Urgent CABG

[Kincavel]

Hi my partner attended for a stent on 17th Dec 24, the angiogram showed extensive CAD, so he was referred for an Urgent Quadruple CABG.

The Cardiothoracic surgeon saw him on 7th Jan 25. Surgeon says op will be approximately in mid Feb.

2 days after the angiogram and abandoned angioplasty on 17th my partner had HA on 19th Dec (tropinine 57) , ( Medics think it was a induced by a combination of GTN Tab and an abandoned angioplasty on 17th).

I recognised the signs and symptoms and sought emergency care- and he was blue lighted to A&E, he came home day after. He is now concerned to use GTN spray and when gets chest discomfort he rests rather than use the GTN spray ( despite being told continuously by myself to use it ).

If he had been alone he would not have been capable of ringing 999 as he had slumped to the floor and his BP plummeted and was nauseous and clammy and extremely weak with cyanoses.

I am a guest lecturer at university and have a few up and coming commitments to travel away overnight ( but can easily rearrange them).

He is also refusing to sit or mix with others because he’s anxious he gets infections pre operation.

I’ve not left his side since 16th December …he’s on meds and his angina seems manageable atm but he doesn’t take health guidance ( GTN) he still thinks he can do things but is slightly more cautious re exerting himself but I have to intervene and ask him to not lift heavy bags etc.

He insists that I go away overnight etc but I’m worried about leaving him because he forgets that his health situation is precarious. I’m in a dilemma what to do.

[mjames1]

The chance of the GTN tab inducing a HA (rare) is outweighed by its benefits, ie preventing an angina attack, turning into a heart attack. I'm going to assume this is what you have all been told by your cardiologist. If your partner still refuses the gtn , he is putting himself at risk.

In addition to being given gtn tabs when in pain, I was also prescribed 240 mg of Diltiazem ER when in a similar situation. Are they given giving him any type of medication other than than PiP GTN to bridge him over until the CABG?

Jim

[Kincavel in reply to mjames1]

yes he’s on bisoprol, ranolazine, rampiril, omeprazole,atorvastin, aspirin.

He has been experiencing chest discomfort for 2yrs, had echocardiography, ecg, X-rays etc but all NAD and was told it was reflux.

He was admitted with crescendo angina, and preinfarction in late Oct 24, that lead to the angiogram with the possibility of angioplasty in Dec 24. That’s when he got diagnosed with extensive CAD calcification 80% in mid LAD Circumflex, Ramus, occluded D1.

Re: HA , they said it’s only the GTN tab that can cause this and it’s probably bcos it was combined with the angiogram, they think the wire may have disturbed some plaque ( both rare events).

Do you take GTN prior to walking or exertion or only if you get chest pain

He has no history of smoking, only drinks 4 units alcohol a year (xmas NY, mine and his birthday), he cycles, runs, walks five miles per day, normal BMI, he’s 66yo.

Leaving him alone overnight or for a few hrs is causing me anxiety, despite how he feels, I’m worried that meds are only managing his pain and BP .

I don’t want to be too protective but it’s a bit of a worry if I leave him.

[mjames1 in reply to Kincavel]

Who is "they"? If his cardiologist does not want him to take GTN., then he shouldn't. But if his cardiologist has prescribed it, and you're listening to the medic in the ambulance then you were listening to the wrong person.

Many similarities to my case where the initial diagnosis was heartburn and Gerd. Finally, they did an angiogram and found CAD.

Jim

[wjb2 in reply to mjames1]

i am one of those rare people, where GNT drops my BP so low it becomes dangerous, when i had my HA the paramedics gave GNT and all seemed ok, but during the night in hospital i had another massive HA and was given GNT, next think i knew , was me coming around with them pounding on me doing chest compressions, it was explained the Spray had dropped my BP so low that my heart couldn’t pump. Anyway a few test later they confirmed GNT a no go for me.

During my stay i was given a triple bypass and all seems well , but i worry that if HA was to happen again as i have some damage to the heart, what would i do.

I’m on heart meds and have a good steady BP and my consultant seems more than happy for me not to have GNT , but advised me to all ways carry Paracetamol obviously it’s not as instant as GNT spray, but if the pain reduces it relieves pressure of the heart muscle.

[Kincavel]

no one said don’t take GTN, it is him that is nervous about taking it. His cardiologist prescribed it so he must take it, he knows that- he’s just hesitant.

Hope your CABG went/ goes well.

