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Operated for bypass. Feeling heaviness in chest while walking. What treatment should be done?

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Practicing since : 1981
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Since last 7 days I have observed that I have a heavy chest during my morning walk. I take the walk on an empty stomach. I was operated for bypass (CABG) in July 2006 , then underwent angioplasty with one stent in Feb.2009 and again followed by re-stenosis in Oct.2011. I become normal after 20 mins of slow walking. But then what are the steps I should take to recover from this present situation? Also I have faced problem of swallowing food when there is a long interval between 2 food intakes. Sometimes I vomit some sticky transparent substance but not the food I have eaten, Then after spitting out this sticky substance I am relieved and then can continue to eat the rest of food without any further obstacle.
Posted Thu, 6 Dec 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 58 minutes later
Hi there,
Thanks for writing in.
I am a qualified and certified cardiologist. I read your question with diligence.
I believe your tendency of getting your normal coronaries, stented arteries and grafts getting block faster than others because of your Diabetes and perhaps genetic predisposition. Normally, after a successul CABG it is unusual for graft or native artery occlusion as early as 3 years. Therefore, among please keep tight control on your modifiable risk factors. Like your HBA1c value for control of diabetes ought to be always below 8. Other factors which you ought to take care of are :
1. Good cholesterol (HDL) > 40 mg
2 Bad Cholestrol always low i.e LDL <100 mg%, Triglycerides <150 mg %, and total below <190 mg %)
3. Blood Pressure always controlled.
4. No Smoking
5. Fair amount of slow steady frequent exercise to cover small distances each time as per your doctor's advice.
6. Philosophical attitude towards stress which; stress is universal it is reaction which matters.
7. Weight contol.

Chest discofort during your morning walk is angina equivalent symptom. Please take a tablet of sorbitrate sublingual rest for 10 minute and then walk. As it is, Diabetics do not get typical chest pain. Please ask your cardiologist he may want to schedule another coronary angiography as you have not mentioned whether you went in for revascularisation in 2011.

Other thing I am tempted to correlate is your symptom of swallowing with enlargement of one chamber of heart, when was your last echocardiography, Doppler examination done? How much was your ejection fraction and whether there was any leakage of mitral valve written as mitral regurgitation.

The course of coronary artery disease after surgery and stenting (the methods of revscularisation) vary from person to person, there is nothing to be disheartened about you will have to fight it out. Therefore, be on follw up with your cardiologist, he is the best judge of a particular situation. One thing is sure, howsoever, severe a situation may be everything has potential treatment in cardiology.Good luck.

If there is further query which you might have I will be most happy to answer. Good Luck.


With Best Wishes:
Dr Anil Grover
MBBS, MD (Medicine) DM(Cardiology)
Cardiologist and Internist
http:/ WWW.WWWW.WW
Above answer was peer-reviewed by
Follow-up: Operated for bypass. Feeling heaviness in chest while walking. What treatment should be done? 10 hours later
Thank you Doctor for your piece of advice. I will definitely consult my regular cardiologist to investigate as suggested by you. Following are the queries arising out of your answers to my questions.
1) You have enquired whether revascularization was done in 2011 ? Actually the stent previously inserted in Feb. 2009 was choked with deposits. Hence it was decided to insert a stent in the previous stent. Other than this block there was no block or deposit in any other artery. Also the by-pass graft was clear.

2) You mentioned that I could use Sorbitrate in case of heaviness in the chest , then rest for 10 minutes and proceed with the walk. Do you suggest this on daily basis? If so then how frequently can I take Sorbitrate in 24 hours ?

3) Can heaviness in the chest be the result of flatulence caused in stomach ?

4) Can I consume 120ml of whisky everyday ? I am habituated for the last 25 years.

Best Regards
Answered by Dr. Anil Grover 10 hours later
Thanks for writing back.
The part that restenting was done in 2011 was missing.
Heaviness in chest means there is disparity between demand and supply of blood to the heart. Therefore, sorbitrate and rest. One can take as many as 5 tablets a day. But that would mean frequency of demand outstripping the supply for 5 times. Meaning, an indication for coronary angiography of graft and native vessels both.
No, in the setting of accelrated atheroclerotic coronary artery heart disease, thinking of other cause will not be prudent, it is cheating on oneself.
Please, restrict to two small pegs that is 60 ml of total of Whisky, Rum or Vodka or one glass of wine. Anything beyond that is positively harmful. Habituation is not an excuse for fatal attraction. You ought to have resolve.
My suggestion is to choose a cardiologist, there are some very good cardiologist in Mumbai. Depends on which part of the city you live. Let him guide you through this difficult phase of your life. Promise to yourself that you will follow his/her every suggestion and approach your cardiologist in what you perceive as an emergency how trivial it may seem. You will do well. Good Luck.
With Best Wishes.

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Operated for bypass. Feeling heaviness in chest while walking. What treatment should be done? 2 hours later

Thank you once again for your prompt advice. I am quite satisfied with your answers. I will be in touch with you on the link given in your first mail.

Best Regards
Answered by Dr. Anil Grover 1 hour later
Thanks for your kind words.
Please close the query with comments and stars.
It was a pleasure interacting with you.
Thank You

Anil Grover
Above answer was peer-reviewed by
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