Surgery considerations for people who have neither chest pain nor a heart attack

There is some debate over the use of surgery in people who have heart failure but who do not have chest pain (angina) caused by their heart disease.

Surgery to restore blood flow (revascularization) usually is not recommended for people with heart failure who do not have angina. However, if there is evidence that part of the heart is not contracting normally, it may mean that there is poor blood flow to that part of the heart, even though there is no angina. These people may require additional studies to determine whether revascularization may be of benefit.

If a person has many risk factors for coronary artery disease, it is much more likely that his or her heart failure is caused by impaired blood flow. In this case, additional testing (thallium scanning) may be appropriate even without angina or a history of a heart attack to determine whether surgery might be helpful.

If the person has no risk factors for coronary artery disease, or if heart failure is most likely the result of another cause (such as chronic alcoholism), areas of impaired blood flow are not likely, and additional testing may not provide any benefit.

The decision to have further testing is difficult. Discuss your options with your doctor. The decision to have surgery is based on each person's situation, risk factors, lifestyle, and other health factors.