CABG- Coronary Artery Bypass Grafting

Detailed and clear idea about CABG this will be useful for both the Medico Students and Normal people In this which includes definition, indication, contraindication,procedure,Risk,recovery stage ,do's and don'ts, diet,good cholesterol and bad cholestrol it contains all the details which is in easy and understandable

1. SRI MANKULA VINAYAGAR MEDICAL COLLEGE AND HOSPITAL KALITHEERTHALKUPPAM, MADAGADIPET, PUDUCHERRRY – 605107 TEAM BY – E. ASWINI S. SVVETHAPRIYA DEPT OF CARDIOLOGY II YEAR

2. CORONARY ARTERY BYPASS GRAFTING

3. INTRODUCTION A form of bypass surgery in which a healthy blood vessel taken from another part of the body is used to make a new path for blood around a blocked coronary vessel which restores the flow of blood to the parts of heart.

4. Restore blood flow to the heart. Relieve chest pain & ischemia. Improves the patient’s quality of life Enables the patient to resume a normal life cycle. Lower the risk of a heart attack. PURPOSE OF CABG

5. CORONARY ARTERY DISEASE Disease in the heart major blood vessels. Usual cause is build up of plaque which leads to narrowing of coronary arteries, limiting blood flow to the heart. LAD is where most blockages can occur .Extent of blockage vary from 1%-100%

6. INDICATIONS LEFT MAIN ARTERY DISEASE TRIPLE VESSEL DISEASE ABNORMAL LEFT VENTRICULAR FUNCTION AFTER ACUTE MI FAILED PTCA OCCLUSION OF GRAFTS FROM PREVIOUS CABG

7. CONTRAINDICATION Abdominal Aortic Aneurysm Haemorrhage Diseases Congenital Heart Disease Pedal Edema Valvular Heart Disease Uncontrolled Hypertension Pregnancy Uncontrolled Arrhythmias

8. TYPES OF CABG Based on the use of HEART LUNG MACHINE On Pump CABG It is a time honored procedure that is performed while the heart is stopped beating , but blood supply is provided to the rest of the body with the use of CARDIOPULMONARY BYPASS MACHINE.

9. TYPES OF CABG CONT… Off Pump CABG It is performed WITHOUT the use of cardiopulmonary bypass machine . This means the heart is continues to provide blood to the rest of the body by pumping.

10. TYPES OF CABG CONT…. Based on number of Bypasses performed Double Bypass Triple Bypass QdrapleBypas Quintuplee Bypass

11. PROCEDURE Patient is brought to the OT room & shift to the OT table. An ANAESTHETIST places IV & Arterial lines and injects an analgesic. An endotracheal tube is inserted and secured by the anaesthetist and mechanical ventilation is started.

12. PROCEDURE CONT … T he chest is opened via a median STERNOTOMY and the heart is examined by the SURGEON. Bypass Grafts are harvested-frequent vessels are Saphenous veins Internal thoracic arteries Radial arteries ✓ When harvesting is done, HEPARIN is given to inhibit blood clotting.

13. PROCEDURE CONT… In case of “OFF PUMP” , the surgeon places devices to stabilize the heart. In case of “ON PUMP” , the surgeon places sutures cannulae into the heart and Instruct the perfusionist to start CARDIOPULMONARY BYPASS. PROTAMINE is given to reverse the effects of heparin

14. PROCEDURE CONT… Chest tubes are placed in the mediastinal and pleural space to drain blood from around the heart and lungs . The sternum is wired together and the incisions are closed by sutures . The patient is moved to an ICU to recover. After awakening and stabilising in the ICU for 18 to 24 hours and then the patient is shifted to the cardiac surgery ward .

15. RECOVERY PERIOD How do I resume my regular activities after CABG ???

16. RECOVERY PERIOD CONT… Recovery from a CABG procedure takes time and everyone recovers at a slight different speed . AFTER 1 DAY : Able to sit in a chair AFTER 3 DAYS : Able to walk : AFTER 5-6 DAYS : Walk up and down stairs MOSTLY PEOPLE RECOVER WITHIN 12 WEEKS OF THE OPERATION

17. RECOVERY PERIOD CONT … As it takes 6-8 WEEKS to heal your breastbone YOU have to ease back into your regular activities slowly . The RTA enforces NO driving for 4-6 weeks

18. PRECAUTIONS AFTER CABG DO’S Regular Spirometry Regular Walking Supine Lie Down Restrict consumption of Salt (3-5 gms /day) Restrict consumption of water (1-1.5 lts /day) Quit smoking and Alcohol Keep binding your chest belt for 24 hrs. Check your body temperature Have regular follow up visits to doctor Take prescribed medicine on time DONT’S Avoid taking bath until stitches are removed. Avoid bending to the floor Avoid lifting heavy things Avoid consuming fried and spicy foods Don’t operate heavy machinery for 8-10 weeks.

19. COMPLICATIONS AFTER CABG Bleeding during or after surgery Blood clots can cause heart attack,Stroke , Infection at incision site Pneumonia Breathing problems Pancreatitis Kidney failure Arrhythmias

20. DIET PRODUCTS TO CHOOSE Fresh vegetable and fresh fruits Fresh juices Whole wheat Whole grain High fibers such as( Beans,Broccoli,Berries,Avocados,Apples , dried fruits ,etc…) Oatmeal

21. DIET CONT … PRODUCTS TO LIMIT OR AVOID Coconut Creamy sauced , fried and canned veggies and fruits Bakery products such as ( cookies,cakes,white bread ,etc… ) High fat snacks

22. FATTY FOODS Two types of fats, SATURATED & UNSATURATED FATS SATURATED FATS it increases the level of bad cholestrol Meat piece Sausages Butter , ghee , cream, Coconut oil & palm oil

23. FATTY FOODS CONT… UNSATURATED FOODS a balanced diet should still include this , it increases the good cholestrol & help to reduce blockage in arteries Oily fish Avocados Nuts & seeds Sunflower , Olive & Vegetable Oil Maintain a healthy weight according to BMI

24. DO YOUR PART, CARE FOR YOUR HEART!