To understand the causes of discomfort after bypass surgery, we must first have a certain understanding of bypass surgery: what is heart bypass surgery? First of all, the so-called heart bypass surgery, this "bypass" is actually what our people say, and sometimes our doctors will say that because of these two words, patients and their families can better understand. You said that our doctor said a coronary artery bypass grafting, which may be a bit difficult for many patients to understand!
But when it comes to "bridging", this operation is easy to explain. Just like our usual rivers, this section is blocked. Let's reopen a river and let the water flow. This is what we call "bridging", which means "finding another way"!
Therefore, the so-called heart bypass surgery is actually narrowing and blocking the coronary artery of our heart. Our doctor takes a blood vessel from other parts of the patient's body and re-establishes a vascular passage next to the blocked blood vessel to let the blood flow through, which can basically have an immediate effect and immediately relieve the myocardial ischemia problem at the distal end of our stenosis.
But this operation, like our heart stent operation, is also a temporary solution, not a permanent cure. It can't cure everyone's coronary heart disease, but can only improve the symptoms of myocardial ischemia. But it is still recognized as one of the most effective and reliable methods to treat coronary heart disease at home and abroad. At present, this operation is very mature. As long as this operation is performed in a big heart center, more than 99% of them are basically fine. But on the whole, it is more expensive than our heart stent surgery, more traumatic and requires thoracotomy.
There was no special situation after operation, and it was basically 8-65438+ 10,000 yuan.
At the same time, the whole heart bypass surgery is much longer than our heart stent surgery. Generally, it takes 4-6 hours from the beginning of anesthesia to the operation. It is a general anesthesia operation, which means that the patient is asleep and will not feel any pain and discomfort.
And I just finished that day and need to observe it in the intensive care unit for a day. There are no special circumstances, and basically most patients can return to the general ward.
So, let's take a look at the precautions after heart bypass surgery. Or what problems may arise? The first one, as I mentioned above, is that heart bypass surgery and stent surgery have the same meaning, and can't cure our coronary heart disease radically.
Why?
First of all, neither bypass nor stent has solved the cause of coronary heart disease. Because atherosclerosis, coronary artery stenosis and blockage, insufficient blood supply and myocardial ischemia and necrosis are the main causes of coronary heart disease. This kind of coronary atherosclerosis is systemic, that is to say, if the coronary artery in one part of your heart has atherosclerosis, the blood vessels in other parts will also have different degrees of sclerosis, while bypass and stent surgery only solve the more serious problem of local coronary artery stenosis, but for other parts, it will continue to narrow and block the blood vessels.
Secondly, the blood vessels used for bypass also have the risk of stenosis and blockage. For example, the blood vessels we use for bypass surgery are basically from the blood vessels in our legs. Sometimes arterial bridges are used, and sometimes venous bridges are used. It is impossible to use the arterial bridge every time.
So what's wrong with this vein bridge?
Note that we usually have a hypotension in venous blood flow, so this leads to a hypotension in our vein itself. At this time, if it is used for coronary artery bypass surgery, it obviously needs to do arterial work, and the blood pressure it needs to bear will be higher!
At this time, we will think about whether this kind of long-term high-load work will also form arteriosclerosis faster, so many times our patients are blocked again after completing this operation for 5- 10 years.
Even the arterial bridge we use is the same. The blood pressure in the previous part was not that high. Moving it to our coronary heart disease at this time will undoubtedly lead to the process of decline.
Therefore, no matter whether bypass or stent can cure coronary heart disease, it doesn't mean that you won't have coronary heart disease discomfort such as chest pain, angina pectoris and myocardial infarction in the future!
Second, we must change the bad lifestyle before. As I said just now, we didn't cure coronary heart disease after bypass surgery. As long as you don't pay attention, it may happen again at any time. Before, you had coronary heart disease. Except for some unchangeable factors such as age, most of them are lifestyle problems of our patients, such as smoking and drinking, staying up late, eating red meat and so on.
If you don't pay attention to this point as before after leaving the hospital, your bridge may be blocked in 3-5 years, but if you pay attention, it may be blocked for more than ten years, so it is very important to change your lifestyle.
