CABG

CORONARY ARTERY BYPASS GRAFTING

 CORONARY BYPASS SURGERY IS AN
OPEN-HEART SURGERY, YOU MIGHT
HAVE COMPLICATIONS DURING OR
AFTER YOUR PROCEDURE. POSSIBLE
COMPLICATIONS INCLUDE: BLEEDING.
AN IRREGULAR HEART RHYTHM.
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There is a wide variety of vascular conduits

available for CABG. The most commonly
used are as follows: internal thoracic artery
(ITA), saphenous vein (SV), radial artery
(RA), right gastroepiploic artery (RGEA), and
occasionally ulnar artery (UA), splenic artery,
and inferior epigastric artery.
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INTODUCTION

Coronary artery bypass graft surgery (CABG) is

a procedure used to treat coronary artery
disease. Coronary artery disease (CAD) is the
narrowing of the coronary arteries – the blood
vessels that supply oxygen and nutrients to the
heart muscle. CAD is caused by a build-up of
fatty material within the walls of the arteries.
This build-up narrows the inside of the arteries,
limiting the supply of oxygen-rich blood to the
heart muscle.
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One way to treat the blocked or narrowed arteries is to

bypass the blocked portion of the coronary artery with a
piece of a healthy blood vessel from elsewhere in your
body. Blood vessels, or grafts, used for the bypass
procedure may be pieces of a vein from your leg or an
artery in your chest. An artery from your wrist may also be
used. Your doctor attaches one end of the graft above the
blockage and the other end below the blockage. Blood
bypasses the blockage by going through the new graft to
reach the heart muscle. This is called coronary artery
bypass surgery. T
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TRADITIONALLY, TO BYPASS THE BLOCKED CORONARY ARTERY, YOUR DOCTOR
MAKES A LARGE INCISION IN THE CHEST AND TEMPORARILY STOPS THE HEART.
TO OPEN THE CHEST, YOUR DOCTOR CUTS THE BREASTBONE (STERNUM) IN HALF
LENGTHWISE AND SPREADS IT APART. ONCE THE HEART IS EXPOSED, YOUR
DOCTOR INSERTS TUBES INTO THE HEART SO THAT THE BLOOD CAN BE PUMPED
THROUGH THE BODY BY A HEART-LUNG BYPASS MACHINE. THE BYPASS MACHINE
IS NECESSARY TO PUMP BLOOD WHILE THE HEART IS STOPPED.
WHILE THE TRADITIONAL "OPEN HEART" PROCEDURE IS STILL COMMONLY DONE AND OFTEN
PREFERRED IN MANY SITUATIONS, LESS INVASIVE TECHNIQUES HAVE BEEN DEVELOPED TO
BYPASS BLOCKED CORONARY ARTERIES. "OFF-PUMP" PROCEDURES, IN WHICH THE HEART DOES
NOT HAVE TO BE STOPPED, WERE DEVELOPED IN THE 1990'S. OTHER MINIMALLY INVASIVE
PROCEDURES, SUCH AS KEYHOLE SURGERY (DONE THROUGH VERY SMALL INCISIONS) AND
ROBOTIC PROCEDURES (DONE WITH THE AID OF A MOVING MECHANICAL DEVICE), MAY BE USED.
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Symptoms of coronary artery disease may include:

•Chest pain
•Fatigue (severe tiredness)
•Palpitations
•Abnormal heart rhythms
•Shortness of breath
•Swelling in the hands and feet
•Indigestion
        
CABG
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SIGNS AND SYMPTOMS

If your coronary arteries narrow, they can't supply enough oxygen-rich blood to your heart — especially
when it's beating hard, such as during exercise. At first, the decreased blood flow may not cause any
symptoms. As plaque continues to build up in your coronary arteries, however, you may develop the
following coronary artery disease signs and symptoms:
•Chest pain (angina). You may feel pressure or tightness in your chest, as if someone were standing on
your chest. This pain, called angina, usually occurs on the middle or left side of the chest. Angina is
generally triggered by physical or emotional stress. The pain usually goes away within minutes after
stopping the stressful activity. In some people, especially women, the pain may be brief or sharp and felt in
the neck, arm or back.
•Shortness of breath. If your heart can't pump enough blood to meet your body's needs, you may develop
shortness of breath or extreme fatigue with activity.
•Heartattack. A completely blocked coronary artery will cause a heart attack. The classic signs and
symptoms of a heart attack include crushing pressure in your chest and pain in your shoulder or arm,
sometimes with shortness of breath and sweating.
•Women are somewhat more likely than men are to have less typical signs and symptoms of a heart attack,
such as neck or jaw pain. And they may have other symptoms such as shortness of breath, fatigue and
nausea.
•Sometimes a heart attack occurs without any apparent signs or symptoms.
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Causes and prevention
The heart is a muscle that pumps blood to all parts of the body. When the heart chambers
contract, blood is pumped out of the heart through the aorta (the main artery from the heart)
carrying oxygen and nutrients to the rest of the body.  The heart itself also needs oxygen to
function. It’s the job of the coronary arteries to deliver oxygen-filled blood to the heart muscle.
Coronary heart disease is also known as atherosclerotic heart disease, ischaemic heart disease
and coronary artery disease.  It is the result of the narrowing or blockage of coronary arteries by
plaque formed by fat/cholesterol on the artery walls (a process known as atherosclerosis).
There are many risk factors related to coronary heart disease. Some of these risk factors can be
controlled through lifestyle changes and/or medications, while others cannot.  Controllable
factors include:
•High blood cholesterol
•Smoking
•High blood pressure
•Type 2 diabetes
•Physical inactivity
•Obesity
•Poor diet
•Stress / anxiety.
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Non-controllable factors include: 
•Age
•Gender
•Ethnicity
•Family history
•Medical history.
The condition affects men more commonly than pre-menopausal women. However,
after menopause, the incidence in women increases to be virtually the same as men.
Men older than 45 years and women older than 55 years are at increased risk. 
Overall, Maori and Pacific Island New Zealanders are more at risk of suffering from
coronary heart disease.
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Diagnosis
If coronary heart disease is suspected a thorough physical assessment will be undertaken. This will include an assessment of risk
factors and current symptoms. Additional tests to assist with making an accurate diagnosis may also be undertaken. Tests may
include:
 
