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British Heart Foundation
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Blockages After Bypass Surgery

Hi I’m new to this forum ,57 year old male and looking for any advice ,I had a quadruple bypass in March 2018 and all was good had a speedy recovery went through rehab no probs.Then in June 2018 Started with same symptoms as before my bypass surgery but worse ,eventually after putting a lot of pressure on Doctors etc I was given an Angiogram which revealed out of the four grafts 1 artery blocked completely,1 partially (80%) blocked,1 unable to find,1 running clear .I have been advised that stents and more surgery are not an option and will be treated by medication .I was sent for the treadmill test but after 58 seconds I was removed as I was about to pass out now awaiting a tilt table test .

My symptoms are Pins and Needles in left arm ,pressure pain on chest ,irregular heart beats and palpitations.dizzyness,breathlessness ,lightheaded all of which are worse upon exercise or simple exertion .I have blacked out twice and been advised not to work or drive .

Consultant seems to think that it’s is not related to the blocked arteries

Just wondered if any one else has had similar and any advice appreciated

Many thanks

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Beyond belief! Has no-one mentioned insulin-resistance and reducing insulin stimulation, starting with a lower glycaemic-load? watermark.silverchair.com/1...

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Hi Concerned ,

Thanks for reply never been mentioned to me do you have any more info

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Where to start? Remember the recent BHF campaign that acknowledged the link between heart disease, stroke, cancer and diabetes? Well, the main underlying risk is insulin resistance. Essentially, high insulin levels are caused by an overstimulation of the pancreas from what we eat, then compounded by blocking the insulin receptors (that feedback the amount of insulin circulating) with visceral fat. This visceral fat results from lipogenesis insulinandmore.com/2018/01/... and has little to do with ingested fat that we've been warned to avoid. You can see from the link that the insulin index rating of whole milk is just 24 compared to skimmed-milk which is 60.

In fact, the low-fat advice that PHE gives lowers our expectation of just how much what we eat affects our chronic health. Typically people follow the advice with little improvement, often being told it is genetic, and rely on statins.

A Mediterranean approach has been proven to be far more effective. The MHRA stats state that statins are effective in preventing 450 heart attacks, strokes or mortality events in 10,000, which is just 4.5%. The PREDIMED study found that having olive oil or nuts improved heart attack rates by 30% compared to a low-fat control.

The ICS-NHS Diabetes Prevention Programme Mediterranean approach has up to 9 portions of berries and/or non-starchy vegetables per day, 4 to 8 portions of natural fat (favouring monounsaturated), 4 to 8 portions of low-Gi carbohydrates, 2 to 3 portions of protein (again, don't remove the natural fat), and 2 to 3 portions of full-fat dairy.

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Hi concerned,Thanks for the info,interesting.

John

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"The MHRA stats state that statins are effective in preventing 450 heart attacks, strokes or mortality events in 10,000, which is just 4.5%."

I think that statement, although possibly true (I'd actually heard 7% but let's not quibble) actually distorts the underlying reality. The problem is that Statins are prescribed willy nilly, including many people with a very low chance of a heart attack. If they were only prescribed to higher risk patients the percentage benefit would be much higher.

But there lies the rub; the cardiac event risk factors used in England & Wales (Scotland follows separate procedures) are looking dated, for example weight/waist measurement/BMI aren't really factored in, neither are co-morbidities. And I've been trying to understand why valuable predictive tests such as cardiac calcium scans aren't more widely used. NICE recognises their superb predictive qualities, but still won't endorse them because of the radiation risk of any incremental scan (which amounts to just four days of normal background radiation!) and the fact that the evidence is skewed towards white ethnic participants and they demand data with a broader ethnic profile (I get that, but I'm white so why am I denied the test?).

However, going back to statins, it's significant that the MHRA still says,

"The benefits of statins are well established and are considered to outweigh the risk of side-effects in the majority of patients. The efficacy and safety of statins has been studied in a number of large trials which show they can lower the level of cholesterol in the blood and reduce cardiovascular disease and can save lives. Trials have also shown that medically significant side effects are rare."

As a genuinely higher risk patient I for one would not want to be without my daily statin.

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This from .gov.uk gov.uk/drug-safety-update/s...

I don't have any heart disease because I keep my insulin levels low instead of relying on medication.

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Here's where I got the 7% figure. This is the NICE report on statins.

nice.org.uk/guidance/cg181/...

