Blood supply to the heart
Heart is supplied by coronary circulatory system. Aorta divides into right coronary and left coronary arteries. Right coronary artery supplies the right side of the heart and left coronary artery supplies the left side of the heart. Coronary arteries supply oxygen rich blood to heart muscles.
Coronary heart disease
Normally blood vessels are elastic and smooth. Plaque accumulation in coronary arteries results in narrowing and thickening of arteries. Narrowing of blood vessels reduces the blood flow to heart causing chest pain (Heart like any other organ needs sufficient blood supply to work and survive).
- Chest pain – Pain in the chest may feel like any of the bellow
- Squeezing Pain
- A Tight feeling or pain in middle or left side of chest
- Heaviness on the middle or left side of chest
- burning sensation in the middle or left side of chest
- Pain may radiate to left arm, shoulder, neck, lower jaw.
- Shortness of breath (Dyspnea)
- Palpitation – irregular heart beat
- Rapid heart beat
- Nausea – Vomiting sensation
- Excessive sweating
- Feeling weak
Risk factors of acquiring Coronary heart disease
- Physically inactive life style
- Uncontrolled hypertension (high Blood Pressure)
- Uncontrolled diabetes (high blood sugar)
- Increased cholesterol level
- Stressful life style.
- Obesity (over weight)
- Life style modifications like stop smoking
- Stress free lifestyle
- Medical Management
- Antiplatelet drugs (aspirin, clopidogrel) to prevent the formation of blood clot.
- Drugs to relive dilate the coronary blood vessel (nitrates, Beta blockers)
- Antihypertensive drugs (atenlol amlodepine) – Drugs to treat high Blood Pressure
- Cholesterol management drugs(statin)
- Surgical management
- Angioplasty is a minimally invasive procedure to open the narrowed or blocked blood vessels. A deflate balloon with catheter is guided to narrow blood vessel and balloon is inflated to widen the artery to increase the blood flow to heart.
- Coronary artery by-pass Graft surgery
- It is advised for patients with severe coronary heart disease where angioplasty is not possible. This surgery reroutes the blood circulation around the diseased coronary artery to supply oxygen rich blood to heart. During coronary bypass surgery, a healthy blood vessel is taken from your leg, arm or chest and connected to the other arteries in your heart so that blood bypasses the diseased or blocked area
- Alternative therapy
Coronary artery by-pass Graft surgery indications – When is it Done?
- Normally advised for patients with above 50% blockage of coronary artery blood vessel.
- When conventional treatment fails.
- Multiple narrowing or blockage of blood vessels.
- Patients not suitable for angioplasty.
Step by step procedure
Prior to surgery the doctor will perform a ‘complete physical examination, blood test and other investigations to make sure the patient is medically fit for surgery.
Just Minutes before the surgery general anesthesia is administered to the patient by anesthetist and the patient’s vitals are monitored continuously by the anesthetist till the surgery is complete.
Frequently surgeons prefer open heart surgery, in which heart is stopped during the procedure and heart-lung machine connected to the patient which performs the function of heart (on-pump surgery). Minimally invasive procedures are developed termed off- pump surgeries, in which heart is not stopped.
During coronary bypass surgery, a healthy blood vessel is taken from your leg, arm or chest and connected to the other arteries in your heart so that blood bypasses the diseased or blocked area. After successfully taking a graft blood vessel, an Incision is made on the Centre of chest (sternum) vertically and retracted. Sternum is cut and divided to expose the heart. Heart-lung machine is connected to aorta pumps the oxygenated blood to the whole body and receives deoxygenated through veins.
Now the heart is stopped. Surgeon detects/visualizes the narrowed or blocked coronary artery and cuts open beyond the blockage.
One end of the graft blood vessel which was removed is stitched to healthy part of coronary artery and another end other end is attached to aorta. Rerouting of blood circulation beyond the blockage is established. Blood from heart-rending machine is routed back to heart gradually to resume its function.
Procedure usually takes 2 to 3 hours to complete. Patient is monitored in intensive care unit for several days (6 to 10 days) and then shifted to standard hospital rooms for a week before discharge. Patients can resume their normal activities within 4 to 8 weeks.
- Significant improvement is seen in patient undergoing coronary artery by-pass surgery. chest pain and discomfort disappears considerably after the surgery. Patients remains symptom free for a long period of time (5 to 10 years after surgery).
- Post-operative advise for the patient are as follows and following these instructions will maintain an healthy heart.
- Life style modifications
- Regular exercise like swimming pool and walking
- Quit smoking
- Balanced diet reducing cholesterol and fat containing foods
- Cholesterol reducing medicine(statins)
- Anti-platelet therapy (aspirin, clopidigrel)
- lower the risk of recurrence of blockage and to lead a healthy active life