Dr. Roach: Heart attack still possible after bypass
Dear Dr. Roach: My friend had a triple bypass last August. He still has problems. At a recent visit to the cardiologist, he was told that one of the grafts has fallen away.
What does this mean? Where is that blood going?
The doctor says he still has coronary heart disease, and they are trying new meds.
What does this mean for him — could he have another heart attack?
Dear P.B.: A coronary bypass surgery is the placement of a new blood vessel to allow blood to go around an obstruction in one of the vessels that supply the heart muscle with blood. The new blood vessel can be taken from the patient’s own vein, usually the saphenous vein in the leg. Or, it can come from an artery, usually the lift inferior mammary artery. The new blood vessels are referred to as “grafts.”
In a “triple bypass,” three grafts are created. These grafts improve blood flow to the heart and improve long-term survival for a subset of people with coronary artery disease.
However, the grafts are subject to blockages themselves, either through blood clotting or from developing the same cholesterol and calcium plaques as the native coronary arteries. When a graft no longer carries blood, we usually say it has “failed,” but it sounds like your friend’s cardiologist used the term “fallen away.”
This doesn’t mean the graft became unattached, a situation that would lead to death in seconds. That is something cardiac surgeons take great care to prevent.
Medications — such as aspirin, beta blockers and statins — also reduce the risk of heart attack and death in people with coronary heart disease, especially when combined with a heart-healthy diet and a good exercise program. However, they only the reduce risk of, not completely prevent, a heart attack. A rough estimate is that 75 percent of people who undergo bypass surgery will be free of coronary events five years after surgery.
Dear Dr. Roach: Plastic pill crushers and a mortar and pestle are very painful for my arthritic hands. The pharmacist offered me no better option for crushing pills. Then my aging brain had a moment of lucidity — an electric coffee grinder! It works perfectly and can handle several different pills at the same time. Please let your readers know.
Dear S.L.P.: I think it’s brilliant; however, do make sure the machine is clean, and I would use it only for medicine. Use a brush (also, used just for this task) to remove all the powdered medicine after each use. Finally, check with the pharmacist to make sure the pills can be safely crushed. Some cannot be, especially those with an extended-release formulation.
Email questions to ToYourGoodHealth@med.cornell.edu.