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❤️❤️ Heart and Cardiovascular Diseases ❤️❤️
Cardiovascular disease includes a number of conditions affecting the structures or function of the heart. They can include:
Coronary artery disease (narrowing of the arteries)
Heart attack
Abnormal heart rhythms or arrythmias
Heart failure
Heart valve disease
Congenital heart disease
Heart muscle disease (cardiomyopathy)
Pericardial disease
Aorta disease and Marfan syndrome
Vascular disease (blood vessel disease)
Cardiovascular disease is the leading cause of death for both men and women in the world. It is important to learn about your heart to help prevent heart disease. And, if you have cardiovascular disease, you can live a healthier, more active life by learning about your disease and treatments and by becoming an active participant in your care.
Coronary Artery Disease
Coronary artery disease (CAD) is atherosclerosis, or hardening, of the arteries that provide vital oxygen and nutrients to the heart.
The diseases affecting heart and cardiovascular system
Abnormal Heart Rhythms
The heart is an amazing organ. It beats in a steady, even rhythm, about 60 to 100 times each minute (that's about 100,000 times each day!). But, sometimes your heart gets out of rhythm. An irregular or abnormal heartbeat is called an arrhythmia. An arrhythmia (also called a dysrhythmia) can involve a change in the rhythm, producing an uneven heartbeat, or a change in the rate, causing a very slow or very fast heartbeat.
Heart Failure
The term "heart failure" can be frightening. It does not mean the heart has "failed" or stopped working. It means the heart does not pump as well as it should. This then leads to salt and water retention, causing swelling and shortness of breath. The swelling and shortness of breath are the primary symptoms of heart failure.
Heart failure is a major health problem affecting the world.
Heart Valve Disease
diseases affecting heart and cardiovascular system
Your heart valves lie at the exit of each of your four heart chambers and maintain one-way blood-flow through your heart.
Examples of heart valve problems include mitral valve prolapse, aortic stenosis, and mitral valve insufficiency.
Congenital Heart Disease
Congenital heart disease is a type of defect in one or more structures of the heart or blood vessels that occurs before birth.
It affects about eight out of every 1,000 children. Congenital heart defects may produce symptoms at birth, during childhood, and sometimes not until adulthood.
In most cases scientists don't know why they occur. Heredity may play a role, as well as exposure to the fetus during pregnancy to certain viral infections, alcohol, or drugs.
Cardiomyopathies
Cardiomyopathies are diseases of the heart muscle itself. People with cardiomyopathies -- sometimes called an enlarged heart -- have hearts that are abnormally enlarged, thickened, and/or stiffened. As a result, the heart's ability to pump blood is weakened. Without treatment, cardiomyopathies worsen over time and often lead to heart failure and abnormal heart rhythms.
Pericarditis
Pericarditis is inflammation of the lining that surrounds the heart. It is a rare condition that is often caused by an infection.
Aorta Disease and Marfan Syndrome
The aorta is the large artery that leaves the heart and provides oxygen-rich blood throughout the body.
These diseases and conditions can cause the aorta to dilate (widen) or dissect (tear), increasing the risk for future life-threatening events, such as:
Atherosclerosis (hardening of the arteries)
High blood pressure
Genetic conditions such as Marfan Syndrome
Connective tissue disorders (that affect the strength of the blood vessel walls) such as, scleroderma, osteogenesis imperfecta, polycystic kidney disease, and Turner's syndrome Injury
People with aorta disease should be treated by an experienced team of cardiovascular specialists and surgeons.
Other Vascular Diseases
Your circulatory system is the system of blood vessels that carry blood to every part of your body.
Vascular disease includes any condition that affects your circulatory system.
These include diseases of the arteries and blood flow to the brain.
Symptoms of Heart Disease
Coronary artery disease,
congestive heart failure, heart attack -- each type of heart problem requires different treatment but may share similar warning signs. It is important to see your doctor so that you can receive a correct diagnosis and prompt treatment.
Learn to recognize the symptoms that may signal heart disease. Call your doctor if you begin to have new symptoms or if they become more frequent or severe.
Symptoms of Coronary Artery Disease
The most common symptom of coronary artery disease is angina, or chest pain. Angina can be described as a discomfort, heaviness, pressure, aching, burning, fullness, squeezing, or painful feeling in your chest. It can be mistaken for indigestion or heartburn. Angina may also be felt in the shoulders, arms, neck, throat, jaw, or back.
During a heart attack, symptoms typically last 30 minutes or longer and are not relieved by rest or oral medications. Initial symptoms may start as a mild discomfort that progresses to significant pain.
Some people have a heart attack without having any symptoms, which is known as a "silent" myocardial infarction (MI). It occurs more often in people with diabetes.
If you think you are having a heart attack, DO NOT DELAY. Call for emergency help Immediate treatment of a heart attack is very important to lessen the amount of damage to your heart.
Symptoms of Arrhythmias
When symptoms of arrhythmias, or an abnormal heart rhythm, are present, they may include:
Palpitations (a feeling of skipped heart beats, fluttering or "flip-flops" in your chest)
Pounding in your chest
Dizziness or feeling light-headed
Fainting
Shortness of breath
Chest discomfort
Weakness or fatigue (feeling very tired
Symptoms of Atrial Fibrillation
Atrial fibrillation (AF) is a type of arrhythmia. Most people with AF experience one or more of the following symptoms:
Heart palpitations (a sudden pounding, fluttering, or racing feeling in the heart)
Lack of energy
Dizziness (feeling faint or light-headed)
Chest discomfort (pain, pressure, or discomfort in the chest)
Shortness of breath (difficulty breathing during normal activities) Some patients with atrial fibrillation have no symptoms. Episodes may be brief.
Shortness of breath and/or difficulty catching your breath; you may notice this most when you are doing your normal daily activities or when you lie down flat in bed.
Weakness or dizziness
Discomfort in your chest; you may feel a pressure or weight in your chest with activity or when going out in cold air.
Palpitations (this may feel like a rapid heart rhythm, irregular heartbeat, skipped beats, or a flip-flop feeling in your chest.) If valve disease causes heart failure, symptoms may include:
Swelling of your ankles or feet; swelling may also occur in your abdomen, which may cause you to feel bloated.
Quick weight gain (a weight gain of two or three pounds in one day is possible.)
Symptoms of heart valve disease do not always relate to the seriousness of your condition. You may have no symptoms at all and have severe valve disease, requiring prompt treatment. Or, as with mitral valve prolapse, you may have severe symptoms, yet tests may show minor valve disease.
