CORONARY ARTERY DISEASE

Coronary artery disease is the narrowing or full blockage in one or more arteries called “coronary artery”, which supply blood to the heart muscle. The main cause of the disease is the hardening of the vessels, called “atherosclerosis”. Fat accumulations, which occur in the coronary arteries over time, appear in the form of thickening, called “plaque”, which do not cause a complete blockage in the vessel. The subsequent rupture of this plaque and the resulting clot leads to a complete blockage in the vessel. 

When the coronary arteries begin to narrow due to plaque formations, the amount of blood supplied to the heart reduces. Especially, in the cases of exercise and excitement when the tissues need more oxygen and energy than usual, the amount of blood sent to the heart does not suffice to supply the heart, leading to fatigue, chest tightness and extremely severe, short-term chest pain called angina, a condition which disappears when the patients take a rest. At this point, the patient must definitely see a doctor. If this blockage in the coronary arteries causes a complete blockage in time, the patient will have a heart attack and the heart muscle will be damaged permanently. A patient who has a heart attack suffers very severe chest pain, which does not go away with rest or it will recur over and over again.

WHAT ARE THE TREATMENT OPTIONS?

Treatment options for a person diagnosed with coronary artery disease include medication, opening the blocked vessel by means of balloon or stent method and coronary artery bypass surgery.
Depending on the number of blocked vessels, the severity of the blockage and the localization within the vessel, one of these three treatment methods is preferred. 

Medication mainly reduces the severity of the patient's main complaints such as pain and shortness of breath. Medication also slows down the progression of the disease.

Generally, balloon or stent method is preferred in the case of a blockage in one or two vessels, whereas coronary artery bypass surgery is preferred in widespread blockages involving multiple vessels.

Coronary artery bypass surgery is a bridging operation performed by attaching one end of the artery or vein taken from another part of the body, beyond the obstruction in a blocked vessel. The veins (saphenous vein) used for this purpose are generally taken from the legs and the arteries are taken from underneath the breastbone (internal mammary artery) or from the arm (radial artery). 

 

 

 

 

 

 

 

 

 

 

If the vein taken from the leg or the artery taken from the arm is used, then the other end of the vessel is sutured to the aorta, which is the main vessel coming out of the heart. The artery taken from underneath the breastbone ( internal mammary artery) is sutured  directly to the distal end of the occluded artery. 

Coronary artery bypass operations are performed with the help of a device called heart-lung machine in our country and all over the world. This device enables the heart and lungs to be stopped during the surgery. These operations can be performed in a bloodless and stable heart. In some rare cases, this operation can also be performed on a beating heart. 

The patients usually stay in intensive care for 1 or 2 days postop. The length of hospital stay is 5-7 days. It is a period of approximately one month before the patients get back to their daily routine.