Third, after the operation, you must strictly follow the doctor's advice and take medicine well. In particular, aspirin, clopidogrel and other drugs that can prevent thrombosis and prevent platelet aggregation should not be stopped casually. If you don't take these drugs, it is likely to form a new thrombus and block it, and in many cases the blockage is more serious than before, and the risk of myocardial infarction or sudden death is higher, which can not be ignored!
There are also some drugs, such as hypolipidemic drugs, which are also very important and have a great influence on our long-term prognosis after operation, because atherosclerosis is partly caused by dyslipidemia.
Fourth, after heart bypass surgery, you must maintain a good mental state, ensure sleep, and don't always worry. As I said just now, as long as bypass surgery is performed in some big heart centers, the success rate is over 99%, so don't worry too much. Long-term negative emotions will only increase the burden on our heart. For example, I met a patient who had been anxious after the operation and had some minor illnesses, especially worried about whether there was something wrong with his heart. Later, a year later, he died soon! Therefore, it is very important to treat diseases, especially heart patients!
Finally, let's look at more than 200 days after the bridge. I feel less and less energetic. What are the possible reasons? How should it be handled correctly? First of all, we should review this situation as soon as possible, because as I mentioned in my article, heart bypass surgery is not a radical operation, but a treatment that treats the symptoms rather than the root cause, and the disease may recur and recur. However, a small number of patients with coronary heart disease do have symptoms of fatigue and fatigue instead of chest pain and angina pectoris. Therefore, considering the past history of coronary heart disease and heart bypass surgery,
Secondly, this person feels less and less energetic. In addition to coronary heart disease, in fact, this kind of fatigue symptoms may appear in many of our diseases. For example, it can be relieved in a short time, which may be related to our lifestyle, lack of sleep, and inability to eat or sleep. For example, if you are more and more tired, you must see a doctor in time. The following common diseases may have fatigue symptoms:
The first type, hypokalemia, can draw blood to check an electrolyte to see if potassium is low, because there are many patients with hypokalemia in clinic, who have no other symptoms, but show atypical symptoms such as general fatigue and fatigue;
The second type, hypothyroidism, due to insufficient secretion of thyroid hormone, there will always be lack of sleep, fatigue and listlessness. You can draw blood to check a manicure and B-ultrasound to see a thyroid gland;
Third, anemia, which is easy to understand;
Fourth, liver-related diseases such as fatty liver. Many patients with liver diseases are also prone to fatigue, and they are ignored by us. Liver function can also be checked.
Fifth, tumor. Like about 70% of cancer patients, in fact, there will be some cancer fatigue in the early stage, which is related to the fact that our tumors affect the metabolism in the body through various channels, resulting in the body being unable to absorb nutrients from the outside world, but it is also easy to be ignored by everyone.
So, in the end, we said that when we feel weaker and worse, if life intervention still doesn't improve, we should see a doctor as soon as possible!
It's been 200 days since heart bypass surgery, and I feel less and less energetic. What happened? This problem is a concern of many patients after bypass surgery. Many people have similar problems, and many people say it is vitality or something. So, what is the truth of the matter? Dr. Zhang will explain it to you today.
Many people may think that the problem of heart bypass surgery is a problem of heart surgery, and Dr. Zhang, who is from the Department of Cardiology, may not know much about it. In fact, Dr. Zhang does have experience in managing patients after heart surgery and bypass surgery. Because in the process of his growth, Dr. Zhang worked with a team of top domestic cardiac surgeons and former vice president of Fuwai Hospital. The Heart Center led by Professor Wu Qingyu is a place where cardiology and cardiac surgery work together. As a cardiologist, I also participate in the reception and management of patients undergoing cardiac surgery, including patients undergoing bypass surgery and patients undergoing cardiac stent implantation. Therefore, Dr. Zhang also has some experience in managing patients undergoing coronary artery bypass grafting in cardiac surgery. Let's talk about why some people feel overwhelmed after heart bypass.
For some patients after coronary artery bypass grafting, electrolyte disorders such as hypokalemia occur due to various reasons such as poor diet, excessive loss and insufficient potassium supplement. In this case, patients are particularly prone to fatigue, that is, medical fatigue. There is nothing else at this time. Pay attention to check the electrolyte to see if it is abnormal. If there is abnormality, it can also improve the patient's sense of fatigue.