Symptoms of Heart Failure
Symptoms of heart failure can include:
Shortness of breath noted during activity (most commonly) or at rest, especially when you lie down flat in bed
Cough that produces white sputum.
Rapid weight gain (a weight gain of two or three pounds in one day is possible.)
Swelling in ankles, legs, and abdomen
Dizziness
Fatigue and weakness
Rapid or irregular heartbeats
Other symptoms include nausea, palpitations, and chest pain.
Like valve disease, heart failure symptoms may not be related to how weak your heart is. You may have many symptoms, but your heart function may be only mildly weakened. Or you may have a severely damaged heart, with few or no symptoms.
Symptoms of Congenital Heart Defects
Congenital heart defects may be diagnosed before birth, right after birth, during childhood, or not until adulthood. It is possible to have a defect and no symptoms at all. Sometimes, it can be diagnosed because of a heart murmur on physical exam or an abnormal EKG or chest X-ray in someone with no symptoms.
In adults, if symptoms of congenital heart disease are present, they may include:
Shortness of breath
Limited ability to exercise
Congenital Heart Defects in Infants and Children
Symptoms of congenital heart defects in infants and children may include:
Cyanosis (a bluish tint to the skin, fingernails, and lips)
Fast breathing and poor feeding
Poor weight gain
Recurrent lung infections
Inability to exercise
Symptoms of Heart Muscle Disease
Many people with heart muscle disease, or cardiomyopathy, have no symptoms or only minor symptoms, and live a normal life.
Other people develop symptoms, which progress and worsen as heart function worsens.
Symptoms of cardiomyopathy may occur at any age and may include:
Chest pain or pressure (occurs usually with exercise or physical activity, but can also occur with rest or after meals)
Heart failure symptoms
Swelling of the lower extremities
Fatigue
Fainting
Palpitations (fluttering in the chest due to abnormal heart rhythms)
Some people also have arrhythmias. These can lead to sudden death in a small number of people with cardiomyopathy.
Symptoms of Pericarditis
When present, symptoms of pericarditis may include:
Chest pain which is different from angina (chest pain caused by coronary artery disease); it may be sharp and located in the center of the chest.
The pain may radiate to the neck and occasionally, the arms and back. It is made worse when lying down, taking a deep breath in, coughing, or swallowing and relieved by sitting forward.
Low-grade fever
Increased heart rate
Some standard and simple exam techniques provide your doctor with the first clues as to how your heart functions and whether you have heart disease. During your visit, your doctor will listen to your heart, take your heart rate, and check your blood pressure.
Checking Your Heart Rate
Your doctor feels your pulse in order to check your heart's rate and rhythm. Each pulse matches up with a heartbeat that pumps blood into the arteries. The force of the pulse also helps evaluate the amount (strength) of blood flow to different areas of your body.
You can tell how fast your heart is beating (heart rate) by feeling your pulse. Your heart rate is the amount of times your heart beats in one minute.
Hi-Tech Scans Spot Brain Damage in High Blood Pressure Patients
To measure your pulse, all you need is a watch with a second hand.
Place your index and middle finger of your hand on the inner wrist of the other arm, just below the base of the thumb. You should feel a tapping or pulsing against your fingers.
Count the number of taps you feel in 10 seconds.
Multiply that number by six to find out your heart rate for one minute (pulse in 10 seconds x six = beats per minute)
When feeling your pulse, you can also tell if your heart rhythm is regular or not.
Checking Your Heartbeat
Your doctor listens to your heartbeat with the aid of a stethoscope. The opening and closing of your valves make a "lub dub" noise known as heart sounds. The doctor can evaluate your heart and valve function and hear your heart's rate and rhythm by listening to your heart sounds.
Checking Your Blood Pressure
Blood pressure is the force or pressure exerted in the arteries by the blood as it is pumped around the body by the heart. It is recorded as two measurements:
Systolic blood pressure. Pressure in the arteries during the period of the heart's contraction (the higher number)
Diastolic blood pressure. Pressure in the arteries when the heart is relaxed, between heartbeats (the lower number)
Blood pressure is measured in millimeters of mercury (mm Hg), which refers to how high the pressure in the arteries can raise a column of mercury in a sphygmomanometer, a device for measuring blood pressure.
Normal blood pressure for an adult, relaxed at rest, is less than or equal to 140 over 90. The 140 is the systolic pressure; the diastolic pressure is 90. Blood pressure may increase or decrease, depending on your age, heart condition, emotions, activity, and the medications you take. One high reading does not mean you have high blood pressure. It is necessary to measure your blood pressure at different times while resting to find out your typical value.
Checking Your Heart by a Physical Exam
Your doctor can also tell about your heart's function by examining other parts of your body, such as your eyes, arms, legs, and skin.
Checking Your Heart Through Blood Tests
Your doctor may recommend a blood test to check your cholesterol and other markers that may indicate heart disease.
Understanding Heart Disease
How Do I Know If I Have Heart Disease?
In diagnosing heart disease, a doctor will first ask you for a description of symptoms and your medical history.
Your physical condition also will be assessed through a standard medical exam. Listening to the heart for swishing or whooshing sounds, collectively known as heart murmurs, may provide important clues about heart trouble. If heart disease is suspected, further tests are done to find out what is actually happening inside the heart.
An electrocardiogram, or ECG, is usually the first test to be performed. By recording electrical activity within the heart, the ECG quickly reveals any electrical abnormalities that may be a source of trouble or may indicate that the heart muscle has been or is being injured by ischemia (lack of oxygen-rich blood).
Further details can be gathered by taking images of the heart using X-rays, a variety of of other scans using CT, MRI or nuclear technology, or via angiography, a special technique that allows for detailed imaging of blood vessels. Echocardiograms (ultrasound evaluations of the heart) can also determine how well the heart and valves are working.
Other tests may include stress testing, with or without additional imaging of the heart, and sophisticated testing for arrhythmias (such as electrophysiology testing or EP testing).
The most common cause of death from a heart attack in adults is a disturbance in the electrical rhythm of the heart called ventricular fibrillation.
Ventricular fibrillation can be treated, but it requires applying an electrical shock to the chest called defibrillation.
If a defibrillator is not readily available, brain death will occur in less than 10 minutes.
One way of buying time until a defibrillator becomes available is to provide artificial breathing and circulation by performing cardiopulmonary resuscitation, or CPR.
The earlier you give CPR to a person in cardiopulmonary arrest (no breathing, no heartbeat), the greater the chance of a successful resuscitation.
