A Brief Note On Coronary Artery Bypass Grafting

Coronary artery disease remains number one killer of the western civilization despite 40 years of aggressive drug and surgical interventions (Esselstyn). Usually, pharmaceutical drugs, such as statin, are given to try to slow the progression, but may provide uncomfortable side effects. In fact, the majority of patients discontinue statins within 1 year of treatment initiation (Maningat). Furthermore, surgery is performed to circumvent clogged arteries and literally bypass the symptoms. In the last year, 500,000 coronary bypass procedures were performed (Swaminathan et al). However, these surgeries can have significant risks, including the potential to cause further heart damage, stroke, and brain dysfunction. Thus, it is evident that these way of treatments may not be enough on its own, and that getting to the

Patient has underlying conditions: Obesity, Coronary Artery disease, Edema, Hypertensions, Dyslipidemia, Ischemia, and hx of quadruple Coronary Artery Bypass Graft.

The patient's comorbidities include Hypertension, hyperlipidemia, CAD, and GERD. The patient had a CABG operation a few days back from admission day on 4-10-2017. In addition to the CABG surgery, other procedures such as TEE, cardiopulmonary bypass, vein harvest, and a thoracotomy with a chest tube and JP drain. Significant surgical procedures also include angioplasty and left and right knee arthroplasty.

Mr. Howard, a 57-year-old man, had a 3-month history of progressive typical anginal chest pain. He reported that the symptoms first occurred with heavy exertion and involved what he described as“heaviness” in his chest. The symptoms were promptly relieved with rest. Over the past weeks, he had been experiencing increasingly frequent episodes of chest pain and diaphoresis. The episodes had become more prolonged, and he had experienced one episode of pain occurring at rest after a heavy meal. Mr. Howard was moderately obese and had a 20-year history of hypertension, which was being treated. Other risk factors in Mr. Howard’s history include hypercholesterolemia (350 mg/dL), which he was attempting to treat with dietary modifications, and a 30-year two-pack-a-day smoking history which continued up to the present time. Mr. Howard previously had surgery for a bilateral inguinal hernia repair, cholecystectomy, and arthroscopic surgery on his left knew. He also gave a history of problems with gastric reflux and was currently taking cimetidine (Tagamet).

(Mayo Clinic, 2013) Some surgical procedures used to treat CAD are angioplasty and coronary artery bypass surgery. (Mayo Clinic, 2013) The angioplasty surgery is when your doctor inserts a catheter to the blockage in the artery and threads the wire through the narrowed arteries. (Opening blocked coronary arteries: New questions about the old answer, nd., p.2) Once the balloon is in place, at the sight of the blockage, the balloon inflates which causes the plaque to crack and the artery to become free from blockage. (Opening blocked coronary arteries: New questions about the old answer, nd., p.2) The other surgical opinion for CAD is coronary artery bypass surgery is a procedure done by a doctor using a graft. (Mayo Clinic, 2013) The doctor will construct a graft to direct the blood flow around the blockage using existing blood vessels in the body. (Mayo Clinic, 2013) Due to the fact that this procedure requires open heart surgery, it is usually used for patients with several partial or full blockages. (Mayo Clinic, 2013)

This helps to improve the blood flow to the heart. A surgical procedure known as coronary artery bypass graft is done when multiple arteries of a patient’s heart become clogged and need to be opened by performing ‘open heart’ surgery. When heart valves get damage because of Lyme disease or any other heart disease, valve replacements might also be done by the doctor.

QRTC= quasi-experimental -nonrandomized controlled trials CD=cross-over design CS=case series PCS= prospective cohort study RCS=retrospective case series MA=meta-analysis

“Coronary Artery Bypass Graft (CABG) surgery is a widely used surgical procedure for the relief of symptoms of Coronary Artery Disease” (Bagielia, Connerney, McLaughlin, Shapiro, & Sloan, 2001, p. 1766). Coronary Artery Disease is the narrowing of the blood vessels that supply oxygen and nutrients to the heart muscles. The buildup of fatty material within the walls of the arteries causes cardiac diseases (Coronary Artery Bypass Surgery,, 2010) .To resolve this issue, surgeons take veins and arteries from elsewhere in the patient’s body. Then, surgeons graft the veins and arteries to the coronary arteries to bypass the atherosclerotic narrowing and improve the blood supply to the heart muscles (Coronary Artery Bypass Surgery,, 2010). This procedure increases the blood flow to the heart by giving the blood a new route around the diseased or clogged artery (Bagielia, Connerney, McLaughlin, Shapiro, & Sloan, 2001).

