What is coronary heart disease?
Coronary artery disease is short for coronary atherosclerotic heart disease, which is part of systemic atherosclerotic disease. Coronary artery disease involves the arteries of the heart, causing the otherwise soft and flexible blood vessels to harden and form atheromatous plaques. Atherosclerotic plaques can undergo calcification, ulceration, bleeding, local thrombosis and clot formation. As atherosclerotic plaques and blood clots increase in size, they cause narrowing or even complete occlusion of the coronary artery lumen, resulting in myocardial ischemia or myocardial infarction.
What are the risk factors for coronary heart disease?
Coronary heart disease is the main heart disease among adults in developed countries, and has become the number one killer threatening human health. In China, the incidence of coronary heart disease is also increasing year by year as the standard of living continues to improve. The occurrence of coronary heart disease is associated with a variety of risk factors, which are present in our daily life and closely related to our lifestyle. These risk factors mainly include genetics, hypertension, high cholesterol, hyperlipidemia, diabetes, smoking, and obesity. Coronary atherosclerosis and plaque are formed gradually, and the above risk factors can be controlled and improved, except for heredity. Therefore, we should understand and reduce these risk factors as much as possible in order to fight or delay the hardening and narrowing of coronary arteries and reduce the occurrence of myocardial ischemia or myocardial infarction.
What are the typical symptoms of coronary heart disease?
In a person in a normal state, due to exercise or emotional excitement, the number of heartbeats increases, the contraction of the heart increases, and the blood flow to the heart muscle increases. However, in coronary heart patients, due to the narrowing of coronary arteries, the blood flow supplying the myocardium cannot increase with the needs of the heart, and there is an imbalance between the blood supply to the myocardium and the demand of the myocardium, causing ischemia of the myocardium. Patients experience weakness, chest tightness and discomfort, or feel a crushing pain in the chest, which is known as angina pectoris. Typical angina presents as pain in the left anterior chest area or behind the sternum, with a feeling of tightness, pressure, suffocation, heaviness or numbness in the chest. Angina can radiate to the left upper extremity, shoulder, jaw, upper abdomen, and back, and can be accompanied by chest tightness, breath-holding, and weakness. Angina usually starts gradually and is relieved by rest for a few minutes or by taking nitroglycerin.
If the chest pain or chest discomfort persists without relief, there may be an occlusion of the coronary artery, where blood flow to the heart muscle stops completely and permanent damage occurs to part of the heart muscle, known as myocardial infarction. In severe cases of myocardial infarction, arrhythmias, heart failure and sudden death can occur. Even if death does not occur, the infarcted myocardium has scar tissue to replace it and loses contractile function. If the scar tissue is large, a ventricular wall tumor can also form, with significantly impaired heart function, reduced quality of life and shorter life expectancy.
What tests should be done to diagnose coronary artery disease?
Your ECG may be completely normal if it is not at the time of an angina attack. An exercise ECG is a non-invasive and effective test to aid in diagnosis. The heart rate is increased by exercise to see if myocardial ischemia is present. If an exercise ECG has a positive result, it indicates a more severe stenosis of the coronary arteries and should be followed immediately by a coronary angiogram. If the results of the exercise ECG are negative, most patients probably do not have severe stenosis in the coronary arteries. If the patient is not comfortable with exercise ECG, an echocardiogram combined with a drug test can be used to determine if there is myocardial ischemia. Isotope myocardial perfusion imaging and myocardial metabolic status are also ancillary tests to screen for the presence of myocardial ischemia. If any of the above tests suspect myocardial ischemia, coronary angiography should be performed as soon as possible. Coronary angiography is the most effective test to determine the presence of coronary artery disease and to determine the severity of coronary artery stenosis.
What is coronary angiography?
