What are the symptoms of coronary artery stenosis?
The common symptoms of this disease are mostly chest tightness radiating to the left shoulder and left arm. Some cases may radiate up the neck. Symptoms worsen with exertion but improve with rest. In cases where the coronary artery is severely narrowed or completely blocked, it can cause severe myocardial ischemia leading to myocardial infarction, which presents with severe chest tightness, restlessness, sweating, and cold extremities. If not promptly taken to the hospital, it may result in death. Some patients, especially those with diabetes, may not experience chest tightness but may have heart failure symptoms such as easy breathlessness. Some may come to the hospital with cardiac arrest.
Surgical treatment for coronary artery stenosis
There are 3 types of surgical treatments for coronary artery stenosis:
- Traditional Coronary Artery Bypass Grafting using cardiopulmonary bypass machine is a major surgery that requires opening the chest. Medication is used to stop the heart from beating, and special equipment is used to maintain blood circulation throughout the body without passing through the heart until the surgery is completed. This method has been used for over 30 years and has been proven effective both in the short and long term.
- Off-Pump Coronary Artery Bypass Grafting is a bypass surgery that opens the chest similar to the first method, but the heart is not stopped with medication, and no special blood pumping equipment is used.
- Minimally Invasive Direct Coronary Artery Bypass Grafting is surgery using special equipment that allows the surgeon to avoid opening the chest. It is usually performed when the coronary artery blockage is located at the front of the heart. This method is not suitable for patients with multiple coronary artery blockages.
Who needs CABG surgery?
- Patients with coronary artery stenosis symptoms that cannot be treated by other methods
- Patients with severe stenosis of the left main coronary artery
- Patients with severe multiple coronary artery stenoses, especially those with diabetes or chronic kidney failure
- Some patients who need to prevent acute myocardial ischemia, even without symptoms but have significant stenosis of the main coronary arteries supplying a large area of the heart muscle
Preparation before coronary artery bypass surgery
Coronary artery bypass surgery is a major operation, so patients need to prepare their bodies well. Doctors and nurses will guide and take care of the patient’s readiness, but the patient must strictly follow the instructions. There are many details to prepare before surgery, but the main points are as follows:
- Take food and medication strictly as prescribed by the doctor
- Stop certain activities such as smoking and drinking alcohol
- Stay in the hospital to prepare the body before the surgery day
- Undergo preoperative evaluation by a cardiac surgeon and anesthesiologist
- Check blood tests and prepare blood
- Stopping antiplatelet drugs depends on the doctor’s diagnosis, as in some cases stopping medication may be dangerous and cause myocardial infarction before surgery
- Leave valuables, dentures, glasses, or other personal items with a close person or nurse before surgery
Postoperative care after coronary artery surgery
Patients should stay in the CCU for about 2 days because immediately after surgery, they may have a breathing tube. Once the patient recovers well, they will be able to breathe on their own, and the nurse will remove the breathing tube. When the patient can breathe well independently, they will be transferred from the CCU to a room with heart rate monitoring equipment. As the patient gets stronger, they will be able to walk to the bathroom by themselves, with physical therapists assisting in rehabilitation. Usually, patients stay in the hospital for about 1 week after surgery, then return home to recover and follow up with the doctor for ongoing monitoring and treatment.
Assoc. Prof. Dr. Kittichai Luangtaweeboon
Cardiovascular and Thoracic Specialist
Heart Center, Phyathai 1 Hospital
