Coronary Artery Bypass

What is coronary artery disease?

The heart is a hard working muscle which constantly pumps blood throughout the body. To do its job, the heart needs its own oxygen-rich blood supply. Coronary arteries provide the blood supply to the cardiac muscle. Coronary artery disease is caused by atherosclerosis, which causes irregularities and thickening of the wall of these coronary arteries. Atherosclerosis is a progressive disease, beginning as early as the childhood years.

As the coronary arteries becoming more diseased, the blood flow to the cardiac muscle is decreased. Chest pain (also called angina) results when the cardiac muscle is not receiving adequate blood supply.

Risk factor for coronary artery disease
Major modifiable risk factors which contribute to coronary artery disease are:

  • High cholesterol
  • High blood pressure
  • Smoking

Non-modifiable risk factors include:

  • Heredity
  • Increasing age
  • Male gender

Other contributing risk factors are:

  • Diabetes
  • Obesity
  • Sedentary lifestyle
  • Illicit drug use

Signs and symptoms of coronary artery disease
Chest pain (or angina) is often described as a squeezing chest discomfort which may mimic heartburn. The discomfort may occur in the neck, back, jaw, or arms. The chest pain may occur with exercise, stressful situations, over eating, or exposure to cold.

A heart attack, or myocardial infarction (MI), occurs when there is a sudden stop or a prolonged reduction of blood flow to a portion of the cardiac muscle. A heart attack is characterized by severe chest pain which is not relieved by rest or oral mediations. The pain may radiate to the arms, neck, jaw, or back. Other symptoms may include shortness of breath, sweating, nausea, and vomiting. Some myocardial infarctions are called “silient,” meaning that there are no symptoms at all. Diabetics are more susceptible to silent MIs.

Surgical treatment for coronary artery disease
Coronary artery disease is diagnosed by a test called cardiac catheterization with coronary angiography. This test produces x-ray images of the coronary arteries. After diagnosis of coronary artery disease, medical treatment and lifestyle changes may be sufficient to manage the disease process. Other non-surgical invasive treatments include coronary artery balloon angioplasty and/or coronary artery stent placement, which increase the lumen of the diseased artery to provide increased blood flow to the cardiac muscle.

The surgical treatment of coronary artery disease is Coronary Artery Bypass Surgery. The purpose of this surgery is to restore blood supply to the cardiac muscle by bypassing the blocked coronary arteries with grafts. The grafts are veins, usually taken from the legs, and/or arteries, which come from underneath the breastbone (internal mammary artery), or from the forearm (radial artery).

To provide exposure for heart surgery, an incision is made down the middle of the chest and the breastbone (sternum) is separated.

This surgical procedure may be done with the use of the heart-lung machine, or more often, it is done on a beating heart with special equipment designed to make this operation possible. The length of this surgical procedure is dependent upon how many coronary arteries need to be bypassed.

After the surgery has been completed, the breastbone is brought together with stainless steel wire. It will take 6-8 weeks for the breastbone to heal.

The surgical team members
The surgical team works together to provide the best and safest patient care possible. The team consists of the surgeon, the surgeon’s assistant, an anesthesiologist, surgical technicians, registered nurses, perfusionists (who run the heart-lung machine), patient care partners, and sterile processing technicians.

After surgery
The heart surgery patient will experience grogginess and some discomfort which is common after any surgical procedure. Medications are provided to ease the discomfort.

The patient may have a breathing tube. Drainage tubes help to remove any fluid which collects around the heart. A catheter drains urine from the bladder. IV lines are used to give fluid and medications. As the patient progresses, these tubes and lines are removed.

Increasing the activity level of the heart surgery patient increases muscle strength, blood flow, and resistance to illness. It is important to sit up and walk as soon as possible after surgery. Respiratory therapists assist the patient with deep breathing and coughing exercises which help to prevent lung problems.

Heading home!
The patient is instructed on medications, nutritional guidelines, smoking cessation, and physical activities. A follow-up appointment is made. It will take about six to eight weeks of healing before the patient is ready to return to their normal daily routine.

Warning signs to be aware of
The patient should call (800) NHI DOCS if any of the following occurs:

  • you gain 3 pounds in one day, or 5 pounds in one week
  • you have chills, sweating, or a fever over 100 F for more than 1 day
  • your heart seems to be beating fast or slow, or if there are skipped beats
  • you have shortness of breath
  • you have pain in your chest or shoulder that worsens with deep breathing or coughing
  • you have swelling, redness, oozing, or tenderness near an incision
  • you have unexplained bruising or bleeding

The incision site may appear bruised and it may be itchy or numb. Wound care instructions are provided before dismissal from the hospital.

If you have any question about Coronary Artery Bypass Surgery, contact the Nebraska Heart Hospital at (800) NHI DOCS.