Primary care management of chest pain after coronary artery bypass surgery

Abstract

### What you need to know Coronary artery bypass grafting (CABG) is increasingly common and accounts for over half of all adult cardiac surgeries globally.1 Over 16 000 operations were performed in the UK in 2015.2 Recurrent or chronic chest pain after CABG can be extremely worrying for the patient and affect their quality of life.3 In a prospective cohort study (183 patients), a third of patients reported chronic chest pain on movement and 17% reported chest pain at rest at one year after CABG.4 This presents a diagnostic challenge in primary care and requires prompt investigation.5 This article presents a practical approach for non-specialists to evaluate chest pain in patients after a CABG with a median sternotomy (see box 1). We focus on chest pain in the medium to long term after surgery, when the patient has been discharged from postoperative services and is under the care of their general practitioner in the community. The approach can be relevant in patients with post-sternotomy chest pain after …