A coronary angiogram is performed by inserting a catheter through the femoral artery of the patient’s lower extremity or the flexural artery of the upper extremity, reaching the coronary arteries of the heart and injecting a contrast medium. The display will show the severity of the stenosis of the coronary artery and the left ventriculogram will be performed to determine the systolic function of the ventricles.
What are the treatments for coronary artery disease?
There are three main treatments for coronary artery disease: medication, interventional therapy, and coronary artery bypass surgery, all of which are interrelated to achieve optimal treatment. Each of these treatments has clear indications, which are based on scientific research and a lot of clinical experience. Therefore, the choice of treatment is based on scientific evidence and cannot be made blindly based on personal preference and cost. Usually the doctor is able to develop a reasonable treatment plan based on the degree of angina, the condition of the heart function, the severity, length, number and location of the diseased vessels as revealed by coronary angiography.
What is PTCA?
PTCA stands for Percutaneous Transluminal Coronary Angioplasty and is an invasive, but non-surgical treatment for coronary artery disease. The technique begins with the insertion of a sheath catheter through the femoral artery in the lower extremity or the radial artery in the upper extremity to gain access to the aorta, and then a catheter is inserted through the sheath catheter to reach the coronary artery. A smaller catheter is then inserted through this catheter to reach the site of coronary artery stenosis. The tiny catheter has a balloon at the front of the catheter, which fills the balloon and squeezes the plaque, increasing the internal diameter of the stenotic vessel and dilating the coronary artery. In addition, a stent can be placed through this catheter at the site of coronary artery stenosis in order to keep the vessel from narrowing locally.
What is coronary artery bypass surgery?
Coronary artery bypass surgery, known professionally as coronary artery bypass grafting, is a surgical procedure to treat coronary heart disease. Coronary artery bypass grafting involves using a normal artery or vein from another part of the body to supply blood to the distal end of a narrowed coronary artery by taking a normal blood vessel from the patient and connecting one end to the ascending aorta and the other end to the distal end of the narrowed coronary artery. This procedure is called coronary artery bypass surgery because it is like building a bridge. The arterial vessels commonly used for coronary artery bypass surgery are the internal thoracic artery or known as the internal mammary artery, the right flexural artery gastric omentum, and the commonly used venous vessel is the saphenous vein of the leg.
What is the difference between coronary artery bypass surgery and PTCA?
Coronary artery bypass surgery is a surgical procedure to span the narrowed coronary artery to increase the blood supply to the heart muscle. PTCA is a mechanical procedure to widen the internal diameter of the narrowed coronary artery by dilation and placement of a stent. Both have the same result, increasing the blood supply to the heart muscle. The difference is that bypass surgery is performed in the operating room, which requires an open chest and is more traumatic. PTCA is performed in the catheterization laboratory, which is less traumatic and results in a faster postoperative recovery. However, restenosis of the coronary arteries is likely to recur after PTCA. The incidence of restenosis is 30-40% 3-6 months after PTCA and 20% after stenting. Patients who develop restenosis need to undergo PTCA again or switch to coronary artery bypass surgery.
What are the benefits of coronary artery bypass surgery?
The purpose of coronary artery bypass surgery is to surgically improve the blood supply to the heart. Due to the increased blood demand of the heart during exercise, the already narrowed coronary vessels are unable to provide the necessary blood volume and myocardial ischemia and angina occurs. Receiving coronary artery bypass surgery increases the blood supply to the heart muscle and directly resolves the blood supply conflict to the heart muscle. When the patient exercises, the blood supply to the heart increases, myocardial ischemia no longer occurs, and angina symptoms are relieved. over 90% of the patients’ angina symptoms can disappear completely. And the effect is maintained at more than 70% after 5-8 years.
Coronary artery bypass surgery is one of the best treatments for coronary artery disease, and its immediate and long-term results are excellent and have been tested for a long time. Coronary artery bypass surgery is a definitive and effective treatment for coronary artery disease. The long-term results of coronary artery bypass surgery for coronary artery disease are still better than drug or interventional therapy.
