<s>[INST] i have a five heart bypass 1996,17 years ago.ijust turned 65 now.recently igot a new doctor.he told me that i can t be fix anymore cause i got only two main valve left,i went for second opinnion to special cardiologist the anwer is the same. the first doctor prescribe me a ranexa 500 mg. the ather doctor prescribe me isosorbide 60 mg.and iam taking lisinopril and nitrostat. they said no more surgery for me.ijust live with my medication.is ther any more out ther to help me insted of living day by day. [/INST] Sir I consider that you have symptoms of angina / chest pain, the reason of you going to your doctor. I would like to say that The number of grafts is not a contraindication of another bypass surgery, also many closed grafts can be opened via angioplasty.  However, any comment on that will be only after I see the angiography film.  But considering that you have taken two opinion and both are for conservative medical management, maybe the risk of procedure and the success of procedure would be less.  In this generic optimization of medication is best.  Apart from reinflating, other Chat Doctor.  Optimization of beta blocker dose, gabardine and nitrates. To bring it to your notice that isosorbide and nitro stat are similar  </s>