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Why am I getting chest pain 2 years after a bypass?

Wednesday, 18 July 2007
Answered by: Dr. V. S. Ramchandra
Professor and Head, Department of Cardiology
Kasturba Medical College
Manipal
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Q. I am a 56 years old male. I had undergone a CABG 2 years ago. I am feeling heaviness in the chest. There is pain as well. The TMT reports were positive and the angiogramme was also OK. The lipid count is within the optimum range. I am a diabetic. I can walk for more than 45 min bearing this pain and uneasiness. When I press the chest, I feel much better. Would I be able to walk for more than 45 minutes without this pain and uneasiness?

A.  Heart pain does not always mean that you are at increased risk or that you should not exercise. If the angiogramme is totally OK, the pain could be due to microvessel deficiency in people with history of high blood pressure and thickening of heart muscle. Many a times, small branches of the main vessels are not bypassed even if they are narrowed. The pain on walking can come from areas supplied by these small branches. If your pain decreases with compression of the chest by your hand it is most likely a chest wall pain, not related to the heart. Since the angiogramme is very reassuring and you can continue to walk briskly resting whenever you get the pain. A stress nuclear scan can be very helpful in ruling out cardiac causes of chest pain and you may discuss it with your doctor if the pain is really bothering you.

A.  Heart pain does not always mean that you are at increased risk or that you should not exercise. If the angiogramme is totally OK, the pain could be due to microvessel deficiency in people with history of high blood pressure and thickening of heart muscle. Many a times, small branches of the main vessels are not bypassed even if they are narrowed. The pain on walking can come from areas supplied by these small branches. If your pain decreases with compression of the chest by your hand it is most likely a chest wall pain, not related to the heart. Since the angiogramme is very reassuring and you can continue to walk briskly resting whenever you get the pain. A stress nuclear scan can be very helpful in ruling out cardiac causes of chest pain and you may discuss it with your doctor if the pain is really bothering you.

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