By performing CPR, you keep oxygenated blood flowing to the heart and brain until a defibrillator becomes available.
Because up to 80% of all cardiac arrests occur in the home, you are most likely to perform CPR on a family member or loved one.
CPR is one link in what the "chain of survival." The chain of survival is a series of actions that, when performed in sequence, will give a person having a heart attack the greatest chance of survival.
When an emergency situation is recognized, the first link in the chain of survival is early access. This means activating the emergency medical services.
The next link in the chain of survival is to perform CPR until a defibrillator becomes available.
In some areas or countries simple, computerized defibrillators, known as automated external defibrillators, or AEDs, may be available for use by the lay public or first person on the scene. If available, early defibrillation becomes the next link in the chain of survival.
Once the EMS unit arrives, the next link in the chain of survival is early advanced life support care. This involves administering medications, using special breathing devices, and providing additional defibrillation shocks if needed.
Treatments for Heart Diseases
Medical care is essential once heart disease is diagnosed. The goals of treatment are stabilizing the condition, controlling symptoms over the long term, and providing a cure when possible.
Stress reduction, diet, and lifestyle changes are key in managing heart disease, but the mainstays of conventional care are drugs and surgery.
Lifestyle and Your Heart
If you smoke, quit. You should also get in the habit of exercising, because exercise strengthens the heart and blood vessels, reduces stress, and has been shown to reduce blood pressure while also boosting HDL (good) cholesterol levels. Numerous studies done in recent decades indicate that drinking alcohol in moderation may actually reduce the risk of heart disease. But more than one drink a day for women, or more than one to two a day for men, is not recommended.
Ventricular Septal Defect
Learning to relax may help prevent and treat heart disease. While success varies from person to person, stress-reduction techniques have been shown to reduce high blood pressure, heart arrhythmias, and emotional responses such as anxiety, anger, and hostility that have been linked to coronary heart disease, angina, and heart attack. The choice of relaxation technique is up to you. Some that have proved beneficial are meditation, progressive relaxation, yoga, and biofeedback training.
Nutrition, Diet, and Your Heart
Even modest changes in diet and lifestyle can significantly reduce the risk of heart disease. Being overweight, especially in the mid-section, can lead to high blood pressure and diabetes. If you are 20% or more over the ideal weight for your age, height, and sex, you put a strain on your heart's ability to pump blood efficiently. Although lowering sodium and trans fat consumption are important for lowering blood pressure and reducing the risk of coronary heart disease, equally vital is increasing intake of fresh fruits and vegetables, whole unprocessed high-fiber grains, and healthy sources of fats and proteins (as from fish, nuts, seeds, soy-based items, avocados, etc.).
Treatment for Coronary Artery Disease
Drug treatments may include daily aspirin, and drugs such as ACE inhibitors and beta-blockers. Treatments may also target high blood pressure and high cholesterol -- two major risk factors for coronary disease. In addition, your doctor may recommend surgical treatments such as balloon angioplasty (usually using a metal stent to prop open the vessels) or open heart surgery to bypass blocked heart arteries.
Treatment for Heart Failure
Treatment usually depends on the cause of heart failure, but often includes drugs to help control symptoms, such as diuretics or water pills to flush the body of fluids, beta-blockers to block adrenaline’s action, and ACE inhibitors to help modulate sodium and potassium balance and improve blood pressure levels.
Devices such as pacemakers and defibrillators are sometimes implanted to improve the heart's function and/or prevent deadly arrhythmias. In very advanced cases, heart transplantation may be a consideration.
Treatment for Heart Arrhythmias
Treatment depends on the type of arrhythmia you have, but can include drugs to normalize the heart rate, such as beta-blockers, many newer drugs to help convert your rhythm to normal, drugs to prevent blood clots (such as warfarin and dabigatran), and "cardioversion," a treatment that involves sending a strong electrical shock to the heart to convert the heart rhythm back to normal.
Treatment for Heart Valve Disease
In severe cases, patients may require medications to deal with heart failure, or surgery to repair or replace the abnormal valve.
Heart Disease and Angina (Chest Pain)
Treatment for Pericardial Disease
Pericarditis often subsides on its own, but it also can be treated with anti-inflammatory drugs such as aspirin or, in severe cases, corticosteroid hormones.
Occasionally, fluid must be drained from the pericardium using a long, thin needle inserted carefully through the chest. If a chronic condition develops, a pericardial window may need to be created surgically to permit this fluid to drain.
In the rare circumstance that pericarditis becomes a chronic condition, surgery may be needed to either create a pathway for the extra fluid to drain internally or remove the pericardial sac altogether.
Treatment for Cardiomyopathy (Heart Muscle Disease)
Treatment for cardiomyopathy will depend upon the underlying cause, but often includes the same measures used for patients with heart failure. The outcome is also dependent upon the underlying cause. In selected cases, heart transplant surgery may be recommended.
Using EEP To Treat Chronic Angina
Treatment for Congenital Heart Disease
Some minor conditions can actually clear up on their own, or can be treated easily with medications. Those that are more complex can often be treated surgically, if necessary. Very rarely, the heart problem is so severe that it cannot be corrected.
Dietary Supplements for Heart Disease
Several dietary supplements are being studied to determine if they effectively treat coronary heart disease. They include L-carnitine, coenzyme Q10, and garlic. So far, these are not recommended for use in treating or preventing heart disease.
Vitamins E and C have been studied extensively and do not appear to lower the risk of developing heart disease. In general, a person will derive the greatest benefits from vitamins and other micronutrients if they are consumed as part and parcel of whole foods.
Heart Surgry
Types of Heart Surgery
Coronary artery bypass grafting (CABG) is the most common type of heart surgery. CABG improves blood flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease (CHD).
CHD is a disease in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.
Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.
During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new path for oxygen-rich blood to flow to the heart muscle.
Surgeons can bypass multiple blocked coronary arteries during one surgery.
Coronary Artery Bypass Grafting
CABG isn't the only treatment for CHD. A nonsurgical procedure that opens blocked or narrow coronary arteries is percutaneous coronary intervention (PCI), also known as coronary angioplasty.
During PCI, a thin, flexible tube with a balloon at its tip is threaded through a blood vessel to the narrow or blocked coronary artery. Once in place, the balloon is inflated to push the plaque against the artery wall. This restores blood flow through the artery.
During PCI, a stent might be placed in the coronary artery to help keep it open. A stent is a small mesh tube that supports the inner artery wall.