As you can see they break down the effectiveness of statins by different levels of cardiac risk. So for the least at risk group statins will save 4 people out of every 100 users from heart disease or stroke. But for the most at risk group, statins will save 15 people out of every 100. So it's as I previously said, statins become progressively more effective the higher your personal risk factors. The modal risk factor group is the 20% risk level, and for this group the statin effectiveness score is the 7% I mentioned before.

I've also see this NICE report quoted as evidence that statins increase the risk of diabetes. Yes, at the 80mg dose that's true, but at the far more common 20mg and 40mg daily prescribed dose then the increased risk of diabetes drops to statistical insignificance. In a way this underlines the oft quoted difference between a "toxin" and a "poison", almost everything is a toxin, but what stops it from also becoming a poison is the dose in which its taken!

It's also interesting that Dr Ford Brewer (one of the relatively few YouTube cardiac gurus who isn't an obvious charlatan or snake oil salesman) is also strongly convinced of the general need to tackle insulin resistance for heart care, but within his own personal regime he also takes a statin. And that's where I am too, I take insulin resistance very seriously and diet accordingly, but I see no conflict with also taking a daily 40mg statin.

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For me the conflict is taking something that unnecessarily impairs liver function.

Dr. Kendrick argues any benefit comes from the statin's anti-platelet/anticoagulant properties, which can be attained far more safely from other sources.

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Hi Do you know any stats for people who both follow the Mediterranean diet and take statins? This is what I have chosen to do due to the mountains of conflicting advice out there.

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So what's your calcification score "concerned " You advocate it but have you had one?.

I for one was given my score after a CT scan that showed I had a blocked LAD and later went on to have a stent procedure.

I too take insulin resistance seriously!

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My score's zero. I paid privately, because my wife needed one (only then did the GP pay due attention) then wanted to see what "eating all this fat" is doing to me.

Unfortunately, the company we used don't provide scans anymore.

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Hi Concerned,

I think it would be better to drop the "because" from that sentence. It's very difficult to prove categorically that one is caused by the other. It's fine if you can keep your insulin levels down (through diet and exercise?) but not everyone's in that fortunate position.

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Sorry to hear of your struggles Jonboy. It's every bypass patient's nightmare, you go through all that only to see the benefit partially nullified after a few months.

The artery that remained clear in the Angiogram, was that the Mammalian Artery, with the blocked arteries being the ones that were harvested from your leg?

What medication were you on following your operation?

What lifestyle changes did you implement following your operation?

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Hi Chappychap

Yes I believe it is the Mammalian artery which is clear and the leg arteries which are blocked

Meds post opp Asprin 300mg (now 75mg) 20mg,Bisoprol 2.5 mg mg,Lansorprazole 30mg Astrvastatin 20mg.

Stopped Smoking 6 months pre opp,diet pre and post opp was exercising daily cycling ,walking, but had to stop now .

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Then you have even more of my sympathy.

When I had bypass surgery I was shocked by the attitude of many of my fellow patients, they had little or no intention of changing their lifestyle (one guy was motivated to quickly get up and walking after his operation so he could get outside the hospital and smoke) and they had a pretty cavalier approach to taking their meds.

But that's not you, you sound like you've been serious and responsible about the whole thing.

On a more positive note it's not like this comes as a surprise to the doctors, something like 10% of leg vein bypass arteries are partially or fully blocked within a year (and about 45-50% within ten years). So I'm sure the doctors will find an effective plan for you.

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Yes from diagnosis to opp was 7 months wait so had plenty of time to alter my diet etc, did everything asI was told to and came through the opp all good and then this .No one at any time mentioned the possibility of this happening and now just feel as though no one wants to give me any answers as to my future heath .I feel in limbo at the moment,can’t work,can’t drive and have to do everything at a snails pace.

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Hello there,

All of this scares me! I had the same surgery in August and for the last few weeks have had some chest pain.

I’ve decided to sit with it for a while just to see if it’s the chest area coming back to life as still have numbness also in my ankles.

I’m constantly being told that I should take statins but like many I have read and researched just about everything on the efficiency of them plus my Mother and sister were badly affected by them, my sister losing her mobility at around mid fifties. We have all been around 8st for our whole lives but i do and they did have high genetic cholesterol. My sister died at 59 and my Mother 92 so I am totally confused.

I do hope you get some answers soon and keep us informed.

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Hi Lilyrosy,

I didn’t mean to scare anyone and your pains are probably the normal healing process I still have numbness and swelling in my left leg were the arteries were removed which as you say we put up with .The meds (statins included ) I’m on I just go along with what the medics tell me as I have with the whole process as I trust the experts??? maybe this is were I’m going wrong and need to question them more .

Thank you for your reply and I-hope your healing process progresses rapidly and problem free .

