrrr

Tom confused

Posted 7/4/2006 7:34 PM (GMT 0)
Aldo, what does UAB stand for?

I was told my LAD was 100% blocked and that the bypass was the "gold standard" which using the mammary, should last me the rest of my life. That's what I was told. In my case they cut the sternum. Also told me that 6 weeks after the surgery I could "row a boat" if I wanted. Quite a few inconsistencies in how this is sold.
Posted 7/4/2006 9:19 PM (GMT 0)
UAB = University of Alabama, in Birmingham, Hospital.

Yep, it is a hard thing to do, that is to have some input into your own destiny when you are surrounded by the best and the brightest, who are advising you. We really want no part in our demise, lol. I just thought I would like the most non-invasive route at least tried first. My local hospital was going to try, but on the day before the cath, they explained to me that it might be a little tricky. To me that meant for sure that they would try, then take me to surgery. That is when I asked about the larger hospital and what their capabilities were. They conferenced, my doc said they could do it down there....I rode in an abulance to Birmingham that night, had the stuff done the next day. Went home the next day. I hope I am here for awhile. Of course I had to have another cath about 3.5 weeks ago, and it was good.

I am taking the most toxic medicine that I have ever taken in my life. It is a corticosteroid-13 day dosing package (dexamethasone for possible rheumatoid arthritis). I have not slept for more than 2 hours per try in 11 days. It's really not sleep either. I have never seen so many possible side affects listed. My adrenal cortex could stop the natural production of cortisone when I stop this medicine which I am gradually tapering off on. Gee, it has also made me somewhat psychotic. I guess the sleep helped do that....

Rj
Posted 7/5/2006 1:22 PM (GMT 0)
Hey Rj, have you tried St Johns wort for the arthritis?

I've decided to see the cardiologist today to hear all about this "bad news" about my abnormal blood flow. I'm also calling Cleveland Clinic to start the process of checking this out from scratch.

Was also up last night reading about stem cells in Thailand. Pretty interesting.

Tom
Posted 7/5/2006 3:28 PM (GMT 0)
hey RJ, those corticosteroid's are not fun to take are they?  I take one that is called Florinef which is used to raise blood pressure...it gives me severe headaches.
Posted 7/6/2006 2:28 PM (GMT 0)
Bless your heart Elisha :) I wouldn't trade conditions with you whatsoever!!!!!

I took an equivalent dosage of 60 mg/day of prednisone, or 300mg/day of cortisone, for 6 or 7 days and then completed the 13 day decreasing dose. Yep it helped the A or RA for sure. It is just that it is contraindicated in people with some types of brain damage. I think a prior stroke is in that category.....I am starting to sleep again :)
Posted 7/7/2006 11:37 AM (GMT 0)
Yeah prednisone is a nasty drug too.  I have had to have that after a round of Sol-Medrol IV for MS flares and it always does keep me up too.  Last time I had it though I got a really bad case of the hives so no more prednisone for me...   cant say that I'll miss it
Posted 7/7/2006 2:32 PM (GMT 0)
Well I saw the cardiologist and heres the scoop. He says it was a "failed bypass" which is why the abnormal stress test. I asked him if this means that I will need another bypass surgery and he said he would be very reluctant to recommend that as if it failed the first time, it will most likely fail the second time.

He believes the failure is due to a mechanical thing. That the options now are to do a heart cath, "baloon it to see if we can pop it open", or treat me with medication and gave me a bag of torprol and plavix. I am probably not going to take them.

I asked again if he thinks I'm under any imminent danger and he said no, but he wouldn't recommend I go "chop any piles of wood".

I am going to call Cleveland Clinic and get another opinion. But I am defniitely not going to let this consume our lives again. I am angry and afraid today but not to the extent I was yesterday. darnit this.

