Q.What is coronary artery bypass graft (CABG) surgery ?
A)CABG surgery is advised for a fewer number of patients who have significant narrowings and blockages of the heart arteries.
Q. How does coronary artery disease occur ?
A)Coronary artery disease (CAD) occurs when atherosclerotic plaque (made up of cholesterol) comes up in the wall of the arteries that can happen due to a number of reasons. This results in narrowing in one or multiple arteries. After 70 percent of blockage, the flow of oxygen becomes inadequate. This further becomes the cause of pain in the chest of the patients. A blood clot forms on the top of the plaque, the artery is completely blocked resulting in a heart attack.
Q. How can coronary artery disease be diagnosed ?
A) There are a number of ways such as a resting electrocardiogram (EKG), exercise treadmill tests, the stress test, then there is echocardiography (ultrasound imaging of the heart muscle) with exercise stress testing (stress echocardiography).
In case the patient has problems related to joints or nervous system and he cannot undergo an exercise stress test then medication is injected into him that stimulates stress on heart after which imaging can be performed with ultrasound or a nuclear camera. Another accurate method is Cardiac catheterization with angiography (coronary arteriography)
Q. How can CAD be treated ?
A) Firstly, medicines are prescribed by the doctors for reducing angina. Some of the important drugs are the nitrates, beta blockers and calcium blockers. If the patient's condition is still the same then the data which was collected during coronary arteriography helps the special in deciding whether percutaneous coronary intervention, or percutaneous transluminal angioplasty (PTCA) should be considered. Here a small balloon is used to inflate the blockage. Then is the turn of Angioplasty (PTCA) after placement of a stent or coronary artery bypass graft surgery (CABG) for increasing the flow of blood. But this can only be done in selected patients.
CABG surgery is done for relieving angina in patients who have not gained from medical therapy and cannot be prescribed angioplasty (PTCA). CABG is perfect for those patients who have multiple narrowings in multiple coronary artery branches.
Q. How is the surgery done ?
A) The surgeon first undertakes a process called a median (middle) sternotomy (cutting of the sternum-breastbone). Then the heart is cooled with iced salt water and a preservative solution is injected into the heart arteries. This reduces damage caused by reduced flow of blood (cardioplegia). Prior to the bypass surgery, a cardiopulmonary bypass has to be followed. During the CABG surgery, the aorta is held tightly so that a bloodless field can be maintained.
Q. What is the process of recovery of the patients after CABG surgery ?
A) Before one is given a discharge, sutures are removed from the chest prior and in 7-10 days from the leg. The patient is advised to wear an elastic stockings during the day for the first four to six weeks after surgery for support and also to keep the leg elevated while sitting. The breastbone is healed in around six weeks.
A patient should also not lift anything more than 10 pounds or undertake any heavy exertion during this span. One is also advised not to drive for 4-6 weeks., he can indulge in sexual activities only with minimized positions that do not put weight on the chest or upper arms. One can return back to work after a recovery span of 6 weeks.
Exercise stress testing from time to time for about 6 weeks. Rehabilitation takes a time of at least 12 weeks wherein a patient is given proper guidance about the kind of sober lifestyle he should now be following.
Q. What are the risks and complications involved ?
A) Any kind of risk or complicated becomes high due to the following:
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