If both CABG and PCI are options, your doctor can help you decide which treatment is right for you.
Transmyocardial Laser Revascularization
Transmyocardial (tranz-mi-o-KAR-de-al) laser revascularization (re-VAS-kyu-lar-ih-ZA-shun), or TMR, is surgery used to treat angina.
TMR is most often used when no other treatments work. For example, if you've already had one CABG procedure and can't have another one, TMR might be an option. For some people, TMR is combined with CABG.
If TMR is done alone, the procedure may be performed through a small opening in the chest.
During TMR, a surgeon uses lasers to make small channels through the heart muscle and into the heart's lower left chamber (the left ventricle).
It isn't fully known how TMR relieves angina. The surgery may help the heart grow tiny new blood vessels. Oxygen-rich blood may flow through these vessels into the heart muscle, which could relieve angina.
Heart Valve Repair or Replacement
For the heart to work well, blood must flow in only one direction. The heart's valves make this possible. Healthy valves open and close in a precise way as the heart pumps blood.
Each valve has a set of flaps called leaflets. The leaflets open to allow blood to pass from one heart chamber into another or into the arteries. Then the leaflets close tightly to stop blood from flowing backward.
Heart surgery is used to fix leaflets that don't open as wide as they should. This can happen if they become thick or stiff or fuse together. As a result, not enough blood flows through the valve.
Heart surgery also is used to fix leaflets that don't close tightly. This problem can cause blood to leak back into the heart chambers, rather than only moving forward into the arteries as it should.
To fix these problems, surgeons either repair the valve or replace it with a man-made or biological valve. Biological valves are made from pig, cow, or human heart tissue and may have man-made parts as well.
To repair a mitral (MI-trul) or pulmonary (PULL-mun-ary) valve that's too narrow, a cardiologist (heart specialist) will insert a catheter (a thin, flexible tube) through a large blood vessel and guide it to the heart.
The cardiologist will place the end of the catheter inside the narrow valve. He or she will inflate and deflate a small balloon at the tip of the catheter. This widens the valve, allowing more blood to flow through it. This approach is less invasive than open-heart surgery.
Researchers also are testing new ways to use catheters in other types of valve surgeries. For example, catheters might be used to place clips on the mitral valve leaflets to hold them in place.
Catheters also might be used to replace faulty aortic valves. For this procedure, the catheter usually is inserted into an artery in the groin (upper thigh) and threaded to the heart.
In some cases, surgeons might make a small cut in the chest and left ventricle (the lower left heart chamber). They will thread the catheter into the heart through the small opening.
The catheter has a deflated balloon at its tip with a folded replacement valve around it. The balloon is used to expand the new valve so it fits securely within the old valve.
Currently, surgery to replace the valve is the traditional treatment for reasonably healthy people. However, catheter procedures might be a safer option for patients who have conditions that make open-heart surgery very risky.
Recovering from an aortic valve replacement
After an aortic valve replacement, you'll usually need to stay in hospital for about a week.
The time it takes to fully recover varies depending on factors such as your age and overall health.
Your breastbone will usually heal in about six to eight weeks, but it may be two to three months before you feel your normal self again.
⭐️ Recovering in hospital
You'll usually stay in an intensive care unit (ICU) for the first day or two after your operation, before moving to a surgical ward.
⭐️ Staying in an ICU
While you're in the ICU:
you may be kept asleep for the first few hours, or until the following morning the activity of your heart, lungs and bodily functions will be closely monitored
you'll be given painkillers for when your anaesthetic wears off – let a nurse or the doctor in charge of your care know if these aren't helping
a tube attached to a ventilator will be placed down your throat until you're able to breathe on your own – this may be uncomfortable and you won't be able to talk, eat or drink while it's in place
When you're taken off the ventilator, a mask will be placed over your mouth and nose to supply oxygen for you to breathe.
⭐️ Moving to a ward
You'll be moved from the ICU to a surgical ward once the doctors treating you think you're ready.
You may have several tubes and monitors attached to you during the first few days of your stay. These could include:
chest drains – small tubes from your chest to drain away any build-up of blood or fluid
pacing wires – if necessary, these will be inserted near the chest drains to control your heart rate
wires attached to sensor pads – these can be used to measure your heart rate, blood pressure and blood flow, and the air flow to your lungs a catheter – a tube inserted into your bladder so that you can pass urine
Your care team will focus on increasing your appetite and getting you back on your feet.
Someone from the cardiac rehabilitation team or physiotherapy department will give you advice about getting back to normal, and where there is a cardiac rehabilitation programme or support group in your area.
The aim is to help you recover quickly and get back to living as full and active a life as you can, while preventing further heart problems.
⭐️ Going home
Depending on how well you progress, you should be able to leave the hospital about a week after your operation.
Before going home, you'll be given advice about caring for your wound and any activities you need to avoid until you've recovered.
Returning to your normal activities
You'll need to take things easy at first. Starting gentle exercise such as walking can be helpful when you feel up to it, but don't try to do too much too quickly.
Your doctor or surgeon can give you specific advice about when you can return to your normal activities, but generally speaking:
you can be a passenger in a car straight away
you may not be able to drive for around six weeks – wait until you can comfortably do an emergency stop
you can have sex after four to six weeks – make sure you feel strong enough first
when you can return to work depends on the type of work you do – this could be as soon as six to eight weeks if your job mainly involves light work, but may not be for three months if it involves manual labour
you should avoid strenuous exercise, sudden strains and heavy lifting for three months
Possible side effects
While at home, you may experience some temporary side effects that should start to improve as you recover. These can include:
pain and discomfort – you can take painkillers to relieve this, although it should improve as your wound heals
swelling and redness around your wound that should gradually fade
loss of appetite
difficulty sleeping (insomnia)
constipation – drinking plenty of fluids and eating fruit and vegetables can help with this; your doctor may also suggest taking a laxative
mood swings, irritability, anxiety and depression – these are completely normal after major surgery; talking to your friends and family can help, and your cardiac nurse can also offer support
loss of interest in sex – this is common in people with serious illnesses; in men, the associated emotional stress can also result in erectile dysfunction
Speak to your GP for advice if you're struggling to cope with the after effects of your operation or they don't seem to be improving.
When to get medical advice
Contact your Doctor if you experience:
increasing redness, swelling or tenderness around the wound
pus or fluid oozing from the wound
pain that's getting worse
a high temperature of 38C (100.4F) or above
increasing shortness of breath
a return of the symptoms you had before the operation
⭐️ Risks of an aortic valve replacement
Like any type of surgery, an aortic valve replacement is associated with a number of complications. Fortunately, serious problems are uncommon.
