Coronary Artery Disease

What is coronary artery disease (CAD)?

The three main coronary arteries and their branches course along the surface of the heart providing blood to the heart muscle. When these arteries become blocked by plaque, the blood supply is compromised, causing chest pain (angina) and, when severe enough, a heart attack. Several risk factors put you at risk for CAD. These include family history, high blood pressure, diabetes, high cholesterol, cigarette smoking, inactivity and obesity.

How is CAD diagnosed?

Your primary care doctor will often diagnose coronary artery disease based on your history and symptoms. They will order an electrocardiogram and, if they see an abnormality and/or you have symptoms, they will order a stress test (treadmill or chemical). If the results are abnormal, your cardiologist will perform a coronary artery angiogram in the cardiac catheterization lab. This test will demonstrate the severity and number of blockages, and determine the type of treatment needed.

How is it treated?

Depending on the severity, number and location of the blockages, your cardiologist will determine (often in conjunction with the cardiac surgeon) whether medical management, balloon angioplasty and stenting, or coronary artery bypass grafting (CABG) is necessary.

What is coronary artery bypass grafting?

CABG is an operation involving a median sternotomy, exposing the heart, placing the patient on a heart–lung machine (or occasionally left beating, known as off-pump), and using the internal mammary artery, the greater saphenous vein and/or the radial artery to bypass the blockages in the coronary arteries. This provides blood flow to the heart muscle beyond the blockages to prevent a heart attack, eliminate angina, improve heart function and prolong the patient’s life.

What should I expect after the surgery?

The procedure takes approximately three hours. Then you are taken directly to the intensive care unit (ICU). You will have chest tubes and temporary pacemaker wires, which are typically removed by postoperative day 3. While in the hospital, your activity is increased slowly each day, and discharge from the hospital usually occurs by postoperative day 4 or 5.

Physical therapists, in conjunction with your doctors and nurses, will determine if you will be discharged home with home health assistance or to a rehabilitation facility. You will be given detailed instructions upon discharge concerning diet, medications, incision care, sternal precautions, signs and symptoms of an infection or other potential problems, and activity level. You will follow up with your surgeon three to four weeks after discharge, and typically may resume driving and light work duty (no lifting greater than 10 pounds for three months). You will then follow up with your cardiologist, who will then send you to outpatient cardiac rehab.

What are the risks associated with the procedure?

There is about a 4% (4 out of 100) chance of having a complication including but not limited to infection, bleeding requiring reoperation, stroke, organ system failure such as lungs requiring prolonged ventilation, kidneys requiring either temporary or permanent dialysis, heart attack around the surgery, heart failure or prolonged ICU course. There is about a 2% chance of death. These percentages are based on national averages.