Heart failure after triple bypass

The human heart beats over 100,000 times a day, working tirelessly to pump blood and oxygen throughout the body. It’s no surprise then, that its health is central to overall wellbeing.

In India, cardiovascular diseases account for 28.1% of total deaths, with coronary artery disease (CAD) being a leading cause. According to the Global Burden of Disease report, over 17.9 million people globally die from cardiovascular conditions each year. Coronary artery bypass grafting (CABG), commonly referred to as bypass surgery, is a standard surgical intervention for severe CAD. However, even after a successful triple bypass, some patients may develop a serious condition—heart failure.

Dr. Vishal Khullar, an acclaimed Cardiac Surgeon in Mumbai, says: “Triple bypass surgery is life-saving for many, but it’s not a cure for all heart conditions. Some patients may still experience heart failure due to underlying heart muscle damage or other factors. The key lies in early diagnosis, consistent follow-up, and proactive lifestyle changes. Heart health doesn’t stop at surgery—it begins anew.”

Heart failure after bypass surgery is not uncommon, but how frequent is it? Let’s break it down.

• According to a study in the Journal of Cardiac Surgery, about 10–15% of patients may develop symptoms of heart failure within 5 years of bypass surgery.
• In India, with over 60,000 CABG surgeries performed annually, approximately 6,000–9,000 patients might be at risk post-surgery.
• The risk is higher in individuals over 65 years of age, those with diabetes, hypertension, or a history of myocardial infarction.

The condition is often referred to as congestive heart failure after triple bypass, which indicates the heart’s inability to pump blood effectively post-surgery.

Dr. Vishal Khullar, a trusted heart bypass surgeon in Mumbai, shares: “Even when bypass surgery restores blood flow, the damage from previous heart attacks or long-standing hypertension might compromise heart function. That’s why patient education and postoperative monitoring are crucial to long-term outcomes.”

Now that we know heart failure can occur post-surgery, let’s explore why it happens.

Here are some of the leading causes and risk factors:

Pre-existing heart damage

Many patients undergoing CABG already have a weakened heart due to prior heart attacks. Scar tissue reduces the heart’s pumping capacity.

Incomplete revascularization

Not all blocked arteries may be bypassed during surgery, leaving parts of the heart muscle still deprived of blood.

Arrhythmias (irregular heartbeat)

Post-operative arrhythmias, especially atrial fibrillation, can lead to reduced cardiac output and heart failure.

Infections or complications post-surgery

Conditions such as pericarditis or sepsis can place additional strain on the heart.

Lifestyle factors

Continued smoking, poor diet, lack of exercise, and stress can hasten heart failure even after surgery.

Uncontrolled comorbidities

Diabetes, high blood pressure, and kidney disease are major contributors to post-bypass heart failure.

Understanding the type of heart failure helps doctors tailor treatment plans more effectively.

Heart failure can manifest in different forms:

Left-sided heart failure

The most common type. The left ventricle struggles to pump blood efficiently to the body. Symptoms include shortness of breath, fatigue, and fluid retention.

Right-sided heart failure

Often follows left-sided failure. The right ventricle fails to pump blood to the lungs, causing swelling in legs, abdomen, and liver.

Systolic heart failure

Also known as heart failure with reduced ejection fraction (HFrEF). The heart muscle loses its ability to contract properly.

Diastolic heart failure

Heart failure with preserved ejection fraction (HFpEF). The heart contracts normally but is too stiff to fill with blood properly.

Acute vs. Chronic heart failure

Acute occurs suddenly post-surgery, while chronic develops gradually due to long-standing issues.

If you’re wondering what signs to watch for, here’s what typically occurs:

• Shortness of breath (especially during exertion or lying down)
• Swelling in feet, ankles, or abdomen
• Persistent fatigue or weakness
• Rapid or irregular heartbeat
• Reduced ability to exercise
• Persistent coughing or wheezing
• Sudden weight gain due to fluid retention
• Increased need to urinate at night

These symptoms may appear weeks or even months post-surgery. Paying attention can make a critical difference.

Now, let’s understand how heart failure is confirmed.

Doctors use a combination of tests and evaluations:

Physical Examination – Checking for fluid buildup, irregular heartbeats, or murmurs.

Echocardiogram – An ultrasound of the heart that measures ejection fraction and checks for muscle damage.

Electrocardiogram (ECG) – Identifies abnormal rhythms or prior heart attacks.

Chest X-ray – Detects fluid in the lungs or an enlarged heart.

Blood Tests (BNP/NT-proBNP) – Elevated levels indicate heart strain or failure.

Cardiac MRI or CT scans – Used for a more detailed look at the heart structure and function.

Stress testing – To assess how the heart performs under exertion.

Prompt and accurate diagnosis is essential for effective treatment.

So, what happens if heart failure isn’t managed well?

Here are some serious complications:

Reduced quality of life: Patients experience chronic fatigue, limited mobility, and mental distress.

Frequent hospitalizations: Heart failure leads to repeated ER visits or long-term admissions.

Kidney dysfunction: Reduced blood flow affects renal function, often leading to fluid retention.

Pulmonary hypertension: High pressure in lung arteries due to poor left heart function.

Heart valve issues: Worsening function can strain the mitral or tricuspid valves.

Sudden cardiac arrest: In severe cases, especially with untreated arrhythmias.

Dr. Vishal Khullar, a noted Cardiothoracic Specialist in Mumbai, emphasizes: “Post-operative heart failure can severely impact daily life and longevity. But with timely intervention and lifestyle support, many patients live productive, fulfilling lives.”

Thankfully, multiple treatment options are available. Here’s how it’s typically managed:

Medications

• ACE inhibitors and beta-blockers to reduce heart workload.
• Diuretics to manage fluid buildup.
• Aldosterone antagonists for better heart muscle function.

Lifestyle modifications

Salt-restricted diets, regular low-impact exercise, and quitting smoking make a big difference.

Cardiac rehabilitation programs

Structured, supervised programs that help regain physical stamina safely.

ICDs (Implantable Cardioverter Defibrillators) or pacemakers may be required for rhythm management.

Surgical interventions

In rare, severe cases, ventricular assist devices (VADs) or heart transplants are considered.

A combination approach is usually best, tailored to each patient’s unique needs.

But wait, there’s good news! Prevention is possible.

Here are actionable strategies to lower your risk:

• Stick to follow-up appointments
• Regular cardiac check-ups help catch issues early.
• Take medications as prescribed
• Never adjust doses without consulting your doctor.
• Eat a heart-healthy diet
• Focus on whole grains, lean proteins, and plenty of fruits and vegetables.
• Exercise regularly but safely
• Even walking 30 minutes a day can help, if cleared by your physician.
• Manage other health conditions
• Keep diabetes, hypertension, and cholesterol under tight control.
• Avoid alcohol and smoking as they contribute significantly to heart deterioration.

Dr. Vishal Khullar, a respected Cardiovascular Expert in Mumbai, advises: “Surgery is a stepping stone, not the finish line. Prevention is about everyday decisions—nutrition, physical activity, and adherence to medical advice form the cornerstone of heart failure prevention post-bypass.”