What is coronary heart disease? The heart is like an engine in the human body, it is a pump that sends blood to all parts of the body, and it needs blood supply to maintain its normal work, and the coronary arteries are the blood vessels that supply blood to the heart. If the coronary arteries become spasmodic, stenotic, or clogged, it will cause myocardial ischemia or even necrosis, which we call “coronary atherosclerotic heart disease”. “Coronary atherosclerotic heart disease”, referred to as “coronary heart disease”, also known as “ischemic heart disease”. Clinically, patients may experience angina pectoris, myocardial infarction, heart failure, arrhythmia and sudden death. How does coronary heart disease form and develop? Atherosclerosis is the most important cause of coronary artery stenosis. The gradual deposition of lipids, cholesterol and other substances on the inner walls of blood vessels, forming lipid plaques, gradually thickening the inner layer of the blood vessel wall, narrowing the lumen, hardening the wall and reducing blood flow through the vessel, is a pathological process called atherosclerosis, which usually begins in childhood and continues throughout one’s life. This pathological process is called “atherosclerosis” and usually begins in childhood and continues throughout a person’s life. To use a more common analogy, it is like a water pipe, if there is constant dirt gradually attached to the pipe wall, slowly more and more, it will eventually lead to a thin water flow, and in rare cases, even stop the water. Atherosclerosis does not occur only in the coronary arteries, but throughout the body, causing narrowing of the arteries. This is the reason why many patients undergoing preoperative ultrasound examinations will find the presence of sclerotic plaques or even resulting stenosis within the carotid, vertebral, and renal arteries. With the gradual increase of plaque, thickening, may block the coronary arteries, so that the blood supply to the heart is gradually reduced, when the plaque blockage of the coronary artery diameter of 70% or more, the myocardium will be ischemia, hypoxia, manifested as chest pain, chest tightness, breathlessness, precordial discomfort and other symptoms, known as “angina pectoris”, usually occurs when you exert yourself, activity or emotional excitement, rest or tongue, or when you have to go to the hospital. It usually occurs during exertion, activity or emotional excitement, and can be relieved by resting or sublingual nitroglycerin, and in severe cases, it may occur at rest or even during sleep. It should be added here that many patients say that they have never had angina, but only a little chest tightness or “indescribable discomfort” in the anterior region of the heart, so how can angina occur? In fact, the attack of angina is not necessarily “pain”, most people do not “pain”, just the above mentioned “chest tightness, discomfort”, and some patients manifested as “Stomach pain”, “toothache”, “sore throat”, “throat tightness”. “pain in the left shoulder and arm”, or even just weakness, etc. There are even some patients who have no symptoms at all, but only found abnormalities in ECG or heart ultrasound during checkups, and found to have serious coronary heart disease only after coronary angiography. However, the vast majority of such patients, when asked carefully about their medical history, had discomfort, but it was not serious and did not attract enough attention. Regardless of how different the symptoms, coronary angiography is the “gold standard” for the diagnosis of coronary artery disease, if there are problems with the results of the angiography, it is coronary artery disease. The currently popular “coronary CT” examination can only be a preliminary screening, can not be used as the final definitive diagnosis, and can not be used as the basis for whether the need to put stents and bypass grafts. Then, plaque may rupture and cause acute thrombosis, resulting in acute occlusion of the coronary artery, called “acute myocardial infarction”. Patients may experience persistent chest pain or discomfort in the precordial area, radiating to the back, left forearm or throat, which cannot be relieved by rest or sublingual nitroglycerin. If myocardial ischemia exceeds a certain period of time, the myocardial cells will be permanently necrotic and will not be able to regenerate, and if the ischemic area is large, heart failure or sudden death may occur. Coronary arteries are divided into the left coronary artery and the right coronary artery, in which the left coronary artery is divided into the anterior descending branch and the circumflex branch after the shorter left trunk. What we usually call “three-branch disease” means that the anterior descending branch, the rotary branch and the right coronary artery are all narrowed. Why is a “left main stem lesion” considered more serious? As you can see from the figure below, the left main artery (the location indicated by the “left coronary artery” in the figure below) is located at the source of the left coronary artery, just like the water source is blocked, all the downstream areas will dry up, once a serious stenosis occurs here, it will lead to ischemia in two-thirds of the heart, and is therefore said to be more serious. What kind of tests should be done if I suspect coronary artery disease? If diagnosed, is it better to have a stent put in or a bypass surgery? If you suspect that you have coronary heart disease, you should not just take medication, but go to a regular professional hospital, a professional department (cardiology), and the doctor will prescribe electrocardiograms, cardiac ultrasound, exercise stress test, nuclear examination, cardiac CT and coronary angiography and other tests for you. It is important to emphasize that only coronary angiography is the gold standard for diagnosis, and it is up to the cardiologist