Post CABG sternal pain

[JohnHoward]

In June, 2007, I had CABGx3 using an artery harvested from my leg and a rerouted IMA.MI was avoided. Several months after the procedure, I still had persistant sternal pain and had the sternal wires removed.Pain had also developed in my cervical spine, revealed by MRI as a bulging disc.My cardiologist refused to recognise the sternal pain, but finally relented, sending me to a pain specialist without much success. To make a long story shorter, I ended up with a spine pain specialist, a cardiologist with sternum pain his speciality, and an artificial disc replacement. Six years later I am STILL in almost constant pain, working a job that requires physical capabilities such as heavy lifting and climbing. I am 58 years old.Since I avoided having a heart attack, I am not aware of what one feels like.So the local emergency room knows me on a first name basis.The various doctors here in Memphis, Tennessee offer no permanent solution and seem to be just pushing me and my insurance around, waiting for an "Event"........I need help.... Any advice?

[hajibutch786]

i had a heart attack 2 months ago, i am 37 years old used to smoke heavily but have now totally quit, i was always in good health generally before my heart attack,

since having my heart attack i had 1 stent put in and have been on prescribed medicines, I have been told i have high cholestrol but i am not over weight, i am 5"7 and weigh about 78 kilos, i am british of indian origins,

my medicines are:

ramipril 2.5mg
bisoprolol 2.5 mg
asprin 75mg
clopidogrel 75mg
lansoprazole 30mg
atorvastatin 40mg

i have been getting pain occasionally since maybe 4 or 5 times a week,

the pain only lasts for minutes, like a sort of stabbing pain to then being a dull ache across my chest, i have used my nitro spray 4 times since i came out of hospital but i am unsure if i should of used it or not??

nobody is giving me a straight answer to how many times a day maybe could i use my nitro spray.??

or how long will it be before i am back to normal??

is there any other ways or practises that i can use to determine what is happening to me or what i should do??

i.e. check my blood pressure or some thing

PLEASE HELP ME!!!!!

[JohnHoward]

Thank you for your reply. Had cath before disc replacement in May this year and everything OK.Originally asked surgeon to remove sternal wire fearing allergy to SS or nickel. Surgeon reluctantly agreed. Pain slightly better after cervical surgery but cardiologist diagnosis is chronic costochronditis and gives me steroid injections( Dr. Wm. Russo, Stern Cardiovascular Foundation). My treatment there is outlined in an article posted in his bio at their website.I also see a pain specialist at Semmes Murphey Clinic where the Neuro Surgeon that did my neck surgery practices. He has given me meds that I am afraid to use(Butrans patch).
     How does CC evaluate someone as myself. Diagnostic Specialist? Cardiologist? Is it like Mayo where a team tries to figure you out?If I go to CC how long should I expect to stay? How do I know who the best Drs. are?(sorry,naturally I would want the best).......a year or so ago I tried to investigate coming to CC but decided to pospone such until after cervical surgery.My best friend keeps pushing for me to go to Mayo, but CC has the best cardio facility.My insurance says CC is IN Network...sorry for the overload of info but I want to just get back a semi normal life. God bless YOU for your reply. Thank you.

[shinbone1960]

3 yrs ago had cabg 3, 1 has failed sternum never fused now they are talking plating my chest and from what I can find out it is a pretty much re configuring of the chest material I.E. muscle's,tendon's and blood supplies to the chest. I am in the process of getting other Doc's opinions but would much rather hear what real people have to say.

My name is Marvin and I'm fixing to be 54 yo

Thank you to any one who may offer their exp or advice  

[CCFHeartMD 26]

John,
That sounds like it has been really tough to deal with for the last number of years!  Sternal pain after open heart surgery can be problematic for some patients.  It is difficult to know exactly what is going on without seeing you in person or knowing your history/test results in complete detail; however, you may have multifactorial issues going on with the cervical/back pain problems you also have.  Certainly given that you have sternal pain after having bypass surgery for coronary artery disease should raise a concern for angina (pain in the chest from blockages in arteries or bypass grafts of the heart).  If you have not had a recent stress test or another heart catheterization recently, that may be something you should discuss at your next visit with your physician.
Another concern in patients with ongoing sternal pain after surgery is whether there is a smoldering, chronic infection of the sternum or surrounding tissues after surgery (which is likely why they removed the sternal wires).  This can be further evaluated with CT scans of the sternum/chest to make sure no inflammation or abscess is present that would suggest infection as a cause of your symptoms.  Some patients develop scar tissue in the healing process that can lead to chronic inflammatory state in the surrounding tissues, which can lead to pain.  Unfortunately, if scar tissue is the problem in your case, there is not a lot to do in order to completely remedy that issue.  Taking medications that act on the peripheral nerves of the body (like gabapentin) can help with the pain if it is felt to be neuropathic in nature (i.e. from surrounding scar tissue/inflammation of the nerves around the sternum).  Chronic opiates are a last option, but can be helpful in some patients.  Again, it is difficult to know exactly what is going on based on our limited interaction over the internet, but I hope that provides you some help/guidance.