Blood tests
These check the levels of such things as electrolytes, blood cells, clotting factors and hormones in the blood. Specific enzymes and
proteins that can indicate problems with the heart will be tested for.
 
Electrocardiogram (ECG)
A resting ECG records the electrical activity of the heart when at rest. This may show changes that indicate the heart muscle is not
receiving enough oxygen. Electrical activity of the heart will be recorded using electrodes placed on the arms, legs and chest.
 
Exercise ECG/ Exercise Tolerance Test (ETT)
This test is designed to assess the heart’s response to exercise and stress. It involves walking on an exercise treadmill or riding an
exercise bike for up to 12 minutes at varying degrees of speed and incline. Continuous ECG and blood pressure recordings are taken
and symptoms of coronary heart disease such as shortness of breath, and pain in the chest, jaw or arm will be noted. A doctor and an
ECG technician will be present at all times. Results based on the ECG, blood pressure recordings and any symptoms experienced can
indicate whether coronary heart disease is present.
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Treatment
Depending on test results, various treatment options will be considered. Treatment may include medication, coronary angioplasty (with or without
coronary artery stenting), or coronary artery bypass surgery (commonly known as coronary artery bypass grafting or CABG). Treatment is aimed at
reducing or eliminating symptoms andreducing the risk of having a heart attack.
 
Medications
Classes of medications commonly used to treat coronary heart disease include:
•Beta blockers - These medications slow the heart rate and reduce the blood pressure thus reducing the heart’s workload.
•Nitrates - These medications dilate (widen) the coronary arteries making it easier for blood to be pumped through.
•Calcium channel blockers/calcium antagonists - These medications work by slowing the entry of calcium into the heart and blood vessel walls.  This
relaxes the arteries causing them to dilate. This lowers the blood pressure and reduces the heart’s workload.
•Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) - These medications prevent the constriction of peripheral
blood vessels thereby reducing the pressure against which the heart must pump. They may also prevent the coronary heart disease getting worse.
An antiplatelet agent, such as aspirin or clopidogrel, will also be prescribed (unless there's a medical reason not to) as they help prevent the formation of
blood clots which reduces the risk of having a heart attack or stroke.
 
Some people will require medication called statins to lower their blood cholesterol levels, thereby reducing plaque build-up in the arteries and reducing
the risk of having a heart attack. Common types of statin include simvastatin and atorvastatin.
 
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Prevention
There are a number of lifestyle changes or self-management steps
that can be taken to prevent or reduce the risk of developing coronary
heart disease. These include:
•Eating a healthy, balanced diet (see heart disease diet)
•Limiting alcohol intake
•Quit smoking
•Undertaking regular physical exercise – 30 minutes most days of the
week (see heart disease exercise)
•Maintaining a healthy body weight
•Maintaining healthy blood cholesterol levels
•Effectively treating medical conditions such as type 2 diabetes and 
high blood pressure
•Being aware of risk factors.
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Dietary recommendations for CABG patients
 starchy foods, such as wholegrain rice, bread and pasta. fruit and vegetables –
ideally 5 portions a day.
...
Healthy diet
•meat pies.
•sausages and fatty cuts of meat.
•butter, lard and ghee (a type of butter often used in Indian cooking)
•cream.
•cakes and biscuits.
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Stop if you feel short of breath, dizzy, or any pain in your chest. Do not
do any activity or exercise that causes pulling or pain across your chest,
such as using a rowing machine or weight lifting. Keep your incision areas
protected from the sun to avoid sunburn.
This is a plan to eat plenty of nutrient-rich foods—fruits and veggies,
whole grains, lean poultry and fish. And it also means avoiding saturated
fats, trans fats, and excess sodium and sugar.
To optimize heart health, the American Heart Association (AHA)
recommends maintaining a healthy dietary pattern that emphasizes a
variety of fruits and vegetables, whole grains, low-fat dairy products,
skinless poultry and fish, nuts and legumes, and non-tropical
vegetable oils.
THANK YOU