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Coronary Artery Disease And Coronary Bypass Surgery

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During this operation, the surgeon will make an incision, called a median sternotomy, in your chest and through the breastbone.

They will take healthy vessels from another part of your body to 'bypass' the blocked arteries that are preventing oxygenated blood from efficiently reaching your heart. A healthy artery in your chest may be used, or veins from your leg can be taken and used to bypass the blockage. In order for your surgeon to obtain the healthy veins, one or two small incisions are made in the leg.

During most open-heart surgeries it is necessary to connect you to a heart-lung bypass machine. During this time, your heart will stop. This machine takes over the work of the heart, oxygenating your blood and circulating it throughout the body. Your heart will begin beating again once the procedure is complete.

Coronary Artery Bypass

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During a coronary artery bypass, the diseased sections of your coronary arteries are bypassed with healthy artery or vein grafts to increase blood flow to the heart muscle tissue. This procedure is also called coronary artery bypass grafting (CABG). Bypass typically requires open-chest surgery.

There are several newer, less invasive techniques for bypass surgery that can be used instead of open-chest surgery in some cases. In some procedures, the heart is slowed with medicine but is still beating during the procedure. For these types of surgery, a heart-lung bypass machine is not needed. (For open-chest surgery, a heart-lung machine is needed to circulate the blood and to add oxygen to it.) Other techniques use keyhole procedures or minimally invasive procedures instead of open-chest surgery. Keyhole procedures use several smaller openings in the chest and may or may not require a heart-lung machine. These techniques are still being studied and may not be available in all medical centers.

Open-chest surgery

You'll receive anesthesia before the surgery that will make you sleep. In most cases, bypass surgery is open-chest surgery. During the surgery, your chest will be open and your heart exposed. The surgeon makes a large cut, or incision, in the middle or side of your chest. He or she may cut through your breastbone and spread apart your rib cage.

The surgeon removes a healthy blood vessel—often from the leg—and attaches (grafts) it to the narrowed or blocked artery. The new blood vessel bypasses the diseased artery to increase blood flow to the heart. You may need just one bypass graft, or you may need more. Some people have as many as two, three, or even four (double, triple, or quadruple bypass surgery). How many grafts you need depends on how many arteries are narrowed or blocked and where.

When the surgery is complete, the doctor may use wire to put your rib cage back together and stitches to close the incision. The surgery can take 3 to 6 hours. You will stay in the hospital at least 3 to 8 days after the surgery. It can take 4 to 6 weeks to recover at home. Most people are able to return to work within 1 to 2 months after surgery.

Coronary Heart Disease

Coronary heart disease (CHD), also called coronary artery disease, is the most prevalent form of heart disease, contributing to more than 95% of total cardiovascular disease prevalence in India. Heart disease that results in blockage of blood vessels supplying blood to the heart (coronary arteries) is called CHD. The blockage of these arteries reduces blood flow to the heart, depriving the heart muscle of oxygen and other nutrients required for its normal functioning.

Here's what Dr Anil Dhall, Senior Panelist Cardiology, Docplexus has to say about the causes, symptoms, diagnosis and treatment of coronary heart or artery disease.

Causes

CHD is caused by deposition of cholesterol and other fatty substances on the walls of the arteries. These substances get accumulated along the arteries to form a build-up called plaque or atheroma. This process of formation of plaque is called atherosclerosis. Plaques are mainly dangerous because they harden the walls of arteries, restrict the blood flow and hamper the functioning of several organs. Plaques can also rupture and result in a blood clot which further blocks the blood supply to the heart.

Risk Factors

Since deposition of lipids and development of plaque is the primary cause of CHD, factors that trigger and lead to atherosclerosis are its major risk factors. There are some risk factors over which we do not have any control. They are called Non –modifiable risk factors such as age, gender, race and family history. The modifiable risk factors you should know:

1. Smoking: When you smoke, your cholesterol levels increase, causing your blood vessels to narrow down due to plaque deposition. Smoking also damages walls of the arteries, raises blood pressure and reduces your good cholesterol (HDL) levels further leading to CHD.

2. Diabetes: People having diabetes are three times more likely to suffer from CHD compared to healthy individuals.

3. Hypertension: High blood pressure on the walls of the arteries can cause thickening of the blood vessels which along with high cholesterol levels can lead to CHD.

4. High cholesterol level: Cholesterol deposition being the cause of CHD makes high cholesterol a major risk factor.

5. Alcohol: Drinking more than the recommended alcohol limit can increases cholesterol level as well as and blood pressure, both of which contribute to plaque deposition.

6. Obesity: Overweight people are 6 times more likely to suffer from heart disease. Obesity is a path to developing high BP, high cholesterol, high triglycerides, diabetes and stress which individually contribute to coronary heart disease.

