Thank you to Satvik for sharing a great case of an elderly man w/ multiple co-morbities s/p CABG (several years prior) presenting with chest pain and hypertensive emergency. We discussed the management of HTN emergency and how to approach chest pain in a patient s/p CABG. We loved the lively discussion so thank you everyone for your participation!
Key Learning Points
Causes of chest pain in pt w/ hx of CABG vary by time
- Recurrent angina during the early postoperative period is usually due to a technical problem with a graft or with early graft closure. This is indication for prompt coronary angiography with percutaneous coronary intervention (PCI), if feasible.
- Recurrent angina after the first few months and beyond, called late recurrent angina, can occur with the development of stenosis in a bypass graft (either saphenous vein or arterial) or with progression of atherosclerosis in non-bypassed vessels.
- Functional right bundle branch block (RBBB) in atrial fibrillation occurring in the short cycle following a preceding long cycle that lengthened the refractory period in the right bundle branch (the Ashman phenomenon).