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<p>Today, we will introduce you to coronary artery disease, a condition not only risky for the elderly but also for many other groups who may be at risk without realizing it. This disease has symptoms, treatments, and techniques for self-prevention. Let&#8217;s take a look.</p>
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<h4><span style="color: #00826a;">“How does coronary artery disease occur?”</span><strong><span style="color: #00826a;"><br />
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<p>The doctor simply explains to us that <em><span style="color: #00826a;">“Coronary artery disease occurs when fat deposits build up on the blood vessel walls, causing the arteries that supply the heart to narrow. This reduces blood flow, leading to insufficient blood supply to the heart muscle and increasing the risk of heart attack.”</span></em></p>
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<h4><span style="color: #00826a;">Symptoms to watch out for<strong><br />
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<p>Patients with coronary artery disease may experience symptoms such as chest tightness during exercise or heavy work, which improves with rest. They may also have shortness of breath from heart failure. Some may experience acute chest pain, sweating, and fainting.</p>
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<h4><span style="color: #00826a;">What are the risk factors?</span><strong><span style="color: #00826a;"><br />
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<p>Many people mistakenly believe that aging is the only risk factor for coronary artery disease, not realizing that other factors also contribute, including diseases and behaviors such as high blood pressure, smoking, diabetes, obesity, consuming high-fat foods, and even genetics.</p>
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<h4><span style="color: #00826a;">Treatment with “Bypass Surgery”</span><strong><span style="color: #00826a;"><br />
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<p>Coronary Artery Bypass Grafting (CABG) is heart surgery to treat coronary artery disease by creating a new pathway for blood flow to the heart. Patients feel more comfortable, have a better quality of life, and can perform daily activities normally or nearly normally. It also reduces the risk of sudden death.</p>
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<div>Check the <strong><span style="color: #00826a;">“indications”</span></strong> before surgery. The doctor will take a medical history, perform a general physical examination, and may conduct additional special tests such as an electrocardiogram (ECG), treadmill exercise stress test (if chest pain occurs during the test, it indicates coronary artery narrowing shown on the ECG), echocardiography, coronary computerized tomography angiography, and coronary angiography. The doctor will consider indications such as severe left coronary artery stenosis, multiple severe coronary artery narrowings, or symptoms like chest tightness and shortness of breath.</div>
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<h4><span style="color: #00826a;">“Bypass Surgery” procedure</span></h4>
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<div>The procedure begins with the anesthesiologist administering general anesthesia. The surgeon opens the chest bone and takes the internal mammary artery, leg veins, and/or arm arteries to bypass the blocked arteries. One end of the new vessel is connected below the blocked artery, and the other end is connected above the blocked coronary artery, creating a new blood flow path to improve blood supply to the heart.</div>
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<div>Previously, the surgery often required the use of a heart-lung machine (On-Pump Coronary Artery Bypass Grafting, see Figure 3) to stop the heart, making it easier for the surgeon to operate. Nowadays, coronary artery bypass surgery can be performed without the heart-lung machine (Off-Pump Coronary Artery Bypass Grafting), meaning the heart continues beating while the surgeon uses tools to stabilize the surgical area (see Figure 4). The surgeon will choose the appropriate type of surgery for each patient.</div>
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<h4><span style="color: #00826a;">“Heart-Lung Machine” – Helper or Hindrance?</span><strong><span style="color: #00826a;"><br />
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<p>The use of a heart-lung machine has both advantages and disadvantages. The advantage is that when the heart stops beating, the surgeon can easily connect new blood vessels. However, the disadvantages include causing systemic inflammation because all the blood must pass through the machine to be oxygenated before returning to the patient. This process triggers chemical substances that increase inflammation. The machine also affects platelets and blood clotting, which may cause abnormal bleeding after surgery. It impacts lung, kidney, and brain function. Additionally, the chemicals used to stop the heart can affect heart cells, reducing heart recovery and function after surgery.</p>
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<div>In some elderly patients with fatty deposits on the aorta, using the heart-lung machine may dislodge these deposits into the body&#8217;s circulation. Small air bubbles that may form during the use of the machine can also enter the circulation. If these reach the brain, they can cause paralysis. If the surgeon can perform bypass surgery without the heart-lung machine, all complications related to the machine are completely avoided.</div>
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<div>Off-pump coronary artery bypass surgery is an alternative for patients seeking new options. However, if the surgeon lacks sufficient skill and experience, this method may worsen artery blockages. Poor coordination between the surgeon and anesthesiologist can also negatively affect the patient.</div>
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<div style="text-align: right;"><span style="color: #00826a;"><strong>Dr. Permyos Ruangsakulrat</strong></span></div>
<div style="text-align: right;">Cardiovascular and Thoracic Surgery</div>
<div style="text-align: right;">Heart Center, Phyathai 3 Hospital</div>
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Coronary artery stenosis can be treated with bypass surgery to create a new blood flow pathway, allowing blood to circulate to the heart and other parts of the body more easily, reducing the risk of myocardial ischemia and heart failure.

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