What are the methods of coronary artery bypass surgery?
Traditional coronary artery bypass surgery requires assistance with extracorporeal circulation, which allows the heart to be bypassed while it is in arrest. The goal is to provide the surgeon with bloodless, quiet operating conditions to facilitate precise anastomosis in the heart vessels. However, the use of extracorporeal circulation itself has certain risks, such as damage to tissues and organs caused by the inflammatory response of the body. With recent advances in medical technology, it is possible to use a special device to keep only the small part of the heart muscle that needs to be bypassed in minimal motion, while the majority of the heart muscle is still beating normally to ensure blood supply to the whole body. Therefore, this type of heart bypass can be performed without the assistance of extracorporeal circulation. There are advantages and disadvantages to both procedures, and the choice of the procedure depends on the patient’s vascular condition and the presence or absence of other co-morbid heart diseases.
What are the advantages of non-stop coronary artery bypass surgery?
The benefits of non-stop heart bypass surgery are numerous. The complications associated with extracorporeal circulation are avoided because the heart does not stop beating and does not require the assistance of extracorporeal circulation. Patients can be taken off the ventilator earlier after the procedure, which results in less destruction of blood components, less postoperative bleeding, and a corresponding reduction in blood transfusions. The incidence of postoperative vital organ failure is reduced, and the cost of hospitalization is correspondingly reduced.
What are the available vascular materials for coronary artery bypass surgery?
Arterial materials such as internal mammary artery within the chest wall, flexural artery in the upper extremity, gastroretinal artery in the abdominal cavity, and also saphenous vein and small saphenous vein in the lower extremity can be selected for coronary artery bypass surgery. The long-term patency of arterial vessels is good, especially the internal mammary artery with thicker elastic layer and less muscular layer, and the patency rate of more than 10 years is above 90%. The venous vessels are easy to take, but after the venous vessels are subjected to arterial pressure for a long time, the vessel walls are easily degenerated, causing intimal hyperplasia and luminal narrowing, and the patency rate of 10 years is about 50%. Due to the anatomical characteristics of other arterial vessels, the long-term patency rate is between the internal mammary artery and the saphenous vein.
Do I still need to take medication after undergoing coronary artery bypass surgery?
Clinical studies have confirmed that significantly fewer medications are taken after coronary artery bypass surgery than before the procedure. There is also a significant reduction in the amount and cost of medication compared to PTCA treatment. Many of the medications taken after surgery are different from those taken before surgery. The post-operative medications are needed to maintain the patency of the bypass vessels on the one hand, and to prevent and treat coronary heart disease and the risk factors associated with coronary heart disease on the other. If you have high blood pressure, you should insist on taking antihypertensive drugs, and if you have high blood lipids, you should take lipid-lowering drugs. Diabetic patients control blood sugar by taking glucose-lowering drugs or insulin injection and reasonable diet.
What should I pay attention to in my life and diet after coronary artery bypass surgery?
Since one of the causes of coronary atherosclerosis is hypercholesterolemia and hyperlipidemia. Therefore, special attention should be paid to avoid the intake of high cholesterol and high fat foods such as shrimp, crab, egg yolk, fatty meat, cheese, butter and animal offal in the diet. Increase the intake of unsaturated fatty acids in food, and fatty foods should not exceed 30% of the total food. If you have diabetes, you should pay more attention to the diet mix. Because diabetes itself often causes systemic arterial vascular lesions, if diabetes is not well controlled, it will accelerate the lesions of coronary arteries. In addition, even patients without diabetes should reduce the intake of sugar and alcohol, eat more vegetables, fruits, fish and beef, and participate in moderate sports and exercise. It is important to quit smoking after undergoing coronary artery bypass surgery, because smoking is one of the most important factors causing coronary vascular disease. Long-term smoking not only has a serious impact on the lungs, but also causes vascular lesions throughout the body.