The risk of experiencing complications is generally higher for older people and those in generally poor health.
Possible problems include:
Infection – there's a risk of wound infections, lung infections, bladder infections and heart valve infections (endocarditis). You may be given antibiotics to reduce this risk.
Excessive bleeding – tubes may be inserted into your chest to drain the blood, and sometimes another operation is needed to stop the bleeding.
Blood clots – this is more likely if you have had mechanical valve replacement. You'll be prescribed anticoagulant medication if you're at risk.
Stroke or transient ischaemic attack (TIA) – where the supply of blood to the brain becomes blocked.
The valve may wear out – this is more likely in people who have had a biological valve replacement for a long time.
Irregular heartbeat (arrhythmia) – this affects around 25% of people after an aortic valve replacement and usually passes with time. However, 1-2% of people will need to have a pacemaker fitted to control their heartbeat.
Kidney problems – in up to 5% of people, the kidneys do not work as well as they should for the first few days after surgery. In a few cases, temporary dialysis may be needed.
An aortic valve replacement is a major operation and occasionally the complications can be fatal. Overall, the risk of dying as a result of the procedure is estimated to be 1-3%.
However, this risk is far lower than the risk associated with leaving severe aortic disease untreated.
Arrhythmia Treatment
An arrhythmia (ah-RITH-me-ah) is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.
Many arrhythmias are harmless, but some can be serious or even life threatening. If the heart rate is abnormal, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs.
Medicine usually is the first line of treatment for arrhythmias. If medicine doesn't work well, your doctor may recommend surgery. For example, surgery may be used to implant a pacemaker or an implantable cardioverter defibrillator (ICD).
A pacemaker is a small device that's placed under the skin of your chest or abdomen. Wires connect the pacemaker to your heart chambers. The device uses low-energy electrical pulses to control your heart rhythm. Most pacemakers have a sensor that starts the device only if your heart rhythm is abnormal.
An ICD is another small device that's placed under the skin of your chest or abdomen. This device also is connected to your heart with wires. An ICD checks your heartbeat for dangerous arrhythmias. If the device senses one, it sends an electric shock to your heart to restore a normal heart rhythm.
Another arrhythmia treatment is called maze surgery. For this surgery, the surgeon makes new paths for the heart's electrical signals to travel through. This type of surgery is used to treat atrial fibrillation, the most common type of serious arrhythmia.
Simpler, less invasive procedures also are used to treat atrial fibrillation. These procedures use high heat or intense cold to prevent abnormal electrical signals from moving through the heart.
Aneurysm Repair
An aneurysm (AN-u-rism) is a balloon-like bulge in the wall of an artery or the heart muscle. This bulge can occur if the artery wall weakens. Pressure from blood moving through the artery or heart causes the weak area to bulge.
Over time, an aneurysm can grow and burst, causing dangerous, often fatal bleeding inside the body. Aneurysms also can develop a split in one or more layers of the artery wall. The split causes bleeding into and along the layers of the artery wall.
Aneurysms in the heart most often occur in the heart's lower left chamber (the left ventricle). Repairing an aneurysm involves surgery to replace the weak section of the artery or heart wall with a patch or graft.
Heart Transplant
A heart transplant is surgery to remove a person's diseased heart and replace it with a healthy heart from a deceased donor. Most heart transplants are done on patients who have end-stage heart failure.
Heart failure is a condition in which the heart is damaged or weak. As a result, it can't pump enough blood to meet the body's needs. "End-stage" means the condition is so severe that all treatments, other than heart transplant, have failed.
Patients on the waiting list for a donor heart receive ongoing treatment for heart failure and other medical conditions. Ventricular assist devices (VADs) or total artificial hearts (TAHs) might be used to treat these patients.
Surgery To Place Ventricular Assist Devices or Total Artificial Hearts
A VAD is a mechanical pump that is used to support heart function and blood flow in people who have weak hearts.
Your doctor may recommend a VAD if you have heart failure that isn't responding to treatment or if you're waiting for a heart transplant. You can use a VAD for a short time or for months or years, depending on your situation.
A TAH is a device that replaces the two lower chambers of the heart (the ventricles). You may benefit from a TAH if both of your ventricles don't work well due to end-stage heart failure.
Placing either device requires open-heart surgery.
Surgical Approaches
Surgeons can use different approaches to operate on the heart, including open-heart surgery, off-pump heart surgery, and minimally invasive heart surgery.
The surgical approach will depend on the patient's heart problem, general health, and other factors.
Open-Heart Surgery
Open-heart surgery is any kind of surgery in which a surgeon makes a large incision (cut) in the chest to open the rib cage and operate on the heart. "Open" refers to the chest, not the heart. Depending on the type of surgery, the surgeon also may open the heart.
Once the heart is exposed, the patient is connected to a heart-lung bypass machine. The machine takes over the heart's pumping action and moves blood away from the heart. This allows the surgeon to operate on a heart that isn't beating and that doesn't have blood flowing through it.
Open-heart surgery is used to do CABG, repair or replace heart valves, treat atrial fibrillation, do heart transplants, and place VADs and TAHs.
Off-Pump Heart Surgery
Surgeons also use off-pump, or beating heart, surgery to do CABG. This approach is like traditional open-heart surgery because the chest bone is opened to access the heart. However, the heart isn't stopped, and a heart-lung bypass machine isn't used.
Off-pump heart surgery isn't right for all patients. Work with your doctor to decide whether this type of surgery is an option for you. Your doctor will carefully consider your heart problem, age, overall health, and other factors that may affect the surgery.
Minimally Invasive Heart Surgery
For minimally invasive heart surgery, a surgeon makes small incisions (cuts) in the side of the chest between the ribs. This type of surgery may or may not use a heart-lung bypass machine.
Minimally invasive heart surgery is used to do some bypass and maze surgeries. It's also used to repair or replace heart valves, insert pacemakers or ICDs, or take a vein or artery from the body to use as a bypass graft for CABG.
One type of minimally invasive heart surgery that is becoming more common is robotic-assisted surgery. For this surgery, a surgeon uses a computer to control surgical tools on thin robotic arms.
The tools are inserted through small incisions in the chest. This allows the surgeon to do complex and highly precise surgery. The surgeon always is in total control of the robotic arms; they don't move on their own.
* CABG
What Is Coronary Artery Bypass Grafting?
Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease (CHD).
CHD is a disease in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.
Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.
CABG is one treatment for CHD. During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new path for oxygen-rich blood to flow to the heart muscle.
Surgeons can bypass multiple coronary arteries during one surgery.
Coronary Artery Bypass Grafting
Overview
CABG is the most common type of open-heart surgery in the United States. Doctors called cardiothoracic (KAR-de-o-tho-RAS-ik) surgeons do this surgery.
However, CABG isn't the only treatment for CHD. Other treatment options include lifestyle changes, medicines, and a procedure called percutaneous coronary intervention (PCI), also known as coronary angioplasty.
PCI is a nonsurgical procedure that opens blocked or narrow coronary arteries. During PCI, a stent might be placed in a coronary artery to help keep it open. A stent is a small mesh tube that supports the inner artery wall.
CABG or PCI may be options if you have severe blockages in your large coronary arteries, especially if your heart's pumping action has already grown weak.
CABG also may be an option if you have blockages in the heart that can't be treated with PCI. In this situation, CABG may work better than other types of treatment.
The goals of CABG may include:
Improving your quality of life and reducing angina and other CHD symptoms
Allowing you to resume a more active lifestyle
Improving the pumping action of your heart if it has been damaged by a heart attack
Lowering the risk of a heart attack (in some patients, such as those who have diabetes)
Improving your chance of survival
Outlook
The results of CABG usually are excellent. The surgery improves or completely relieves angina symptoms in most patients. Although symptoms can recur, many people remain symptom-free for as long as 10 to 15 years. CABG also may lower your risk of having a heart attack and help you live longer.
You may need repeat surgery if blockages form in the grafted arteries or veins or in arteries that weren't blocked before. Taking medicines and making lifestyle changes as your doctor recommends can lower the risk of a graft becoming blocked.
Coronary Artery Bypass Grafting
There are several types of coronary artery bypass grafting (CABG). Your doctor will recommend the best option for you based on your needs.
Traditional Coronary Artery Bypass Grafting
Traditional CABG is used when at least one major artery needs to be bypassed. During the surgery, the chest bone is opened to access the heart.
Medicines are given to stop the heart; a heart-lung bypass machine keeps blood and oxygen moving throughout the body during surgery. This allows the surgeon to operate on a still heart.
After surgery, blood flow to the heart is restored. Usually, the heart starts beating again on its own. Sometimes mild electric shocks are used to restart the heart.
Off-Pump Coronary Artery Bypass Grafting
This type of CABG is similar to traditional CABG because the chest bone is opened to access the heart. However, the heart isn't stopped, and a heart-lung bypass machine isn't used. Off-pump CABG sometimes is called beating heart bypass grafting.
Minimally Invasive Direct Coronary Artery Bypass Grafting
This type of surgery differs from traditional CABG because the chest bone isn't opened to reach the heart. Instead, several small cuts are made on the left side of the chest between the ribs. This type of surgery mainly is used to bypass blood vessels at the front of the heart.
Minimally invasive bypass grafting is a fairly new procedure. It isn't right for everyone, especially if more than one or two coronary arteries need to be bypassed.
Coronary artery bypass graft surgery
⭐️ Definition
Coronary artery bypass graft surgery is a surgical procedure in which one or more blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart. These grafts usually come from the patient's own arteries and veins located in the leg, arm, or chest.
⭐️ Purpose
Coronary artery bypass graft surgery (also called coronary artery bypass surgery [CABG] and bypass operation) is performed to restore blood flow to the heart. This relieves chest pain and ischemia, improves the patient's quality of life, and, in some cases, prolongs the patient's life. The goals of the procedure are to relieve symptoms of coronary artery disease, enable the patient to resume a normal lifestyle, and to lower the risk of a heart attack or other heart problems.
According to the Best Heart Associations appropriate candidates for coronary artery bypass graft surgery include patients who:
have blockages in at least two to three major coronary arteries, especially if the blockages are in arteries that feed the heart's left ventricle or in the left anterior descending artery
have angina so severe that even mild exertion causes chest pain
have poor left ventricular function
cannot tolerate percutaneous transluminal coronary angioplasty and do not respond well to drug therapy
⭐️ Demographics
Coronary artery bypass graft surgery is widely performed in the world.
⭐️ Description
Coronary artery bypass graft surgery builds a detour around one or more blocked coronary arteries with a graft from a healthy vein or artery. The graft goes around the clogged artery (or arteries) to create new pathways for oxygen-rich blood to flow to the heart.
⭐️ Procedure
After general anesthesia is administered, the surgeon removes the veins or prepares the arteries for grafting. If the saphenous vein is to be used for the graft, a series of incisions are made in the patient's thigh or calf. If the radial artery is to be used for the graft, incisions are made in the patient's forearm. It is important to note that the removal of veins or arteries for grafting does not deprive the area of adequate blood flow.
More commonly, a segment of the internal mammary artery is used for the graft, and the incisions are made in the chest wall. The internal mammary arteries are most commonly used because they have shown the best long-term results. Because they have their own oxygen-rich blood supply, the internal mammary arteries can usually be kept intact at their origin, then sewn to the coronary artery below the site of blockage.
The surgeon decides which grafts to use, depending on the location of the blockage, the amount of the blockage, and the size of the patient's coronary arteries.
In traditional coronary artery bypass surgery, the surgeon makes an incision down the center of the patient's chest, cuts through the breastbone, and retracts the rib cage open to expose the heart. The patient is connected to a heart-lung bypass machine, also called a cardiopulmonary bypass pump, that takes over for the heart and lungs during the surgery. During this "on-pump" procedure, the heart-lung machine removes carbon dioxide from the blood and replaces it with oxygen. A tube is inserted into the aorta to carry the oxygenated blood from the bypass machine to the aorta for circulation to the body. The heart-lung machine allows the heart's beating to be stopped, so the surgeon can operate on a still heart. Aortic clamps are used to restrict blood flow to the area of the heart where grafts will be placed so the heart is blood-free during the surgery. The clamps remain until the grafts are in place.
During a coronary artery bypass graft (CABG), the chest is opened to visualize the heart (A). A heart-lung machine takes over the function of the heart during the procedure. A portion of the saphenous vein of the leg is removed (B). This vessel is used to bypass a blockage of the coronary artery. It is attached from the aorta past the point of blockage (C). Another option is to bypass a blockage with the mammary artery (D). The bypass increases blood flow to the area served by the coronary artery (E). (Illustration by Argosy.)