Coronary artery bypass grafting has become more and more common in recent years, but it still needs to stay in bed for a period of time after operation. During bed rest after operation, people don't have any physical activity. Sometimes, because of the reduction of physical activity, the sense of powerlessness caused by consuming human muscles is quite obvious. If nothing else, it is also very uncomfortable to let normal ordinary people lie still for a few days. You will feel weak after getting up, which is caused by muscle cost.
Many people say that after coronary artery bypass surgery, it hurts their vitality, so they feel weak. This statement is not accurate, but it also has some truth, at least it is easy for the general public to understand. In fact, medically speaking, that is, after major surgery, bypass patients need a gradual recovery and rehabilitation process. This process really needs a period of hard work, good nutrition collocation, the formulation of postoperative exercise plan, the rehabilitation of postoperative psychological state and so on. It should be said that this process is sometimes slow, but as long as it is done well, it will get better gradually. Everyone must have confidence. If you have the conditions, you can also do cardiac rehabilitation after surgery, which will definitely help you recover.
The above is Dr. Zhang's experience in coronary artery bypass grafting in cardiac surgery, which is briefly introduced to you from the perspective of a hospital bed doctor. I hope that the majority of patients with coronary artery bypass grafting and their families will benefit, and I hope that such patients will recover soon.
Although heart bypass is not the job of our cardiovascular physicians, most patients who have completed bypass will find a cardiovascular physician again after subsequent follow-up and hospitalization.
We can meet many patients with heart bypass, so if a patient who has finished heart bypass feels less and less energetic, what is the general reason?
First, let's see if there is heart failure.
We need to find out what's wrong with people undergoing heart bypass surgery. First, we need to find out who needs heart bypass surgery. Under normal circumstances, patients will be advised to choose heart bypass surgery if angina pectoris is very serious, cardiovascular stenosis is serious after cardiac angiography, or there are many narrow blood vessels that are not suitable for cardiac stent.
In other words, the blood vessels were originally narrow, but the stent was not suitable, so we took suitable blood vessels from other parts of the body and sewed them on the heart. This is a heart bypass operation.
It shows that these people are all patients with severe myocardial ischemia, and for patients with severe myocardial ischemia or long-term myocardial ischemia, the heart may be enlarged because of myocardial ischemia, which we call ischemic cardiomyopathy, that is, heart failure caused by coronary heart disease.
Bypass itself can only solve the problem of myocardial ischemia. For an enlarged heart, the help to cardiac function is limited, so the angina pectoris can only be controlled from happening again after bypass, but if there is already heart failure, bypass can't be solved.
So after the bypass surgery, I became weaker and weaker. First, check the heart function to see if it is caused by heart failure.
The typical symptoms of heart failure are chest tightness, fatigue, loss of appetite, edema of lower limbs and abdominal distension. Conventional cardiac function is divided into four grades, the most serious is that the above symptoms will appear at rest, and mild heart failure is the above symptoms after exercise.
Second, look for anemia.
If there is no heart failure, it depends on whether it is caused by anemia. Why do you think of anemia? Because bypass patients are patients with coronary heart disease, they need to take aspirin for a long time. Taking aspirin may lead to bleeding, especially chronic gastrointestinal bleeding, which may lead to anemia. The most common manifestations of anemia are getting weaker and weaker, palpitation and shortness of breath.
So for all people who take aspirin for a long time, I will explain that we must form the habit of observing the color of stool. If the stool turns black, you must be highly suspicious of gastrointestinal bleeding and need to go to the hospital for a follow-up visit.
Third, you need to go to the hospital as soon as possible.
1. To check whether there is cardiac insufficiency or heart failure, it is necessary to do a color Doppler ultrasound to see whether the left ventricle is large or not, and to see the left ventricular ejection fraction, that is, the EF value. The normal value is 55-65%. If it is significantly lower than 55%, then there is good reason to suspect cardiac insufficiency and heart failure. In addition to color Doppler echocardiography, BNP can be checked if necessary, that is, blood test to see if this value is normal, which is also conducive to the judgment of heart failure.
