Management of Worsening Heartburn After CABG

Initial Assessment and Red Flags

• The American Heart Association recommends evaluating for graft failure or cardiac ischemia, as angina can present as epigastric discomfort and is predicted by depression after CABG 1, 2

Pharmacological Management

• The American College of Cardiology suggests considering poor medication compliance, as the patient may not be taking the medication as prescribed 1

Lifestyle Modifications

• The American Heart Association recommends weight reduction if BMI >25 kg/m², as weight loss improves BP, diabetes control, lipid profiles, and quality of life after CABG 3, 4
• The American College of Cardiology advises smoking cessation, as continued smoking increases mortality, MI, and reoperation rates after CABG 5

Medication Review

• The American College of Cardiology recommends avoiding or minimizing NSAIDs, which can cause gastric irritation; if needed for pain, use lowest dose for shortest duration with PPI protection, according to the American College of Cardiology 6

Nutritional Considerations

• The American Heart Association suggests ensuring adequate nutritional intake with controlled caloric support (30 kcal/kg/day), as post-CABG patients often experience weight loss and nutritional depletion 7

Depression Screening

• The American Heart Association recommends screening for depression, as it occurs in up to 33% of patients after CABG and is an important predictor of angina recurrence, which can mimic heartburn 1, 2, 8
• The American College of Cardiology advises considering cognitive behavioral therapy or collaborative care if depression is identified, as these interventions improve quality of life and reduce symptom burden 2, 8, 6