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  • The Review Course in Family Medicine

Caring After Coronary Bypass: Tips for Primary Care Providers

Someone cupping their ear showing that their hearing is poor. There is also a red colour effect around the ear showing there is a problem.

1 in 10 patients develop complications post-coronary artery bypass graft (CABG). Primary care providers improve outcomes by monitoring recovery, optimizing medications and referring if complications occur. Here are 6 key areas to watch for!

1. Wounds: Assess for superficial and deep infections. ‘Mediastinal clicking' is worrying for non-union.

2. Cardiac complications:

  • New A-fib is common and often transient. Reassess anticoagulation at 3 months.

  • Post-pericardiotomy syndrome (immune mediated pericarditis) can occur months later, assess with an early echo and treat pericarditis.

  • Avoid graft occlusion and stenosis with DAPT for 12months post-CABG.

  • Monitor for CHF exacerbations with regular weights and manage with diuretics.

3. GI Bleeding: Monitor patients on NSAIDS and anticoagulation as intra-operative TEEs can cause trauma and stress ulcers.

4. Diabetes: Tight targets for glycemic control (A1C <7) peri-operatively and post-operatively

5. Blood pressure: antihypertensives are held on cardiopulmonary bypass. Reassess and optimize anti-hypertensive therapy.

6. Mobility: Encourage cardiac rehabilitation and ongoing daily exercise.

Bonus! The Canadian Cardiology Society permits driving 4 weeks post-CABG.

In summary, successful post-CABG care requires primary care providers to closely monitor and manage key areas: wound healing, cardiac complications, GI risks, diabetes, blood pressure, and mobility. Timely intervention and lifestyle modifications are essential to ensure the best possible patient outcomes.

Ref: Management of patients after coronary artery bypass grafting surgery: a guide for primary care practitioners.



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