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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Distal And Ischemic Disease Post CABG

Dear Sir, my name is Krishnan and am from Mumbai. my wife underwent a CABG in Aug 2009, there were multiple blocks, she is fine now. The surgeon said she has distal & isechemic disease, she is currently prescribed )1) Novastat - one at bedtime (2) Telesartan - one in the morning and (3) Glycomet 500, 1 each thrice a day, worried about her distal & isechemic disease, the doctors have told me that there is nothing much to worry, can you pl guide

she is 49 years old now and was 48 when she underwent surgery

Fri, 15 Dec 2017
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Cardiologist,  's  Response
Sorry to hear of your wife's situation. Does she in fact have closure of some or all of her bypass grafts? Does she have stenosis (narrowing) of any of the bypass grafts? Those might be treatable with angioplasty ballooning or stenting. What you describe is "diffuse" or severe narrowing of the smaller arteries of her heart, or of the distal (farthest-along) parts of her larger coronary arteries. Those blockages are usually too small or too widespread to treat with balloon or stent catheters.

The way we try to treat those is with a Statin (cholesterol-lowering medication), which she is taking; control of hypertension and diabetes (which the other 2 medicines should do); discontinuation of smoking if that is an issue for her; and sometimes the addition of nitrates (such as Isosorbide) and/or Ranolazine (a medicine that has been shown to decrease shortness of breath with exertion and increase exercise tolerance in people with distal coronary blockages such as your wife's).

I recommend you ask your wife's Cardiologist about those latter 2 drugs, as well as whether she has had a recent angiogram to show us the state of her bypass arteries.

Good luck, and let us know how she does.
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Suggest Treatment For Distal And Ischemic Disease Post CABG

Sorry to hear of your wife s situation. Does she in fact have closure of some or all of her bypass grafts? Does she have stenosis (narrowing) of any of the bypass grafts? Those might be treatable with angioplasty ballooning or stenting. What you describe is diffuse or severe narrowing of the smaller arteries of her heart, or of the distal (farthest-along) parts of her larger coronary arteries. Those blockages are usually too small or too widespread to treat with balloon or stent catheters. The way we try to treat those is with a Statin (cholesterol-lowering medication), which she is taking; control of hypertension and diabetes (which the other 2 medicines should do); discontinuation of smoking if that is an issue for her; and sometimes the addition of nitrates (such as Isosorbide) and/or Ranolazine (a medicine that has been shown to decrease shortness of breath with exertion and increase exercise tolerance in people with distal coronary blockages such as your wife s). I recommend you ask your wife s Cardiologist about those latter 2 drugs, as well as whether she has had a recent angiogram to show us the state of her bypass arteries. Good luck, and let us know how she does.