One of the scariest medical diagnoses a patient can receive from a physician is, their heart is not functioning properly. A malfunctioning heart will eventually lead to death if correction of the issue is not attempted. The heart supplies the entire body with oxygenated blood but also needs its own supply of oxygen rich blood. This is why coronary arteries are vital to the hearts ability to pump. A final option to correcting malfunctioning coronary arteries is a surgical procedure, coronary artery bypass grafting (CABG). Every year approximately 450,000 patients have CABG surgery in the United States (Mullen-Fortino & O 'Brien, 2008). Based on continuing healthcare trends, more and more people each year are having coronary artery issues, causing the need for CABG surgery to rise. Also patient demographics are changing, they are older, sicker, have more extensive coronary artery blockage / damage, and likely have poorer functioning ventricles of the heart (Sidebotham, McKee, Gillham & Levy, 2007). The nursing profession has a critical role in caring for the patients but also teaching and educating them before and after any procedure. Education and teaching has been implemented into evidence-based practice for years to facilitate better patient

Vascular closure devices following cardiac catherization through the femoral artery have been gaining significant traction since its use in the mid-1990s. Compared to the previous gold standard of manual compression, VCDs allow for shortened time to ambulation, decreased duration of hospitalization post procedure, and increased patient comfort. The devices have also shown safeness comparable to manual compression. Despite the many advantages and variety of devices available, there are still complications to take into account. More common issues include device failure, bleeding, and hematoma. Less common but more serious complications include infection, ischemia, limb loss, and death.

Cardiac surgery is among the most frequently performed surgical procedures in the United States. According to the American Heart Association, over 575,000 open heart surgeries were performed in 2005. Until relatively recently, sedation and prolonged ventilatory support through the first twelve to eighteen hours post operatively have been standard. This allowed adequate time for the patient’s hemodynamic, respiratory and coagulation physiological

1. Angioplasty: Kereiakes and Wetherill write that “angioplasty is a procedure in which a heart doctor inserts a balloon catheter over a thin wire across an artery. The balloon is inflated and compresses the plaque to clear the arteries of any blockage.”(p. 106-107).

Cardiac catheterization is often referred to as coronary angiography or a coronary angiogram. It is a radiographic procedure that is used to look at and visualize the heart and the coronary arteries. During a cardiac catheterization it is possible for the cardiologist performing the procedure to see how effectively blood is flowing through the coronary arteries. In addition, this procedure allows the cardiologists to see how blood is moving through the chambers of the heart and how effective the heart valves are functioning. A cardiac catheterization can also allow for the visualization of the movement of the walls of the heart to see if the pumping action of the heart is normal.

There are countless scenarios throughout this series that are similar to what takes place every day in a hospital and what the doctors and nurses see on a daily basis. Grey’s Anatomy benefits its viewers through realistic portrayals. Multiple surgeries have performed on the show that are consistent with literature. This could be a medium for medication students to review their content of interest or for those who are considering joining the medical field. Coronary bypass is one of many surgeries that is often completed on this show. During this procedure blood is diverted around a section of a blocked artery in the heart to restores blood flow to a patient’s heart muscle. Coronary bypass surgeries are just as common on Grey’s Anatomy as they

The goal of medical management is to minimized myocardial damage, preserve myocardial function, and prevent complications. These goals are achieved by reperfusing the area by emergency use of Percutaneous Transluminal Coronary Angioplasty (PTCA) or thrombolytic medication. Minimizing myocardial damage is also accomplished by reducing myocardial oxygen demand and increasing oxygen supply with medications, oxygen administration, and bed rest.