During a coronary artery bypass graft (CABG), the chest is opened to visualize the heart (A). A heart-lung machine takes over the function of the heart during the procedure. A portion of the saphenous vein of the leg is removed (B). This vessel is used to bypass a blockage of the coronary artery. It is attached from the aorta past the point of blockage (C). Another option is to bypass a blockage with the mammary artery (D). The bypass increases blood flow to the area served by the coronary artery (E). Illustration by Argosy.
Some patients may be candidates for minimally invasive coronary artery bypass surgery or for off-pump bypass surgery. During minimally invasive surgery, smaller chest and graft removal incisions are used, promoting a quicker recovery and less risk of infection. Off-pump bypass surgery, also called beating heart surgery, is a surgical technique performed while the heart is still beating. The surgeon uses advanced equipment to stabilize portions of the heart and bypass the blocked artery while the rest of the heart keeps pumping and circulating blood through the body.
After the grafts are prepared, a small opening is made just below the blockage in the diseased coronary artery. Blood will be redirected through this opening once the graft is sewn in place. If a leg or arm vein is used, one end is connected to the coronary artery and the other to the aorta; if a mammary artery is used, one end is connected to the coronary artery while the other remains attached to the aorta. The procedure is repeated on as many coronary arteries as necessary. On average, three or four coronary arteries are bypassed during surgery. Blood flow is checked to assure the graft supplies adequate blood to the heart.
If the procedure was done "on-pump," electric shocks start the heart pumping again after the grafts have been completed. The heart-lung machine is turned off and the blood slowly returns to normal body temperature. After implanting pacing wires and inserting a chest tube to drain fluid, the surgeon closes the chest cavity. Sometimes a temporary pacemaker is attached to the pacing wires to regulate the heart rhythm until the patient's condition improves. After surgery, the patient is transferred to an intensive care unit for close monitoring.
⭐️ Diagnosis/Preparation
Diagnosis
The diagnosis of coronary artery disease is made after the patient's medical history is carefully reviewed, a physical exam is performed, and the patient's symptoms are evaluated. Tests used to diagnose coronary artery disease include:
electrocardiogram
stress tests
cardiac catheterization
imaging tests such as a chest x ray , echocardiography , or computed tomography (CT)
blood tests to measure blood cholesterol, triglycerides, and other substances
Preparation
The individual should quit smoking or using tobacco products before the surgery. The individual needs to make the commitment to be a nonsmoker after the surgery. There are several smoking cessation programs available in the community. The individual can ask a health care provider for more information about quitting smoking.
Coronary artery bypass graft surgery should ideally be postponed for three months after a heart attack. Patients should be medically stable before the surgery, if possible.
During a preoperative appointment, usually scheduled within one to two weeks before surgery, the patient will receive information about what to expect during the surgery and the recovery period. The patient will usually meet the cardiologist, anesthesiologist, nurse clinicians, and surgeon during this appointment or just before the procedure.
If the patient develops a cold, fever, or sore throat within a few days before the surgery, he or she should notify the surgeon's office.
The evening before the surgery, the patient showers with antiseptic soap provided by the surgeon's office. After midnight, the patient should not eat or drink anything.
The patient is usually admitted to the hospital the same day the surgery is scheduled. The patient should bring a list of current medications, allergies, and appropriate medical records upon admission to the hospital .
Before the surgery, the patient is given a blood-thinning drug—usually heparin—that helps to prevent blood clots. A sedative is given the morning of surgery. The chest and the area from where the graft will be taken are shaved.
Coronary angiography will have been previously performed to show the surgeon where the arteries are blocked and where the grafts might best be positioned. Heart monitoring is initiated. The patient is given general anesthesia before the procedure.
The length of the procedure depends upon the number of arteries being bypassed, but it generally takes from three to five hours—sometimes longer.
⭐️ Aftercare
Recovery in the hospital
The patient recovers in a surgical intensive care unit for one to two days after the surgery. The patient will be connected to chest and breathing tubes, a mechanical ventilator, a heart monitor, and other monitoring equipment. A urinary catheter will be in place to drain urine. The breathing tube and ventilator are usually removed about six hours after surgery, but the other tubes usually remain in place as long as the patient is in the intensive care unit.
Drugs are prescribed to control pain and to prevent unwanted blood clotting. Daily doses of aspirin are started within six to 24 hours after the procedure.
The patient is closely monitored during the recovery period. Vital signs and other parameters such as heart sounds, oxygen, and carbon dioxide levels in arterial blood are checked frequently. The chest tube is checked to ensure that it is draining properly. The patient may be fed intravenously for the first day or two.
Chest physiotherapy is started after the ventilator and breathing tubes are removed. The therapy includes coughing, turning frequently, and taking deep breaths. Sometimes oxygen is delivered via a mask to help loosen and clear secretions from the lungs. Other exercises will be encouraged to improve the patient's circulation and prevent complications due to prolonged bed rest.
If there are no complications, the patient begins to resume a normal routine on the second day, including eating regular food, sitting up, and walking around a bit. Before being discharged from the hospital, the patient usually spends a few days under observation in a nonsurgical unit. During this time, counseling is usually provided on eating right and starting a light exercise program to keep the heart healthy.
The average hospital stay after coronary artery bypass graft surgery is five to seven days.
⭐️ Recovery at home
INCISION AND SKIN CARE. The incision should be kept clean and dry. When the skin is healed, the incision should be washed with soapy water. The scar should not be bumped, scratched, or otherwise disturbed. Ointments, lotions, and dressings should not be applied to the incision unless specific instructions have been given.
DISCOMFORT. While the incision scar heals, which takes one to two months, it may be sore. Itching, tightness, or numbness along the incision are common. Muscle or incision discomfort may occur in the chest during activity.
Swelling or aching may occur in the legs if the saphenous vein was used for the graft. Special support stockings may be needed to decrease leg swelling after surgery. While sitting, the patient should not cross the legs and the feet should be elevated. Walking daily, even if the legs are swollen, will help improve circulation and reduce swelling.
LIFESTYLE CHANGES. The patient needs to make several lifestyle changes after surgery, including:
Quitting smoking. Smoking causes damage to the bypass grafts and other blood vessels, increases the patient's blood pressure and heart rate, and decreases the amount of oxygen available in the blood.
Managing weight. Maintaining a healthy weight, by watching portion sizes and exercising, is important. Being overweight increases the work of the heart.
Participating in an exercise program. The exercise program is usually tailored for the patient, who will be encouraged to participate in a cardiac rehabilitation program supervised by exercise professionals.
