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What are Coronary Arteries?

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Coronary arteries are arteries that surround the heart and supply blood to the heart muscle. There are three main coronary artery systems. These arteries are nourished by the aorta, which is the artery that originates from the heart.

What is “Coronary Artery Disease” ?

Coronary Artery Disease (CAD) is a condition caused by the narrowing or blockage of arteries known as coronary arteries that supply blood to the heart muscle, leading to partial or complete interruption of blood flow.

CAD is a leading cause of death in our country, with approximately 200,000 people losing their lives due to CAD each year. The life-threatening nature of this disease is attributed to its ability to lead to myocardial infarction in advanced stages.

CAD is commonly observed after the age of 40, occurring about four times more frequently in men than in women. The presence of the estrogen hormone in women is protective, so the frequency of occurrence increases in the post-menopausal period when estrogen decreases. In men, it is most prevalent between the ages of 50-60, while in women, it is between 60-70. Understanding the risk factors that contribute to this disease and taking preventive measures are as crucial as the treatment itself.

The most common cause is atherosclerosis of the coronary arteries, which is the hardening of the arteries. The type of fat called “cholesterol,” found in animal products and sticking to the inner surface of blood vessels when consumed in excess, reduces the flexibility of our normally elastic arteries and accumulates in the vessel walls, narrowing the vessel lumen. This hardening or blockage of the vessel wall is referred to as “atherosclerosis.”

Risk Factors of Coronary Artery Disease:

Non-modifiable (unavoidable) risk factors:

  • Advanced age (over 45 in men, over 55 in women, and postmenopausal)
  • Gender (more common in men)
  • Family history of the disease

Modifiable (preventable) risk factors:

  • Smoking
  • Hypertension (blood pressure exceeding 140/90 mmHg)
  • Diabetes
  • Stress
  • High levels of cholesterol in the blood

Other risk factors:

  • Obesity
  • Sedentary lifestyle
  • Gout
  • Excessive alcohol and coffee consumption
  • Hypercalcemia (high blood calcium levels)
  • Oral contraceptive (birth control pill) use in women

What are the Preventive Measures for Coronary Artery Disease?

  • Avoid smoking, as it is a significant risk factor.
  • Reduce alcohol and coffee consumption.
  • Lower high cholesterol levels through diet or medication.
  • Engage in regular walking and exercise.
  • Maintain a healthy weight and reach an appropriate weight for your height.
  • Control hypertension and diabetes through diet and medication.
  • Avoid stressful living conditions.

What are the Symptoms of Coronary Artery Disease?

In the early stages, there may be no symptoms when there is no significant narrowing of coronary vessels. Symptoms may include:

  • Chest pain (may radiate to the left shoulder and arm), especially during exercise
  • Limited exercise capacity and easy fatigue
  • Shortness of breath with exertion
  • Syncope (fainting)
  • Sudden death

Sometimes CAD may not exhibit symptoms, and the first sign could be a myocardial infarction.

How is Coronary Artery Disease Diagnosed?

In non-emergency situations (excluding heart attacks), the patient’s physical examination, symptoms, and general condition are initially assessed. Electrocardiography (ECG), Echocardiography (ECHO), and Exercise stress test are used for preliminary diagnosis. In necessary cases, tests like Computed Tomography (CT) and Myocardial Perfusion Scintigraphy can be utilized for further evaluation. For high-risk individuals or those with suspected artery blockages, Coronary Angiography (Cardiac Catheterization) is performed to provide detailed information and confirm the diagnosis.

How is Coronary Artery Disease Treated?

Treatment options include medications, coronary bypass surgery, and percutaneous interventions (balloon angioplasty, stent placement). The choice of treatment depends on various factors such as the number of diseased vessels, the degree of narrowing, the contraction strength of the heart muscle, the patient’s response to medication, age, and more. Treatment plans are personalized for each patient based on their specific conditions.

Medications used in CAD aim to dilate coronary arteries or reduce the oxygen demand of the heart to prevent angina pectoris attacks. Additionally, blood-thinning medications such as aspirin can reduce the risk of heart attacks. Sublingual vasodilator medications taken 5 minutes before exertion can prevent chest pain or terminate an ongoing attack.

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What is Myocardial Infarction (Heart Attack)?

Myocardial infarction occurs when a coronary artery is completely blocked by a blood clot, leading to the death of the heart muscle tissue that the artery supplies. The pain in myocardial infarction is more severe and prolonged than in CAD. It is not related to exercise and can manifest differently. Immediate diagnosis and treatment are crucial to prevent complications.

What is Coronary Bypass Surgery?

Coronary bypass surgery is a procedure that involves creating vascular bridges with vessels taken from other parts of the body to bypass the narrowing in the heart’s own arteries (coronary arteries). This procedure is called “coronary bypass surgery.”