to make a judgment based on your condition as to whether or not it is necessary. If the diagnosis is clear after coronary angiography, there are the following five situations: First, there is indeed coronary heart disease, but the degree is not serious, there is no need for medical stenting or surgical bypass surgery, and only oral drug therapy with dietary adjustments and appropriate exercise. Second, the extent of the lesion has reached the point where it cannot be solved by taking medication alone, and stenting is needed and suitable for internal medicine. Third, the extent of the lesion is so large that it is not suitable for stenting, and surgical bypass surgery is necessary. Fourth, the extent and scope of the lesion is suitable for medical-surgical collaboration, whereby the surgeon minimally invasively bridges a major artery with a high long-term probability, and the surgeon puts stents into the other diseased vessels. We call this hybridization surgery. Fifth, the degree and scope of the lesion and other conditions, can not be put into the stent and surgical bypass, only rely on medication to maintain, this state is patients and their families, as well as our doctors do not want to see, therefore, we recommend that you have the disease actively early treatment. As for the patient’s most concerned question, if the coronary angiography examination, it is clear that the lesion is serious, need to put stents, bypass surgery or hybridization technology, which is better? How to choose? This is a professional issue, the specific choice needs to be based on the lesion of the doctor, combined with other factors such as the patient’s physical condition and other factors to consider. It varies from person to person and it is impossible to give a specific answer. Even for us, we choose what is best for the patient according to the guidelines that are constantly being updated. Our general principle is that while the physician is doing the coronary angiogram, the physician determines whether stenting is appropriate, and if it is, then stenting is done. If stenting is not suitable, then we will consider surgical consultation to see if bypass surgery is suitable. There are a small number of patients who are suitable for hybridization surgery. In conclusion, our advice on this issue is that patients and their families should fully trust their doctors and recognize and respect their treatment plans. It is only through mutual trust that the best outcome can be achieved. What is coronary bypass surgery? The term “bypass” is short for coronary artery bypass grafting or coronary artery bypass surgery. It is a procedure in which the patient’s own blood vessels, such as the saphenous vein, radial artery, or internal mammary artery, are used as the “bridge” material to create a new pathway for the area corresponding to the blocked blood vessel in the heart to cross the narrowed coronary artery and anastomose with the distal blood vessel, so that the oxygen- and nutrient-rich blood in the aorta can pass around the narrowed area and reach the distal blood vessel, making the narrowed area more accessible to the patient’s blood. The blood in the aorta, rich in oxygen and nutrients, bypasses the stenosis and reaches the distal blood vessels, so that the ischemic myocardium at the distal end of the stenosis can be supplied with blood again, thus solving the problem of myocardial ischemia at its root. Bypass surgery has an “immediate” effect on the relief of angina pectoris. Depending on the patient’s pre-operative condition, many patients are able to walk up and down stairs within a few days after coronary artery bypass surgery. If they recover well, they can walk the streets a week later. One to two months after surgery, they are able to perform light work. At 3 to 4 months after surgery, recovery is almost complete. Coronary artery bypass grafting surgery is now internationally recognized as the most effective and reliable method of surgical treatment of coronary heart disease, and the success rate of the surgery can reach more than 99% in many large heart centers. It can effectively relieve patients’ angina pectoris, improve patients’ mobility and quality of life, as well as reduce the incidence of myocardial infarction, malignant arrhythmia and sudden death, and prolong patients’ life. What preparations are needed before bypass surgery? First of all, necessary preoperative examinations, including blood tests, electrocardiogram, chest X-ray, cardiac ultrasound, carotid ultrasound and coronary angiography, and other special tests if necessary. Secondly, you need to stop taking oral anticoagulants, such as Polivir, before the operation and wait for a certain period of time. Wait for these drugs to be metabolized and eliminated from the body so as not to increase the risk of bleeding, with the exception of emergency surgery. Also need to reduce activities, bed rest, avoid mental tension, emotional excitement, etc., do not eat too saturated force defecation, keep the bowel movement, if necessary, can be drugs to assist defecation. At the same time in order to prevent postoperative respiratory complications, but also quit smoking, practice deep breathing, coughing action, avoid colds. Ensure a good night’s sleep and take sleeping pills if necessary. It is very important that you tell your supervising doctor if you have had other surgeries or taken other medications in the past, as well as if you have suffered from other illnesses such as glaucoma, peptic ulcers, severe hemorrhoids, stroke, etc.! In a word, no matter what diseases, surgeries or medications you have had in the past, inform your supervising doctor in as much detail as possible. As for the recent increase in the number of patients seeking medical treatment in other places, please consult your local hospital and medical insurance department before coming to the hospital for treatment.