2, for suspected anemia, do a stool routine to see if there is occult blood+,do a blood routine to see if hemoglobin is normal, you can judge whether there is anemia or gastrointestinal bleeding.
3, if there is no anemia, no heart failure, then see if there are any side effects of drugs, check liver function, renal function, creatine kinase, electrolyte and so on. See if there is anything unusual.
4. If none of the above conditions exist, it is necessary to make a comprehensive judgment to see if it is caused by other reasons, such as the slow recovery of some people after surgery or psychological reasons.
In short, if you feel worse and worse after the bridge bypass operation, you must go back to the hospital for reexamination and see a doctor before you can rest assured.
Heart bypass is generally used to treat patients with coronary heart disease with severe vascular disease and unsuitable stent. In this case, ischemic cardiomyopathy is generally serious, and it is easy to develop into heart failure with a slight blow, such as fatigue, fear of cold and even satiety, especially for elderly patients, who have more basic diseases, poor general condition, poor postoperative recovery and greater possibility. This situation still needs to go to the hospital for treatment to control heart failure.
Fatigue symptoms began to appear 200 days after bypass surgery, which had nothing to do with the bypass itself. This means that whether you take bypass or not, this symptom may appear, maybe earlier.
Let's analyze it carefully: the patient is a 70-year-old woman, and her physical function should be relatively poor, especially the aging degree of arterial blood vessels. Moreover, the bypass surgery itself has disproved this information, and we must make clear the indications of bypass surgery.
As one of the first-aid measures of heart disease, patients who need bypass often have severe coronary artery obstruction and the myocardium can't get enough blood oxygen perfusion. In addition, because the bypass was used instead of the preferred stent, it was initially identified as multiple stenosis.
To sum up, we can get the following information: old age, poor physique, multiple stenosis of blood vessels and severe myocardial ischemia.
Let's see what bridging is. Will everything be all right after the bypass? Bypass is a surgical thoracotomy, which is called "the magic weapon for heart patients" together with medical stent in clinic.
Specific flow: Take good blood vessels from other parts of the patient, use them at both ends of the narrow blood vessels, re-establish a new connection channel, and make the blood vessels bypass the narrow and blocked blood vessels and reach the myocardium directly.
After bypass surgery, you should not take it lightly. You know, bypass itself is more traumatic. After operation, we should pay close attention to the changes of ECG, heart rate and blood pressure, and observe the wound carefully to prevent infection and bleeding. In addition, the patient's own myocardial ischemia has not been completely cured, but only temporarily recovered (bypassing the blocked blood vessels). Not only does this artificially established blood vessel have the risk of blockage, but other unblocked or slightly blocked blood vessels will gradually deteriorate with time, eventually leading to the clinical reality of myocardial ischemia.
Combined with the above information, the fatigue symptoms of patients at present are caused by heart failure! Heart failure is the late stage of the heart, which can be caused by many kinds of heart diseases. Its most common clinical manifestation is fatigue and weakness. The patient had long-term myocardial ischemia before, which probably damaged the heart function before the bypass, but the degree was not high, so there were no specific symptoms. But with the passage of time, his heart function has gradually declined, and his activities are limited to the second level. Even simple daily movements at the third level may cause fatigue, chest tightness and other symptoms.
Patients like coronary heart disease and myocardial infarction like heart failure most. Moreover, these patients are older, have lower myocardial vitality than other young people, and are more prone to heart failure.
What examination should the patient do at this time? 1, Color Doppler Echocardiography: Color Doppler Echocardiography can clearly see the structure and function of the heart, and most patients with heart failure can find terminal doubts through color Doppler Echocardiography.
2, electrocardiogram: heart failure can not be directly found, but can judge whether myocardial ischemia and arrhythmia, to avoid worse.
3, heart failure markers: blood test products, look at the value of BNP, if BNP is too high, although it can not be directly defined as heart failure, but combined with symptoms, heart structure and function, you can basically draw a conclusion.
If heart failure is finally diagnosed, please treat it immediately. Heart failure is different from other diseases. It is very stable, and its damage to myocardium will affect its normal work. Once the heart can't work at full capacity, it will gradually change its structure, affect the blood supply to the myocardium, and cause a vicious circle, which will become more and more serious. Drugs can not reverse this process, but can only delay the deterioration of the disease. The five-year survival rate after diagnosis of heart failure is less than 50%.