Commonly used vessels in coronary artery bypass surgery:

  • Saphenous vein (from the leg)
  • Internal mammary artery (IMA) (supplies the front wall of the chest)
  • Radial artery (from the forearm)

The selection of these vessels varies from patient to patient. Generally, arteries have a higher chance of remaining open in the long term compared to veins. Coronary artery bypass surgeries can be performed using different techniques.

Thanks to modern surgical techniques and technology, patients can be discharged from the hospital shortly after open-heart surgery (approximately 5 days). They can comfortably engage in activities at home and desk work. Within 4-6 weeks, they can return to their normal lives without any restrictions, including activities like driving and sexual activity.

The long-term results of coronary bypass surgery are generally successful. The majority of patients report complete relief from pain and shortness of breath, with improved performance both in professional and personal aspects of their lives. In a small percentage of patients, a repeat surgery may be required within 10 years or longer.

Coronary bypass surgery is a procedure that addresses the consequences, not the causes. By controlling modifiable risk factors, patients can reduce the likelihood of encountering problems again. It is crucial to eliminate risk factors such as smoking, high cholesterol, high blood pressure, stressful living, and uncontrolled diabetes to extend the lifespan of the newly bypassed vessels. Proper diet and medication are significant in improving and enhancing the long-term outcomes of the surgery.

What is Coronary Bypass Surgery, and Who is it Applied to?

The arteries called “coronary arteries” bring the blood that our heart needs. Over time, these arteries may experience narrowing and blockages. As a result, the heart may become inadequately nourished, and its functions may be compromised. In individuals with these issues, the risk of chest pain or a heart attack arises. At this point, the procedure of attaching new vessels in place of blocked heart arteries is called “Coronary Bypass Surgery.”

How is Bypass Surgery Performed?

The operation related to coronary artery blockage is known as “Aorta Coronary Bypass.” This operation can be performed on a “working” or “stopped” heart. “Working heart bypass” was widely practiced for a period, but in today’s context, it is a method preferred in certain special cases. More commonly applied is the “stopped heart bypass,” where the body’s circulation is maintained with a lung-heart pump. After completely stopping the heart, a “bypass” (bridging) is created for the blocked arteries in the heart. Vessels taken from the body, such as the saphenous vein (SV), radial artery (RA), or internal thoracic artery (ITA), can be used for this purpose. Adequate lengths of segments from these vessels are connected to the large vessel (aorta) leaving the heart, creating a bridge to the vessels beyond the blockages in the coronary arteries. This allows sufficient blood flow to the areas of the heart affected by a heart attack.

Does the Use of These Vessels Obtained for Bypass Cause Any Issues?

Since these vessels function as part of a redundant system, taking them from their original location and using them in the heart does not lead to any functional deficiencies.

Is Bypass Surgery Risky?

There are various risk factors in bypass surgery. These can be listed as follows:

  • Patient’s age
  • Patient’s gender
  • Presence of heart muscle weakness due to previous heart attacks or the heart muscle not functioning
  • Presence of additional complications in the heart valves
  • Presence or absence of functional loss in other systems outside the circulatory system is crucial.

In Which Cases is Bypass Performed?

Bypass surgery is performed in the following cases:

  • When multiple coronary arteries cannot be opened with non-surgical methods (balloon-stent)
  • When one or more arteries, previously opened with non-surgical methods, become blocked again
  • In cases where heart valve surgery is required, involving one or more diseased coronary arteries.

What Should Patients Pay Attention to After Bypass Surgery?

After such an operation, the patient needs to significantly change their previous lifestyle. Eating and drinking habits, medication use, travel plans, sports activities, and daily life should be conducted in accordance with the doctor’s recommendations.

Is Diet Important After Bypass Surgery?

A person undergoing the operation should establish a new routine for dietary habits and adapt to a diet that preserves heart health. It is recommended for the patient to seek assistance from a nutrition and diet expert if possible.

Does Bypass Surgery Cause Psychological Disorders in Individuals?

Although many patients easily tolerate the radical changes in their lives after the surgery, it can sometimes lead to significant psychological difficulties. In such cases, psychological assistance may be necessary.

Is the Sexual Life of Individuals Affected Negatively After Bypass Surgery?

Certainly, the sexual life of those undergoing such an operation is significantly affected. However, for patients in the elderly age group, this condition is somewhat alleviated. For younger patients, avoiding the use of drugs that can exacerbate this condition as much as possible is advised. This is a matter that cardiologists and cardiac surgeons pay careful attention to. Additionally, it should be clearly stated that some drugs used for erectile dysfunction in these patients can be very risky and, in some cases, lead to fatal consequences.