Heart bypass surgery - an operation which is carried out by blocking one or more coronary arteries. Coronary arteries - the blood vessels that supply the heart with blood, and therefore oxygen and nutrients. Their blocking, partial or total, may lead to various diseases. Heart bypass surgery may be imposed after a failed medical treatment, or after other operations.

Description of operations

The operation is performed under general anesthesia. When the anesthesia takes effect, the surgeon makes an incision in the chest vertical length of 20-25 cm. At the time of surgery, the patient is usually connected to a heart-lung machine, and it does the work of the heart - the body's tissues with blood supplies.

Typically, this option is used the operation if it is assumed that the patient may have problems due to the use of cardiopulmonary bypass.

During such an operation, create a "detour" around the blocked portion of the coronary artery. This may be used hypodermic Vienna, which is located in the leg - the longest Vienna organism. One end of the "bypass" sewn to the coronary artery, the other - to the holes made in the aorta. It also can be used internal thoracic artery - it is already connected to the aorta, and the other end is sewn coronary artery.

The whole operation usually takes four to six hours. After surgery, the patient is placed in the intensive care unit.

Risks

Risks associated with any surgery:

• The formation of blood clots that can get to the lungs;
• Trouble breathing;
• Infections, including infections of the lungs, urinary tract, and chest;
• Blood loss.

Risks specific to cardiac bypass:

• Chest wound infection, which is most likely in people with obesity, diabetes, and those who previously endured the operation;
• Heart attack or stroke Stroke - a serious brain injury ;
• Problems with heart rhythm;
• Renal or pulmonary insufficiency;
• Heat and pain in the chest Chest pain is one symptom - a lot of diseases Characteristic of the condition called postpericardiotomic syndrome, and can last up to 6 months;
• Loss or impairment of memory, fuzzy thinking.

Before surgery

Be sure to tell your doctor about all the medicines you are taking, including non-prescription drugs, as well as grass.

Two weeks before surgery patients are usually asked to stop taking drugs that can hinder blood clotting. This can lead to severe bleeding during surgery. These drugs include aspirin, ibuprofen, naproxen, and others. If you are taking blood thinning medications, talk to your surgeon about when you need to stop taking them.

After midnight the night before the surgery, the patient is generally recommended not to eat or drink. If you experience dry mouth, rinse your mouth with water but do not swallow it. If you still are taking any medications, take them with a very small sip of water.

After operation

After surgery, the patient will spend in the hospital for three to seven days. The first 24 hours it is in the ICU, and then - in a normal ward.

By using two three-tube liquid discharge region of the heart - they are usually removed after one to three days. With the help of special devices medical staff constantly monitors the condition of the patient.

Typically, the patient begins to feel much better within four to six weeks after surgery.

Forecast

Complete recovery from surgery can take a long time - up to six months. The results of operations are saved over the years. However, heart bypass surgery can not prevent another blockage of the coronary arteries. To avoid this, or slow down the process, it is recommended to take the following measures:

• Smoking cessation;
• Healthy eating;
• Regular physical activity;
• Treatment of hypertension Hypertension - dangerous consequences ;
• Control of blood sugar levels Blood sugar - a very important indicator   (diabetic) and cholesterol.

Unstable angina - angina is accompanied by a constant risk of serious complications, mainly myocardial infarction. In unstable angina is almost always trauma cholesterol plaques of the coronary vessels and blood clots.

What is unstable angina

Angina - a sudden onset of sharp pain in the heart, associated with myocardial ischemia Myocardial ischemia - the effect on the functional activity of the heart . That is the pain associated with impaired oxygen supply to the heart muscle. The cause of angina in most cases is coronary heart disease (CHD), which develops against the background of atherosclerosis. In the walls of blood vessels are formed atherosclerotic plaques, soldered with the vessel wall and reduces the lumen, and therefore delivery of arterial blood to the myocardium.

In most cases, angina is initially stable, i.e. depending on the degree of physical activity of the patient. But at some point it becomes unstable angina and depends not only on the physical activity, but also on other factors. Unstable angina - a form of angina, which is intermediate between stable angina Stable angina - one of the manifestations of coronary heart disease   and acute myocardial infarction.

The external factors may include high blood pressure, increased activity of the sympathetic nervous system (for example, against the background of constant stress), high blood lipids, and so on. The internal factors include changes in the structure of cholesterol plaque due to various pathological processes, including the inflammatory disorders.

Under the influence of these factors atherosclerotic plaque (and with it and the wall of a blood vessel) is injured, it activates the process of thrombus formation, by which the body is a "patchwork". In the injured plaques formed thrombus, which further narrows the lumen of the vessel. In the future, or a blood clot may dissolve completely, or break off and "travel" through the circulatory system trombiruya small coronary arteries and causing mikoinfarkty. A blood clot can also be organized, that is to germinate connective tissue and enter the structure of the vessel wall, steadily reducing its lumen.

Sometimes unstable angina and not developing on the background of atherosclerosis. The reason for it in this case are biochemical changes in the cells of the inner shell (endothelium) of the coronary vessels, which leads to increased formation of vasoconstrictor substances and the development of sudden (spontaneous) strokes.

Possible symptoms of unstable angina

There are several options manifestations of unstable angina.

For the first time emerged angina - is characterized by the appearance of angina attacks no more than a month ago. It may be seizures, which appeared for the first time or after a long break. Since the causes of angina and the nature of its intended course still unknown, patients are usually observed and assign them active treatment.

Progressive angina - increased number and severity of available long-term angina attacks, occurring under the influence of earlier exercise tolerance. Angina attacks worse may be removed by nitroglycerine, for their removal requires more than before the dose of nitroglycerin.

Spontaneous (vasospastic, Prinzmetal) angina - the occurrence of angina attacks spontaneously, regardless of physical activity, usually at night. Seizures are long (up to 15 minutes) are not always removed nitroglycerin and accompanied by changes on the ECG.

Postinfarction or postoperative angina - or more frequent occurrence of angina attacks in 24 hours and for 28 days after myocardial infarction, or within 4-8 weeks after the successful surgical treatment of coronary heart disease.

Diagnostics

Diagnosis of unstable angina is based on a thorough questioning of the patient and the analysis of its claims data in conjunction with the diagnostic examination. The main feature of unstable angina is the changing nature of attacks, increasing their frequency and duration.

But quite often the ECG is normal, therefore, to confirm the diagnosis is carried out daily (Holter) ECG monitoring that can detect cases of myocardial ischemia and to correlate them with patient complaints.

Coronary angiography - X-ray examination of the vessels with contrast to evaluate the location, extent and prevalence of atherosclerotic lesions of the coronary vessels. With this study can reveal spasm of the coronary arteries, the presence of thrombi.

To confirm the diagnosis is also carried out to determine the level of activity of cardiac enzymes in the blood (creatine kinase, CK-MB, LDH, ACT), echocardiography (ultrasound of the heart), myocardial scintigraphy (radionuclide study) and some other studies.

Unstable angina requires serious consideration by both the physician and by the patient.

Galina Romanenko