Here are few more risk factors of heart disease you should be know about.

Symptoms

CHD is a silent disease. There is no classic sign that indicates plaque deposition or narrowing of arteries. Unless the arteries are blocked to an extent that blood supply to the heart gets reduced drastically, symptoms do not develop. But if you notice any of these signs then you probably should get your heart function tested.

1. Chest pain: Chest pain (angina) is a symptom of CHD but the type of pain and the duration for which it lasts is important because chest pain is also caused in other forms of heart diseases. Pain may be described as short-term, constant, stabbing or sharp. It can last for a few seconds or for hours together.

2. Shortness of breath: Breathlessness is a warning sign of heart attack. Breathing difficulty while exercising or any other physical exertion may indicate a problem with the heart valves.

3. Arrhythmia: Once the heart muscle gets deprived of oxygen, you may feel a fluttering feeling in your chest due to abnormal heart beat.

4. Signs of heart attack: Complete blockage of the arteries can cause heart attack. Some common signs of heart attack include fatigue, pain in the limbs, nausea and chest pain.

Here are 8 common heart disease symptoms and warning signs you should know.

Diagnosis

Based on your symptoms, risk factors and physical examination, your doctor might suspect CHD. There is no single test that can confirm it. But if your doctor suspects it, then you might be recommended to undergo the following tests:

1. Blood tests: Blood tests are basic and the most important diagnostic tool used for screening coronary artery disease. Your blood contains various markers like cholesterol, lipids, fibrinogen, C-reactive protein and glucose that can help identify your chances of suffering from CHD.

2. Echocardiography: Echocardiography is real-time imaging of the heart (similar to sonography) that uses high-frequency radio waves to determine structural aspects of the heart while it pumps blood.

3. Coronary angiography: In this test, a catheter is used to release a coloured dye in the blood stream. With the help of special X-ray, the flow of blood through the blood vessels can be visualized.

4. Exercise stress test: A stress test determines the level of strain that your heart can handle under physical activity. The test uses an ECG device to record electrical activity of the heart while exercising. So the patient is instructed to perform activities like walking on the treadmill.

5. Electrocardiography: The test measures the electrical activity of the heart. In this test, electrodes attached to the patient's chest, legs and arms signals from these electrodes are received and captured by the device and an electrocardiograph is generated.

6. Electron-beam computed tomography (EBCT): This test is used to check calcium deposits in the lining of the arteries. the more calcium, the higher your chance for CHD.

Here's detailed information about 8 tests that can tell if you have heart disease.

Treatment

Heart disease can be treated with medicines and surgical interventions depending on your symptoms and severity of the disease.

Medicines: Your doctor may prescribe you medicines to control risk factors like blood pressure, cholesterol and diabetes that may worsen CHD.

Cholesterol lowering drugs (statins): They help reduce cholesterol and prevent plaque formation due to atherosclerosis.

ANGIOTENSIN BLOCKERS:used to treat high blood pressure.

Beta blockers: They are a class of drugs used to lower the heart rate and lessen the contracting force with which the heart beats.

Nitrates or nitroglycerin: They may be prescribed if you have chest pain.

Surgical procedures:

Angioplasty: It is the most common surgery performed to open up blocked arteries using a small device called stent. Here are indications, procedure, risks of angioplasty.

Coronary artery bypass surgery: In this surgery, a healthy blood vessel (called the graft) is used to form a bypass or another route for the heart to pump blood to the other body parts to make up for a blockage in a coronary (heart artery).

Heart surgery: A minimally invasive heart bypass surgery is done in case your 1 or 2 coronary arteries near the heart are blocked. In this procedure, the surgeon attaches an artery present on your chest wall to the coronary arteries that are partially blocked. Prevention

Dr Aashish Contractor, Head of Department, Preventive Cardiology and Rehabilitation of the Asian Heart Institute, Mumbai offers some tips to prevent heart disease.

1. Eat healthy food: Eating healthy is a starting point of keeping heart disease at bay. Simple changes like eating fresh fruits and vegetables, switching to heart-healthy cooking oils, limiting salt and sugar can go a long way in preventing heart disease.

2. Avoid sedentary lifestyle: Exercising daily is a must, even if it is for 30-45 min. Regular physical activity helps you control your weight and reduce your chances of developing conditions such as high blood pressure, high cholesterol and diabetes, which may put a strain on your heart.

3. Don't be stressed: Stress can be a main reason you turn to an unhealthy lifestyle. It can be a starting point for smoking, drinking and unhealthy eating which in turn are risk factors for heart disease.

Here are more expert tips to prevent heart disease.

The content has been verified by Dr Anil Dhall, Senior Panelist Cardiology, Docplexus.

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