They pitched me that this bypass surgery is "the gold standard" and that this mammary to lad should last the rest of my life. That was the pitch. Now, 14 months later because "I" asked to be checked out, the new pitch is that it's a failed bypass, and maybe I need a stent or medication when in fact I went in there feeling just fine. No symptoms. Before the bypass I had symptoms. Now I don't.

GRRRRR.

I think I'll just play it by ear but I HAVE spoken with the people in Thailand and they DO think the stem cell will benefit my PVD. I'm not in need of straightening that out at this moment but when I am in that position my Wife and I will hop a flight I think. Far as the heart, I've had about as much of this as I'm going to stand. Maybe I'll feel differently next week but right now we're making plans to go look at real estate in Fayetteville Georgia. Anybody familiar?

Rgrds

Tom tongue

Posted 7/7/2006 7:22 PM (GMT 0)
Tom

Are you seeing a crackhead or witchdoctor? How can he POSSIBLY be gleaning this failure scenario information from a &^%$% stress test?????? It's totally impossible. ANY cardio knows that. He has pictures that are highly, highly susceptable to error/artifacts.

OK, along with the pictures he has some very good EKG data (maybe), taken during the test. Still, you cannot look at an EKG and get the info he is telling you!

The test also calculated your efection fraction (EF). Did he tell you what yours was?

I would run, not walk from this nut.
Posted 7/7/2006 7:59 PM (GMT 0)
Hey Rj,

It says here " The gated wall demonstrates hypokinesis to the anteroapex and EF of 53%. The resting first pass EF 50%.

Overall Impression

1) Fair excercise capacity

2) Normal blood pressure and heart rate response to exercise

3) Abnormal perfusion consistent with ischemia in the anteroapical distribution

4) Low normal left ventricular systolic function

Rgrds

Tom confused

Posted 7/7/2006 8:35 PM (GMT 0)
Good EF for a CABG guy. Mine is ~45 I think. Normal for healthy folks ~50-60.

So you have signs of deteriorating heart muscle in the upper portion of the front of your left ventricle, which is probably the area the mammary artery supplies.

Even though your EF is good, you have a low normal lv beat (caused by the hypokinesis, which can be reversed, or healed).

OK....This data still comes from a stress test!

You may have done yourself a favor by just routinely having this test. If I were you, I would go for the cath. They could fix a "kink" or a developing blockage/scar tissue easily.

A good interventional cardiologist believes he can do anything better than a thoractic surgeon :) I love that competition....

Dr. Quacker
Posted 7/7/2006 8:43 PM (GMT 0)
""Even though your EF is good, you have a low normal lv beat (caused by the hypokinesis, which can be reversed, or healed).""

I guess my question is how bad is it and can it just wait till we figure out if we're moving away or not. Healed naturally? Is it possible this was exactly like this right after the bypass surgery 14 months ago ya think?

The "kink" you are mentioning might be what he means by "popping it open with a ballon"?

Tom
Posted 7/7/2006 8:50 PM (GMT 0)
No natural healing here Tom. It needs blood to heal and reverse.

You felt great relief after the BP, so it was probably working right, at that time.

They can use a balloon, or even stent a kink to hold it open permanently.
Posted 7/7/2006 8:52 PM (GMT 0)
Doesn't the stent guarantee another bypass surgery down the line in the same place?

T
Posted 7/7/2006 8:53 PM (GMT 0)
Why would you think that?

When stent restenosis happens, they can use a balloon to re-open the stent. Hey, did you know that they can pass an uninflated stent, THROUGH an existing stent, to reach a blockage downstream of the original stent? They did this in my Lad. From the very beginning of my Lad, I have 3 overlapping stents (side by side, or end to end, and very little overlapping). The first is the longest made.

Post Edited (Aldo) : 7/7/2006 3:09:10 PM (GMT-6)

Posted 7/7/2006 9:33 PM (GMT 0)
Why? I don't know, I wondered what happened if it was blocked up again and now you are explaining it.....but how many times can they re-stent a stent?

Looks like we're in for a heck of an adventure. The bypass surgery was more like Chiller Theatre.
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