Coronary Artery Disease occurs when the blood vessels supplying blood and oxygen to the muscles of the heart become narrow, restricting the natural flow. This is caused by Atherosclerosis (hardening of the arteries) – a process by which cholesterol and fat deposits build up inside the arteries forming plaque.
- High blood pressure
- Abnormal cholesterol levels (high LDL/low HDL)
- Genetics and family history of heart disease
- Age and sex: 40+ males; Post menopausal women
- High triglyceride levels
- Obesity/sedentary lifestyle
- Previous stroke
- Previous abdominal aortic aneurysm
- Chronic kidney disease
Additional risk factors may exist that can be tested by your physician.
Angina pectoris or chest pain is the most common symptom of Coronary Artery Disease. Angina pectoris is a signal that the heart muscle is not receiving sufficient blood flow. While patients suffering from chest pains associated with angina often notice increased pain with activity and relief with rest, it is not uncommon for coronary artery disease or atherosclerosis to progress without symptoms.
A heart attack or myocardial infarction results from progressive coronary artery disease that leads to complete or severe blockage in an artery. This results in permanent damage to the heart muscle. In addition to chest pain, one may experience sweating, shortness of breath, and nausea during the heart attack. It is possible to have absolutely no symptoms at all.
*NOTE – if you or someone you love is experiencing symptoms of a heart attack, call 911 immediately.
Fortunately physicians today have many tools at their disposal to help accurately diagnose and treat coronary artery disease. The first and most important begins with a thorough history and physical. Tests include:
- Electrocardiogram to indicate ongoing ischemia, arrythmias and/or previous heart damage secondary to coronary atherosclerosis. A normal ECG does not completely rule out the possibility of coronary artery disease.
- Echocardiogram is an ultrasound test that displays heart function and any previous damage caused by coronary artery disease.
- Exercise or nuclear stress test is used to determine heart function while under stress.
- Cardiac catheterization may be used if the above tests or patient history suggest coronary atherosclerosis. A dye is injected into coronary arteries and specialized x-rays locate blockages within the arteries. Results of this test determine whether or not a patient is a candidate for surgery or angioplasty.
Generally there are three modes of treatment for coronary artery disease. Medications may be used to lower cholesterol, decrease blood pressure, and assist the heart in functioning more efficiently. When medication therapy is not successful or when the disease progresses, additional interventional therapy may be required. Cardiologists perform percutaneous interventional procedures to increase blood flow through diseased coronary arteries. Balloon angioplasty and stent placement compresses the plaque against the artery wall in order to widen the blood vessel. The number and location of the blockages helps to determine whether or not these interventions are an option.
Coronary Artery Bypass Graft Surgery (CABG)
When medications and percutaneous interventions are not effective or appropriate, a patient is referred for coronary artery bypass grafting, or CABG. The surgery results in oxygen-rich blood being delivered to the heart muscle beyond the area of blockage. A vein from the leg, an artery from the forearm, or an artery that runs under the chest wall is connected to the blocked or narrowed coronary artery.
- Arrested heart CABG (on-pump CABG) is performed using the heart/lung machine which takes over the pumping function of the heart and the oxygenation function of the lungs. The heart/lung machine enables the surgeon to complete the bypasses on the heart when the heart is completely at rest.
- Beating heart bypass surgery or off-pump CABG is completed without the use of the heart lung machine. The heart continues to beat during the time the bypasses are connected to the heart. Off-pump CABG may lead to fewer side-effects.
The decision to use the heart lung machine is made by the surgeon depending on patient characteristics and location of the blockages on the heart. After CABG, a patient typically stays in the intensive care unit one to two days and in the hospital four to seven days.
What happens the day of surgery? Before the operation the patient meets the anesthesiologist and has special IV’s placed that are necessary for monitoring during the surgery. The patient is then brought to the operating room, anesthetized, and the operation takes place. Coronary artery bypass lasts between 2.5 and 5 hours depending on complexity. After surgery, the patient is brought to the open heart ICU where he or she wakes up over the next few hours. Once awake, the patient is taken off the ventilator (breathing machine) and is usually able to leave the ICU the next morning.
When can families visit? Families can visit in the ICU the day of surgery. Visiting hours for the remainder of the hospitalization are dictated further by hospital policy.
How long is the hospitalization and recovery? The hospitalization is from four to seven days depending on various factors. Beginning as early as the first postoperative day, patients are out of bed and walking. Drains and monitors are gradually removed after which patients are discharged to home or rehabilitation as needed. A gradual return to normal activities occurs over several weeks. In general, patients are instructed to walk each day, climb stairs as tolerated but not to lift heavy objects. Driving can begin usually after a few weeks. Full recovery takes an average of about two months.