blood supply to your heart muscle for Humen phisiocal Parts

blood supply to your heart muscle 

Symptoms of coronary artery disease may include:
• Chest pain
• Fatigue (severe tiredness)
• Palpitations
• Abnormal heart rhythms
• Shortness of breath
• Swelling in the hands and feet
• Indigestion

INDICATIONS for CABG

• Left main artery disease or equivalent
• Triple vessel disease
• Abnormal Left Ventricular function.
• Failed PTCA.
• Immediately after Myocardial Infarction (to help perfusion of the viable myocardium).
• Life threatening arrhythmias caused by a previous Myocardial infarction.
• Occlusion of grafts from previous CABGs.

Procedures
The patient is brought to the operating table.
1. An anesthetist places I.V and arteri

al lines and injects and analgesic ( fentanyl) and then injects an induction agent ( propofol) to render the patient unconscious.
2. An Endotracheal tube is inserted and secured by the anaesthetist or assistant and mechanical ventilation is started.
3. The chest is opened via a median sternotomy and the heart is examined.
4. The bypass grafts are harvested- frequently internal thoracic arteries, radial arteries and saphenous veins. When harvesting is done , the patient is given Heparin to prevent the blood from clotting.
5. In the case of OFF- PUMP surgery, the surgeon places devices to stabilize the heart .
6. If the case is ON- PUMP surgery, the surgeon sutures cannulae into the heart and instructs the perfusionist to start cardiopulmonary bypass.
7 . Once CPB is established , the surgeon places the aortic cross clamp across the aorta and instructs the perfusionist to deliver cardioplegia to stop the heart. One end of each graft is sewn on to the coronary ARTERIES beyond the blockages and the other end is stitched to the aorta.
8 . The heart is restarted ; or in OFF -PUMP surgery , the stabilizing devices are removed. In some cases, the aorta is partially occluded by a C – shaped clamp , the heart is restarted and suturing of the grafts to the aorta is done in this partially occluded section of the aorta while the heart is beating.
1. Protamine is given to reverse the effects of Heparin.
10. chest tubes are placed in the mediastinal and pleural space to drain blood from around the heart and lungs.
11. The sternum is wired together and incision are sutured closed.
12. The patient is moved to the ICU to recover. After awakening and stabilizing in the ICU for 18 to 24 hours, the person is transferred to the cardiac surgery ward until ready to go home. (Approximately 4 days.)

Treatment Goals :
1. Relieve pain of intermittent claudication
2. Improve exercise tolerance by increasing the walking distance before the onset of claudication
3. Prevent critical artery occlusion that can lead to foot ulcers, gangrene , and amputation.
4. Prevent heart attacks and strokes.

MANAGEMENT

• EXERCISE : BUERGER'S EXERCISE - Buerger-Allen exercise — Specific exercises intended to improve circulation to the feet and legs.
The lower extremities are elevated to a 45 to 90 degree angle and supported in this position until the skin blanches (appears dead white).
The feet and legs are then lowered below the level of the rest of the body until redness appears (care should be taken that there is no pressure against the back of the knees);
Finally, the legs are placed flat on the bed for a few minutes
The length of time for each position varies with the patient's tolerance and the speed with which color change occurs. Usually the legs are elevated for 2 to 3 minutes, down 5 to 6 min minutes, and then flat on the bed for 5 minutes.
Exercise performed 5 times during one session and thrice a Day.