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Hello jonboy - sorry to hear that things are not going well for you. I think at this stage you should focus on asking for help with your debilitating symptoms. I know you have raised the issues and been told they are not due to your remaining artery issues but then I would say further investigations are needed to establish the 'real' reasons. I wouldn't have thought your medications were not causing such serious side effects. Have you had a liver function test recently to see if the statin is having a detrimental effect on your liver? I know people get very worried about stations but after reading much research I still believe they are beneficial for high risk people like ourselves. If you still can't get any answers I would request a complete review and second opinion over your current heart situation and medications . If you get the chance let us know how you get on.

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Hi Nathan53 ,

Thank you for the reply and advice ,I am due to have the Tilt Table test later this month and then see the Consultant early January so hopefully get some answers then ,if not I will request a second opinion .

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If you look at other posts, you may notice that some patients, commenting that they failed to make a full recovery or get totally better (either partially or unable to do what they could do before despite the invasive procedures).

Without meaning to sound "harsh", Mother used to tell me that whatever you get "down the line" let's say, beyond the 50s. Over the 50s, you are in a " health danger zone", there is no "quick fix" to reverse the established, cumulative damage done in the past 3-4 decades. She actually used a "payback" time for all the bad habits, leading to a range of health issues, be it Cancer or HD. She was referring to my Dad, who led a "party life" all his life besides his successful career.

I was rather quite shocked by the availability of fast food at motorway service stations of late. I would have thought they would offer some healthy options in this day and age and assumed that M chains went closed down thanks to healthy eating movement.

Without meaning to sound controversial, if you had relied on their offerings, let's say, for over 20-30 years, there's no surprise that someone's major arteries end up blocked up. There are some advanced studies on cardiac issues done in the UK/US, Cardiac diseases are not black and white as it may seem, initially.

A site like this help users to explore issues and you could come up with your own strategies, with the help of wise posters on this site. Good luck with your journey. :)

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Yes, I have same problem as yourself. Had bypass x3 April 17 took a while to recover, but June this year started to suffer with chest pains pins and needles in both arms. Had angiogram which shows two blockages, cannot be stented or bypassed as too risky. Treated with meds for unstable angina. Absolutely devasted as back to how I was pre heart attack. Constantly exhausted and breathless. Even if I had the option I don't think I would opt for another bypass. I am just going to take my life each day as it comes. There is not much else wecan do. Keep exercising diet and do your bet. Restwhen you need to.

Goodluck

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Hi Twobells .

Thank you for your reply as you say we have the same problems ,All I had heard about was the success stories didn’t realise these things happened .I think the hardest thing now is accepting how I am and my limitations .

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Sorry to hear about your condition Jonboy12. Without going back over what others have said, it's possible that your consultant doesn't think your latest symptoms aren't linked to the blocked arteries because they are similar to what I had with ventricular fibrillation. That's an electrical problem not a plumbing problem - an important difference. It requires a different type of treatment too, so don't get distracted by all the stuff you've been offered about statins and diet just yet.

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Hi Jon,

Totally shocked at what has happened to you. I was taken in on a Monday morning with (July 20150) suspect H/A and it appeared , within my blood, that I had had 2/3 attacks but all I had was a small chest pain, which I thought was a chest strain having been lifting my fence panels during the week. I was 68. They kept me in for checks/monitoring and sent me, on the Thursday, for an Angiogram which showed I had at least 3/4 'blocked/furred' arteries and we will keept me in. Bottom line on the the following Friday, 12 days after I had been taken in, I had a quintuple by-pass(x5) and the after care was fantastic. I was home on the Tuesday with a follow up care package which again was fantastic. I will not at this stage, state what Health Authorities I was under but to say they were great and have had (fingers crossed after 3 years) no problems. Dave

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Hi Dave ,

I’m glad your treatment and care was excellent and all is well and hope you remain fit and healthy. I too had excellent care prior and throughout my surgery and hospital stay ( only four days in hospital) .Rehab excellent .

It’s just trying to get to the bottom of what has caused my problem now and how I move on -Jon

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I was 48 when I had a 5 way bypass. 6 months later symptoms came back - shortness of breath and pain in left arm. Had angioplasty which discovered collapses in some of the grafts and ended up with 4 stents only 9 months after the bypass. Made it 12 years before the rest of the grafts collapsed and had a 3 way bypass this time. I was very careful with diet etc. My first bypass (2006) used endoscopic vein harvest which some studies (2009) found could cause graft problems. Sadly, there is a fairly high rate of problems within the first 12 months for many patients and reasons aren't always clear.

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