Generally speaking, 200 days after bypass surgery, that is, about half a year, you should completely recover from the trauma caused by surgery and completely return to the preoperative state. As for the topic, the subject only said that he was getting less and less energetic and did not provide other information. He could only explain it from the following aspects.
1, heart failure
Myocardial ischemia is the main cause of heart failure. After bypass, secondary prevention and treatment of cardiovascular diseases, such as antiplatelet and statins, are needed to keep the bypass vessels unobstructed and prevent cardiovascular events caused by myocardial ischemia.
Primary heart failure is aggravated. Some patients have heart failure during operation and need anti-heart failure treatment after operation. If heart failure progresses or the treatment is not standardized, it may aggravate heart failure.
There is a certain occlusion rate of bridge vessels after bypass surgery, especially in patients with poor control of blood pressure, blood lipid and blood sugar without formal treatment, which is more likely to cause bridge vessel occlusion.
2. No cardiac rehabilitation treatment.
It is suggested to go to other places as soon as possible after heart bypass surgery, and start heart rehabilitation exercise 2-4 weeks after surgery, which can effectively improve heart function, improve exercise tolerance, help alleviate bad emotions and return to work and life. If effective rehabilitation exercise is carried out, you can completely recover to a better state than before operation in 6 months.
3. Malnutrition
After heart surgery, a high-protein diet is needed to promote the body's recovery from the surgical blow. At the same time, we should also pay attention to a balanced and reasonable diet, and it is best to consult a nutritionist.
Therefore, in view of this problem, it is suggested to go to the hospital for reexamination (which is also a requirement for half a year) to see if there are any conditions that affect activity tolerance, such as heart failure, myocardial ischemia, pleural effusion and so on. , check whether the risk factors are up to standard, and adjust the treatment plan in time according to the problems found. In addition, it is suggested to have cardiac rehabilitation consultation and start exercise according to the exercise prescription. If there is no problem, there may be bad emotions such as anxiety and depression, and psychological counseling is needed.
A 70-year-old man, more than half a year after coronary artery bypass grafting, feels more and more listless. To judge what is going on, the doctor needs to see the patient, understand the condition, have a physical examination, and further check if necessary, so as to clarify the reason.
Only a rough analysis of the possibilities can be made here.
There are only two reasons, whether there is a disease; Then there is psychology, whether there is depression or anxiety.
First of all, we must rule out the problem of disease, and we can make it clear by doing some tests in the hospital.
If you are at home, you can see whether the patient's heart rate and blood pressure are in the normal range and whether the patient's vital signs are stable and abnormal. Whether the diet, urination and defecation are normal, whether the weight has been reduced or obviously increased, so as to see whether there is malnutrition or possible edema; What changes have taken place in daily activities? Do you feel short of breath during activities? Can I lie flat at night? Do you need a tall pillow? Will you wake up in the middle of the night because of your chest tightness? Do you have to sit up to relieve it? Do you have edema in your ankles and calves? If so, it suggests that you may have cardiac insufficiency. There are also mental apathy and slow response to the outside world, because some elderly people and heart patients can have hypothyroidism or fatigue symptoms; There is also infection, and the early infection of the elderly can also have no specific manifestations, that is, fatigue, lethargy, loss of appetite and so on. In addition, patients should also pay attention to whether there are other manifestations besides lack of strength. More extreme, more complicated, may also think of the possibility of other malignant diseases, after all, 70-year-old people.
Observing these conditions can be provided to doctors to help them better analyze and judge the condition.
It is possible to find the cause and make a differential diagnosis by going to the hospital for examination.
If the examination excludes organic diseases, it is necessary to exclude mental and mental health problems.
For the elderly, bypass surgery is also a major operation. Although it can be performed under the condition of beating heart, general anesthesia and thoracotomy are also great trauma to patients. In addition, changes in postoperative living ability, worries about diseases, and changes in living environment can all cause abnormal psychological reactions. Abnormal psychological reaction can lead to physical symptoms. These physical symptoms may be confused with the symptoms of heart disease. We used to manage elderly patients after bypass surgery, and they showed obvious depression after surgery, but our patients' symptoms did not last that long, and basically recovered in about 3 months. Of course, there are also individual differences of patients and psychological counseling of medical staff.
