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Heart attack, ventricular systolic dysfunction, cough. Done X-ray, emergency bypass. What is the scar tissue after surgery?

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Practicing since : 1981
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This is a two fold (maybe more) concern. My husband, age 67, suffered massive heart attack with emergency bypass surgery. He was coded 3 times prior to the actual surgery. He made it through 3 months ago. He has 25-30% ejection fraction in left ventrical and severe left ventricular systolic dysfuntion (per echo recently done) We need an answer as to just what this means to his quality of life. He tires very easily still. Would a defibillator be a valid recommendation? Secondly, he has developed a dry hacking cough and has had a very raspy voice since surgery, which appears to be getting worse.Is the voice a result of anything from surgery? (He was on ventilator a couple days) He also experiences severe body temperature changes (sweating one minute and freezing the next )He just had X-Ray done (ordered by our cardiologist), and low--there are 2 suspicous nodules in his left lung, which requires a ct to be administered tomorrow.. We are worried but wonder if it couldn't be scar tissue from surgery? He also has both feet and bottom part of legs still "asleep", as well as under his chin and his right hand(all since his surgical experience) We can't seem to get any straight answers so anything you can tell us would be helpful.and I trust you will give us some reasonable advice.
My husband is going to cardiac rehab 3 times per week, but our question is in this regard if it will strengthen his heart and increase his physical stamina. He is very discouraged at this point. His Dr.. just says that it will all be okay, but just takes time based on what he expierienced.
Posted Mon, 2 Jul 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 1 hour later
Thanks for writing in. I am a cardiologist and read your email with diligence.
My first concern is those two suspicious nodules on x-ray. Once we have established these are benign, we will discuss about other problems:

1.     Repeated cardiac arrests before surgery necessitate the use of ventilator. This has led to dry hacking cough and raspy voice, which will recover, with time.

I suspect there is more to cough. That is due to severely diminished pumping capacity leading to back flow to lungs passive pulmonary (lung) venous congestion is also contributing to cough. Low pumping capacity (EF 25-30%) is also affecting quality of life.

2. This becomes, an ideal situation when anything will help, that can be cardiac re-synchronizing (biventricular pacing) with ICD (Internal Cardiac Defibrillator). Also known as combo device, it is put subcutaneously under the collarbone by using local anesthesia and wires are passed to heart from veins around collarbone. In selected patient, it helps to

a) Increase pumping capacity to levels when all can appreciate the change.

b). Also, it has XXXXXXX mechanism to take care of "code" like situation by rapid pacing or giving intracardiac shock. There are documented survival benefits in medical science.

3. To be XXXXXXX I am not entirely sure why his feet and bottom part of legs feels asleep. I am sure if you ask a direct limited question to his doctor you may get an answer straight as well as the prognosis of this problem.

4. Well, I admire the grit and courage of your husband. After, going through all, all he complains is of being discouraged! He cannot be at fault for that.

Let us hope treatment you all are planning for him will make him again think more positively towards life. You have not given up so far. Please do not now. Keep it up!

I will be looking forward to final diagnosis of chest lesion and shall be happy to answer any query you may have.

Best Wishes.

Dr Anil Grover

Above answer was peer-reviewed by
Follow-up: Heart attack, ventricular systolic dysfunction, cough. Done X-ray, emergency bypass. What is the scar tissue after surgery? 10 hours later
Thank you for your answer. We have had the CT with and without contrast early this morning. We have been informed of the Pathologist report. My husband has a mass in the left upper part of his right lung at 2.8 cn. That is the extent of the report. We will not be able to see the Dr. as he is out of town, for about a week.
What does this mean and what is next step? Does this mass mean cancer? We are terrified at this point, as I doubt if it is cancer that he can withstand radiation and chemo in his weakened condiiton. Comments please.
Answered by Dr. Anil Grover 5 hours later

Thanks for writing in.

No, a mass lesion means a radio opaque mass, in his case measuring 2.8 cm that is about 25 cent coin and with CT it cannot be proven as to its pathology.

I should think they would need fine needle CT guided aspiration cytology to know its exact
histopathological nature.

If it were cancer, they would have told you so. There would be someone junior covering for radiologist who has left for leave. Try to XXXXXXX him/her; things to diagnose ought to move faster than this now.

And, till it is proven either way chances are 50: 50 for it to be benign or malignant. And among malignant to find it curable are also there. Therefore, please do not give up prematurely. One who has survived 3 Codes can survive scare of one more c.

Think positive and hope for the best.

Do write again when you have information which is credible.

All the best.

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Heart attack, ventricular systolic dysfunction, cough. Done X-ray, emergency bypass. What is the scar tissue after surgery? 5 hours later
Thank you - just one more quick question. You stated that if it were cancer they would have told us so. How would they know at this point without further test or "biopsy"?
You have given us more information here than we've received from our doctors.
Answered by Dr. Anil Grover 43 minutes later

In some hospitals whenever malignancy is strongly suspected, it is (as a protocol) deemed better to tell the patient's attendants. It also keeps the doctors on their toes, because this has be proven or excluded at the earliest. I feel that is OK idea to inform the patient's attendants.
Some follow this; but now with more and more cancer being a curable disease and urgency of diagnosis is true for all disease the distinction has merged.

Remember, only histopathology gives a pathological diagnosis. Before that it is only a shadow. We have not reached that bridge yet to cross.

Best Wishes.

Dr Anil Grover
Above answer was peer-reviewed by
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