Ask the Doctors March 2017 Issue

Ask the Doctors: March 2017

I had bypass surgery many years ago after a heart attack when I was in my early 50s. I will need another bypass. What should I know going into my second operation?

Michael Rocco, MD

Michael Rocco, MD, medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic

A “heart reoperation” is not an uncommon occurrence-since individuals with heart disease are living longer—especially if the first operation was done when much younger.

Many issues with the first operation, including extent of heart injury, medical conditions such as kidney disease or diabetes, are important factors at the time of reoperation. But one important difference that may influence reoperation risk is increased age. Recovering from any type of surgery, particularly heart surgery, is usually more complicated when performed in older individuals. Age itself may not be as important as other problems associated with advancing age such as additional medical conditions and medications required to treat them. The good news is that age may be less of an issue if you have otherwise taken good care of your health and remained physically active.

Prior surgery does introduce some distinct concerns such as adhesions or scar tissue in the chest cavity creating technical challenges for the surgeon. Others may include more diffuse coronary disease making bypass more difficult or new valvular disease which may need to be addressed surgically at the same time. With the first operation the best available blood vessels were likely used to create the grafts. Finding additional acceptable vessel segments to create new grafts may be harder.

Because all these issues may combine to make a second operation a greater challenge be sure to select a surgeon who has done several reoperations and don’t hesitate to ask questions no matter how trivial you think they may be. In hospitals were second and third surgeries are commonplace and surgeons work closely as a team with cardiologists other procedures such as stents or catheter placed valves may be alternatives if reoperation risk is very high. The good news is that with every passing year the experience of surgeons and surgical techniques improve, as does success and safety of these procedures.

After the death of actress Carrie Fisher there seemed to be mixed reports about whether she died of a heart attack or cardiac arrest. How are they different?

Carrie Fisher’s cardiac related death and that of her mother Debbie Reynolds from a stroke the next day underscored in a sad way that cardiovascular disease is a concern for women as much as it is for men.

The official cause of death was cardiac arrest, but it is a term that is often used interchangeably (and incorrectly) with heart attack. Think of the heart as having a plumbing system—arteries, veins and valves—and an electrical system with continuous electrical signals to keep the heart beating in a steady rhythm. A heart attack is a plumbing problem. The arteries that supply blood to the heart muscle become blocked preventing oxygenated from reaching it. Within a short amount of time, heart tissue starts dying. If the heart attack is large enough the blood supply to other organs and muscles starts to diminish and may lead to collapse. Unlike a heart attack, which presenting with chest pain, shortness of breath, nausea and sweats, cardiac arrest may occur without any noticeable symptoms. It’s a sudden electrical event in which the signals that control the heartbeat become chaotic or disrupted by an irregular heartbeat (arrhythmia). The body’s organs cannot survive for long without healthy circulation and unless treatment is administered soon, death is often the result. A heart attack can immediately precede cardiac arrest. But not all heart attacks cause cardiac arrest and not all cardiac arrests are the result of heart attacks. A primary heart arrhythmia or one secondary to other structural heart muscle, valve disease or drug use may be to blame.

Comments (1)

a lot has to do with cost,and top hospitals,doctors...Cleveland clinic,mass.general hospital,mayo clinic,etc...

Posted by: wallywedge@hotmail.com | March 4, 2017 10:41 AM    Report this comment

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