Therefore, after more than 200 days of bypass surgery, if you want to know what is going on, you must see a doctor. Doctors also need to see the patient, understand the condition, examine the patient, and conduct further examination when necessary, so as to analyze and judge.
After coronary heart disease surgery, I feel less and less energetic. The reasons should be found in the following aspects:
First, after coronary artery bypass grafting, the recovery of vascular recanalization is not ideal. The reason of bypass is that the coronary artery is severely narrowed and stent treatment is impossible. After bypass surgery, the blood supply of coronary artery will be improved better, and the myocardium will no longer be ischemic. However, due to various reasons, such as poor quality and severe stenosis of the distal end of blood vessels, or poor blood flow caused by contracture after vascular surgery, myocardial ischemia and hypoxia can be caused, causing fatigue and discomfort. Whether this reason is specific or not needs further coronary angiography to evaluate.
Second, cardiac insufficiency. Due to long-term chronic myocardial ischemia and hypoxia, myocardial cells degenerate and die, and the heart expands continuously, leading to heart failure, and people will feel tired, weak and asthmatic. This is caused by long-term ischemia of tissues and organs. Even if the bridge is built, it is difficult to improve it in a short time. Cardiovascular physicians need accurate treatment and correct heart function to improve symptoms.
Third, electrolyte disorders such as severe hypokalemia. Long-term heart disease, will take a lot of drugs, these cardiovascular drugs will lead to electrolyte disorders, such as severe hypokalemia, will cause general weakness, and even life-threatening. Therefore, it is recommended to go to the hospital for further examination to eliminate electrolyte disorder.
Fourth, the side effects of drugs. Many cardiovascular drugs can cause fatigue and discomfort, such as betaloc and diltiazem, which can cause side effects such as fatigue and burnout. In addition, some drugs, such as statins, will affect liver and kidney function and cause general discomfort.
Fifth, chronic malnutrition. Due to the poor heart function of coronary heart disease, gastrointestinal congestion and edema will occur, which will affect appetite. In addition, the treatment needs to limit diet, low salt and low fat, and control drinking water, which will lead to loss of appetite, reduced food intake, long-term malnutrition and corresponding symptoms.
In short, in view of the above symptoms, if the cause is unknown, it is recommended to go to the hospital to see a cardiovascular specialist, make a clear diagnosis, and constantly adjust, and the condition will gradually improve.
200 days after heart bypass surgery, I feel less and less energetic. What happened?
Cardiac bypass surgery uses great saphenous vein or internal mammary artery to supply blood to the distal end of coronary artery stenosis, so as to restore the blood supply to ischemic myocardium and improve the ischemic symptoms and cardiac function of patients.
How is it that patients become more and more listless after heart bypass surgery?
(1) Cardiac insufficiency: As mentioned above, the myocardial blood supply in the ischemic area of the patient returned to normal after bypass surgery. However, if there are too many necrotic myocardial cells before operation or the necrotic area is too large, it is difficult for the patient's heart function to return to normal after operation because of the non-renewable myocardial cells, and the patient will have heart failure, and then the activity endurance will decrease.
(2) Electrolyte disorder: If the patient takes diuretics for a long time after bypass surgery and the diet is too light, the patient may have electrolyte disorder, especially low potassium and magnesium, which may easily lead to fatigue.
(3) Stay in bed or rest for too long: Bypass surgery is traumatic, and patients and parents will attach great importance to it. After operation, staying in bed for too long or restricting activities too much will lead to muscle atrophy and decreased activity endurance, so fatigue symptoms are increasing.
(4) Others: If anticoagulants are taken orally for a long time, patients will have symptoms of chronic gastrointestinal bleeding, which will lead to anemia and fatigue.
To sum up, after 200 days of bypass surgery, people become more and more listless, which may be related to cardiac insufficiency, electrolyte disorder, lack of exercise, anemia and so on. It is recommended that patients see a doctor in time, find out the reasons and treat them when necessary.
I hope I can give a good answer in the personal suggestion authentication.