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Chest pain, leg pain, back pain. CABG, TMT done, positive. History of diabetes, high BP. Treatment?

Hi, my father is 69 years old, he underwent a CABG 8 months ago, he has pain in his chest area, and we got a TMT done, and it has come positive, we also got a echo test done, and they said his heart function is good. He complains of leg pain and back ache. He is a diabetic, and a BP patient. Cholestral was in good control and other tests were normal when we got done two months back. Please advise if there could be blocks again as TMT is positive.
Asked On : Sun, 15 Jul 2012
Answers:  2 Views:  117
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Cardiologist 's  Response
Hi Ms. Naga Raja,
Thanks for writing in.
I am qualified and certified cardiologist. I read your question with diligence.
It is very difficult to make a value judgement with available data about blockade of grafts. I have to know to which artery(s)grafts were given? Were these venous grafts or arterial grafts? What was his TMT if done before and how this positve TMT from that? Was there any symptom free interval between surgery and in subsequent 8 months? His present resting EKG? Is he diabetic, hypercholesterolemic or obese and sedantry? EKG can be uploaded on healthcare magic and question can be directly asked from me. At present, I can say it is rare for grafts to close in first eight months it is not unknown. Of all the graft it could one crucial graft occlusion can give rise to such symptoms. Not forgetting other conditions like anemia, chronic infection can also produce similar symptoms. Regards

With Best Wishes
Dr Anil Grover,
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)

Answered: Mon, 16 Jul 2012
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Ayurveda Specialist Dr. Dinesh Kumar Bhatia's  Response
Hello Shwetha and welcome to HCM
I am a jr. to cardiologist and read your mail in detail. Firstly I want to know the severity of chest pain, when it started, does you get relief from chest pain by taking Tab. Sorbitrate or Nitroglycerin spray, is pain associated with breathlessness, does your father feel chest pain and breathlessness on exertion?
Alone TMT positive for inducible ischemia does not means that their is a block in coronary artery. Although TMT positive is a strong indication for Coronary heart disease but you must have changes in ECG and associated symptoms present and most importantly you must achieve 80% heart rate at the time of TMT. Other important sign is what is the cause of stopping the TMT whether it is chest pain or Leg and back pain.
As you have explained that your father has leg and back pain so their is possibility of false report of TMT. But as the patient is Hypertensive and Diabetic, there is also possibility of block of graft done during CABG. Usually the possibility of graft block is after 8 -10 years but lot depends of regular intake of medication and life style.
My last opinion is to consult your cardiologist immediately and get your father checked clinically and go for investigation as per his advice and even go for Coronary Angiography if he advise. Till you get the consultation keep the Tab. Sorbitrate in your pocket all the time and take regular medication for Hypertension and Diabetes Mellutus.
Best Wishes
Dr. Dinesh Kumar Bhatia
Health Care Magic
Answered: Mon, 16 Jul 2012
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