[mjames1 in reply to Kincavel]

Thanks. I ended up with six stents instead of CABG. It can be a very stressful time waiting for something to be done after a diagnosis of CAD. I wish you both well.

Jim

[Kincavel in reply to mjames1]

Thank you and here’s to a healthy bright future for you too Jim.

[APC65]

Hi, your partners situation is very similar to my own experience and history. No risk factors of CAD, on slight chest discomfort o n exertion was referred for tests all normal so referred for angiography and stents on Dec 29th 2022... once in there was told 100% blockages so they couldn't stent so referred for urgent triple CABG which was done Feb 13th 2023. However as I had kept myself fit my heart had developed colaterals which is what had prevented me having a HA..... it was only at 100% blockages and under extreme exertion that the collaterals were not able to keep up with oxygen demand...... I had been blocked up for years but not known it due to collaterals. Whilst waiting for the CABG I was prescribed GTN spray but never used it as it drops your blood pressure and mine was already very low naturally. The GTN is for relief if having an angina attack.... if the angina is controlled, this is likely to be on exertion only. . If you get angina attacks when resting this is more concerning and they will prescribe a medication to be taking regularly which dilates the blood vessels to prevent angina attacks. Even though your partner doesn't want you to change your plans to be away, My experience was that I was terrified of being on my own until after the op. And whilst waiting I had 4 trips to A and E with suspected HA which were simply anxiety attacks ... every niggle becomes a warning sign. I expect he'll be relieved if you just rearrange your plans.

[wjb2 in reply to APC65]

ye i get anxiety attacks even now coming up to three years in march since my bypass op.

had one two nights ago, followed my rehab teams advice , pulse normal , BP in my normal range. did my relaxation system, rather large burb later panic over, trapped wind 🤭.

My issues is my HA was so violent it was like being kicked by a horse in the chest, so little twinges send me into ( is this what a normal attack feels like) panic.

It always seems to happen at about three in the morning 😤 so all logic goes out the window.

[Kincavel in reply to wjb2]

Sounds really frightening- I hope the situation improves for you.

Your history sounds very like my partners, he just needs to start realising he can’t do heavy lifting and exerting as he did pre HA etc.

I’m going to persuade him to take paracetamol with him too.

Thx for advice all the best 🙌

[Suebedoo]

You need to do what is right for you. If going away is too stressful for you at the moment, then don’t go. Watching your partner have a HA and having to deal with that would have been traumatic for you and it’s not surprising you don’t want to leave him alone.

[devonian186]

Your partner will naturally be very anxious. Provided there is no threat to your career by not guesting at the lecture then I think you should rearrange them for the peace of mind of both of you.

He certainly needs to rein in his activities but not to the extent he loses fitness or puts on weight as they are important to coping with the surgery and the recovery.

If he has had health advice prior to surgery then he needs to follow it.

[Ron0325]

think about getting him some sort of panic button/medical panic button that connects directly with you , if he can press it and your away you ring your neighbours to go check up on him !

[Qualipop]

You've answered yoru own question. You are too worried and anxious about leaving him so don't- regardless of what he says. As for the spray , could you get the cardiologist or his GP to have a word with him?

[cabgpatch]

It's easy to underestimate the effect of going to the hospital with the possibility of a stent and being told you need a CABG x3, even if it's you that it happens to. I know, I have been there and bought the t-shirt!

7 months on from the op, I can look at it in a more balanced way, but at the time, I had nowhere to hang it, it was so far outside my life experience to that point. We all react differently, some deny it's as bad as it sounds, and others go into a flat spin and every reaction in between. Only your partner knows how he is rationalising it, but his reaction, whilst understandable, is not ideal. With his diagnosis, just resting probably won't cut it as activity isn't the main problem, blood flow and plaque are.

I can certainly understand your reaction, and as others have said, you have to decide what you are most comfortable with. After all, and to be brutally frank, if something happens to your partner whilst you are away, you are the one who is going to have to live with it. Perhaps your partner needs to understand it from your standpoint.

Incidentally, the meds he is on will thin his blood, reduce cholesterol, and, to an extent, stabilise the plaque, as well as treat BP and pain, so that may help you a bit.

All the best, I hope it works out well for you both.

Paul

[RailRover]

No great wisdom to offer, but I do understand his reluctance over GTN. The spray does absolutely zero for me positively, but it does set my heart pounding like it's going to explode. Hate the stuff.