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Forum Name: Ischemic Heart Disease

Question: Is it normal to have pain a year after bypass surgery?


 mgilliam - Thu Mar 26, 2009 4:00 pm

I am a 37 year old woman who has coronary artery disease. I had a mild heart attack in March of 2008 followed by a triple bypass March 28, 2008. Since the surgery I have been experiencing off and on pain in either my chest, the top of my arm, the shoulder blade, and in my wrist. I know the wrist sounds weird but I never had "typical" heart attack symptoms. I had an almost constant burning in my chest for over a year no matter what I ate (or if I ate). I was tired but other than those two things I really didn't have any other symptoms. The night that I had my heart attack my chest burned really, really bad (like really bad indigestion and I wouldn't have thought anything of it had it not been for the fact that the bones in my wrist hurt so bad I couldn't move my hand or my arm. I went to the ER three days later because my chest was still burning and the wrist was still really sore. The cardiac enzymes showed a heart attack. I had a cardiac cath which showed three blockages. They couldn't stent them so they did bypass.

Since the bypass I have had pain off and on in my chest on the left side. It isn't the burning like I had before - it is more like pain but it really hurts. Nothing I do takes care of it. I have tried OTC medications, Bengay and nitro. The nitro MIGHT ease it just a little but not much. Some times my shoulder blade or the top of my arm hurts with it. The bones in my wrist will ache sometimes as well but it isn't as intense as it was the night I had my heart attack.

My cardiologist seems to think all of this is muscular related but it is scaring me. I have had EKGS ran since the surgery and they came back normal. Before the surgery the EKG showed an inverted T wave (whatever that is). I had a stress test done a couple of weeks ago and passed it. The only thing noted was that I had a "hypertensive response" but I think that was because I was told not to take my BP medication before the test. I am not putting much confidence in the stress test because a week before my bypass I jogged almost a mile when my car broke down and never felt a thing in my chest so... I have also had an ECHO done because in addition to the CAD I have a leaking valve that was not fixed during the surgery. The cardiologist had said it is only leaking mildly. I did not go to cardiac rehab after because at the time I didn't have insurance. The cardiologist thinks this might be part of the problem.

My question is: can pain a year after the surgery still be muscular? The cardiologist said that the next step is another cardiac cath. I don't want to go through that again if I don't have to, but I don't want to take the chance of not doing it if there is a problem. The pain is NOT exactly like it was before but I have a hard time determing if what I am feeling is angina or muscle pain. If anyone can enlighten me as to how long muscle pain lasts or if I should have another cath I would appreciate it.

Thanks
 John Kenyon, CNA - Fri Mar 27, 2009 11:06 pm

User avatar Hi there --

Your question is a very good one, and deserves a thoughtful answer. I'll try to give you that. While your symptoms at present are not the same as what you felt before and during your heart attack, and while it is possible to have pain (not muscle pain necessarily, but sometimes nerve pain) for this long post CABG, it seems to me at least suspicious enough to warrant a thallium scan stress test (unless that's what you had -- you only mention "stress test" as in stress test, plain). A plain stress test is not nearly as useful as one with nuc scan, and is still less invasive than an angiogram. If your doctor isn't willing to go the half-step to do this and clear the air, then I guess either a second opinion or an angiogram are your two best alternatives, because what you describe would raise some flags for me, especially in a woman, since women usually do have atypical cardiac pain, as opposed to men, whose "classic" pattern dominates all the textbooks. The reason for that is that for ages men were considered to be by far the more likely gender to develop heart disease, and women were pretty much discounted, even though they have it every bit as often as men, only usually later, unlike you, who are one of those exceptions that just disproves the rule.

I do think there's sufficient cause to look further, and while I certainly understand -- and empathize with -- your desire to avoid an angiogram, it may be the best way to clear this up. Women also develop heart disease sometimes in different patterns than men, too -- more small vessel disease, which is more difficult to spot without more invasive testing. However, I do think a stress test with nuclear scan would make the most sense -- again, unless that's what was done recently. Oh, and the pre-surgery inverted T-wave, while sometimes a "normal abnormality" can also betray cardiac ischemia, which it probably did in your case. It's a matter of how deeply it is inverted. Many people have flipped T-waves that mean nothing, but deeply inverted usually means something more is going on. The absence of this doesn't mean there's nothing going on, either, though. While it's likely all is well and the pains may be due to nerve injury from the surgery, the only way you can really relax is to have some tests done that are fairly cut and dried, and I think yuo deserve that much at least.

I hope this is helpful. Please follow up with us here as needed, and keep us updated.
 NinoMalo - Fri Apr 17, 2009 7:02 pm

Hello:
I am a paramedic who underwent a triple CABG in 2002. Since that time, I have had pretty much continuous chest pain which is best described as a feeling of having a lump in the left side of my chest or like someone sitting on my chest. I have had a left side - right side heart cath, two left side caths, two nuclear stress tests (physical treadmill test) as well as four echos over the years and ischemia has been ruled out as the cause. The nuclear stress test has demonstrated no perfusion defects and an ejection fraction (the strength of my heart's contraction in the ventricles) at 67%. The best guess by several, and I do mean several, cardiologists is that it is "chest wall pain" most likely caused by the traumatic nature of open heart surgery. They do refer to it as "atypical" since the duration has been so long. However, I come to realize that it is something that I have to live with. I might add that it is unrelated to exercise and, in fact, often abates during exercise. I continue to work as a paramedic and live an active lifestyle. It is indeed wise to consult a physician about this condition but I wanted to share my experience with you.

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