Making dietary changes. Patients should eat a lot of fruits, vegetables, grains, and non-fat or low-fat dairy products, and reduce fats to less than 30% of all calories.
Taking medications as prescribed. Aspirin and other heart medications may be prescribed, and the patient may need to take these medications for life.
Following up with health care providers. The patient must schedule follow-up visits to determine how effective the surgery was, to confirm that progressive exercise is safe, and to monitor his or her recovery and control risk factors.
⭐️ Risks
Coronary artery bypass graft surgery is major surgery and patients may experience any of the normal complications associated with major surgery and anesthesia, such as the risk of bleeding, pneumonia, or infection. Possible complications include:
graft closure or blockage
development of blockages in other arteries
damage to the aorta
long-term development of atherosclerotic disease of saphenous vein grafts
abnormal heart rhythms
high or low blood pressure
recurrence of angina
blood clots that can lead to a stroke or heart attack
kidney failure
depression or severe mood swings
possible short-term memory loss, difficulty thinking clearly, and problems concentrating for long periods (These effects generally subside within six months after surgery.)
⭐️ There is a higher risk for complications in patients who are
heavy smokers
have a history of lung, kidney, or metabolic diseases
have diabetes
have had a recent heart attack
have a history of angina, ventricular arrhythmias, congestive heart failure, cerebrovascular disease, or mitral regurgitation
Normal results
Full recovery from coronary artery bypass graft surgery takes two to three months and is a gradual process. Upon release from the hospital, the patient will feel weak because of the extended bed rest in the hospital. Within a few weeks, the patient should begin to feel stronger.
Most patients are able to drive in about three to eight weeks, after receiving approval from their physician. Sexual activity can generally be resumed in three to four weeks, depending on the patient's rate of recovery.
It takes about six to eight weeks for the sternum to heal. During this time, the patient should not perform activities that cause pressure or weight on the breastbone or tension on the arms and chest. Pushing and pulling heavy objects (as in mowing the lawn) should be avoided and lifting objects more than 20 lbs (9 kg) is not permitted. The patient should not hold his or her arms above shoulder level for a long period of time, such as when doing household chores. The patient should try not to stand in one place for longer than 15 minutes. Stair climbing is permitted unless other instructions have been given.
Within four to six weeks, people with sedentary office jobs can return to work; people with physical jobs such as construction work or jobs requiring heavy lifting must wait longer (up to 12 weeks) or may have to change careers.
About 90% of patients experience significant improvements after coronary artery bypass graft surgery. Patients experience full relief from chest pain and resume their normal activities in about 70% of the cases; the remaining 20% experience partial relief.
For most people, the graft remains open for about 10–15 years.
Coronary artery bypass surgery does not prevent coronary artery disease from recurring. Therefore, lifestyle changes are strongly recommended and medications are prescribed to reduce this risk. About 40% of patients have a new blockage within 10 years after surgery and require a second bypass, change in medication, or an interventional procedure.
⭐️ Morbidity and mortality rates
The risk of death during coronary artery bypass graft surgery is 2–3%.
In 5–10% of coronary artery bypass graft surgeries, the bypass graft stops supplying blood to the bypassed artery within one year. Younger people who are healthy except for the heart disease achieve good results with bypass surgery. Patients who have poorer results from coronary artery bypass graft surgery include those over the age of 70, those who have poor left ventricular function, are undergoing a repeat surgery or other procedures concurrently, and those who continue smoking, do not treat high cholesterol or other coronary risk factors, or have another debilitating disease.
Over the long term, symptoms recur in only about 3–4% of patients per year. Five years after coronary artery bypass graft surgery, survival expectancy is 90%, at 10 years it is about 85%, at 15 years it is about 55%, and at 20 years it is about 40%.
Angina recurs in about 40% of patients after 10 years. In most cases, it is less severe than before the surgery and can be controlled with drug therapy. In patients who have had vein grafts, 40% of the grafts are severely obstructed 10 years after the procedure. Repeat coronary artery bypass graft surgery may be necessary, and is usually less successful than the first surgery.
⭐️ Alternatives
All patients with coronary artery disease can help improve their condition by making lifestyle changes such as quitting smoking, losing weight if they are overweight, eating healthy foods, reducing blood cholesterol, exercising regularly, and controlling diabetes and high blood pressure.
All patients with coronary artery disease should be prescribed medications to treat their condition. Antiplatelet medications such as aspirin or clopidogrel (Plavix) are usually recommended. Other medications used to treat angina may include beta blockers, nitrates, and angiotensin-converting enzyme (ACE) inhibitors. Medications may also be prescribed to lower lipoprotein levels, since elevated lipoprotein levels have been associated with an increased risk of cardiovascular problems.
Treatment with vitamin E is not recommended because it does not lower the rate of cardiovascular events in people with coronary artery disease. Although antioxidants such as vitamin C, beta-carotene, and probucol show promising results, they are not recommended for routine use. Treatment with folic acid and vitamins B 6 and B 12 lowers homocysteine levels (reducing the risk for cardiovascular problems), but more studies are needed to determine if lowered homocysteine levels correlate with a reduced rate of cardiovascular problems in treated patients.
Less invasive, nonsurgical interventional procedures—such as balloon angioplasty, stent placement, rotoblation, atherectomy, or brachytherapy—can be performed to open a blocked artery. These procedures may be the appropriate treatment for some patients before coronary artery bypass graft surgery is considered.
Enhanced external counterpulsation (EECP) may be a treatment option for patients who are not candidates for interventional procedures or coronary artery bypass graft surgery. During EECP, a set of cuffs is wrapped around the patient's calves, thighs, and buttocks. These cuffs gently but firmly compress the blood vessels in the lower limbs to increase blood flow to the heart. The inflation and deflation of the cuffs are electronically synchronized with the heartbeat and blood pressure using electrocardiography and blood pressure monitors. EECP may encourage blood vessels to open small channels to eventually bypass blocked vessels and improve blood flow to the heart. Not all patients are candidates for this procedure, and treatments, lasting one to two hours, must be repeated about five times a week for up to seven weeks.
❤️❤️
WHO PERFORMS THE PROCEDURE
The surgery team for coronary artery bypass graft surgery includes the cardiovascular surgeon, assisting surgeons, a cardiovascular anesthesiologist, a perfusion technologist (who operates the heart-lung machine), and specially trained nurses.
❤️❤️ (With Thanx To Seher & Salma) ❤️❤️
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