Coronary Artery Bypass Grafting (CABG)

Diagnosis

To diagnose coronary artery disease, a health care provider will examine the patient. They’ll likely be asked questions about their medical history and any symptoms.

• Electrocardiogram(EKG or ECG) - This quick and painless test measures the electrical activity of the heart. It can show how fast or slow the heart is beating. The doctor can look at signal patterns to determine if the patient is having or had a heart attack.
• Echocardiogram - This test uses sound waves to create pictures of the beating heart. An echocardiogram can show how blood moves through the heart and heart valves.
• Exercise stress test - If signs and symptoms occur most often during exercise, the healthcare provider may ask the patient to walk on a treadmill or ride a stationary bike during an ECG. If an echocardiogram is done while doing these exercises, the test is called a stress echo. If the patient can't exercise, they might be given medications that stimulate the heart like exercise does.
• Nuclear stress test - A nuclear stress test shows how blood moves to the heart muscle at rest and during stress. A radioactive tracer is given by IV. The tracer helps the heart arteries show up more clearly on images.
• CT Scan - A CT scan of the heart can show calcium deposits and blockages in the heart arteries. Calcium deposits can narrow the arteries.
• Cardiac catheterization and angiogram - During cardiac catheterization, a heart doctor (cardiologist) gently inserts a flexible tube (catheter) into a blood vessel, usually in the wrist or groin. The catheter is gently guided to the heart. X-rays help guide it. Dye flows through the catheter. The dye helps blood vessels show up better on the images and outlines any blockages.

Risk factors

Following a coronary artery bypass graft, there are several factors that increase your risk of developing complications. These include:

• Age – Risk of developing complications after surgery increases as one gets older
• Having another serious long-term health condition – Having a condition such as diabetes, chronic obstructive pulmonary disease (COPD) or severe chronic kidney disease can increase risk of complications
• Gender – women tend to develop coronary artery disease later than men; it's thought this may lead to a higher risk of having complications because they're generally older at the time of surgery.
• Having emergency surgery to treat a heart attack – Emergency surgery is always riskier because there's less time to plan the surgery, and the heart can be seriously damaged from the heart attack.
• Having 3 or more vessels grafted – the more complex the operation, the greater the chance of having complications.
• Being obese – if someone is obese, the surgeon will have to make a deeper cut to gain access to the heart, which has a higher risk of becoming infected.

Preparing for surgery

• It's a good idea to be well prepared before going into hospital to have a coronary artery bypass graft (CABG).

• If the surgery is scheduled in advance and isn’t an emergency procedure, the patient will most likely have several preoperative appointments where they'll be asked about their health and family medical history.

• They’ll also undergo several tests to help the doctor get an accurate picture of their health. These may include:

1. Blood tests

2. Chest X-ray

3. Electrocardiogram (ECG or EKG)

4. Angiogram

• Seek doctor’s advice about any medication that affects how the patient’s blood clots. Many pain relievers and heart medications affect clotting, so they may have to stop taking them.

• Quit smoking. It’s bad for heart and increases healing time.

• The doctor must be informed in case of symptoms of a cold or flu. In particular, the flu can put further strain on the heart and can increase chances of a heart attack or worsen heart failure. It can also cause myocarditis, pericarditis, or both. These are potentially serious heart infections.

• Home must be prepared and arrangements must be made to stay in the hospital for several days.

• To reduce the risk of infection, the body of the patient must be washed with a special soap the night before surgery.

• Fast, which includes not drinking water, beginning at midnight before the surgery.

• All the prescribed medication by the doctor must be taken.

Recovery

Most people who have CABG will need several weeks to fully recover from this procedure. During that time, the provider will likely have the patient avoiding any strenuous activities or situations that might put too much stress on the heart and incisions.

During the recovery, the patient should also follow the provider’s guidance regarding the following:

• Taking medication- This is an essential part of recovery. Any questions must be asked directly to the healthcare provider.

• Go to cardiac rehab- These programs can make a huge difference in overall recovery and how the patient feels after your procedure. Because they’re medically monitored and staffed by trained medical professionals, they can also help catch any potential problems or warning signs sooner rather than later.

• Taking care of mental health- People who undergo CABG could experience mental health issues like anxiety or depression. These are normal and are nothing to feel shame over. Talking to mental healthcare professionals about these issues is just as important as seeing a provider about heart problems.

• Make lifestyle changes- Though CABG can restore blood flow, the issues that caused you to need CABG can still happen again. It’s important to follow the healthcare provider’s guidance on improving your lifestyle, including diet and how much to exercise. Improving the lifestyle can help avoid further complications in the future.