What to expect from heart surgery

How the Heart Works
Your heart is a muscle. It is located between the lungs, near the center of the chest. It is the size of your fist and weighs about one pound. The heart pumps blood to your lungs and the rest of your body. The work of the heart changes with your body’s needs. When you are active, more blood and oxygen is needed by the body and the heart works harder and faster to supply it. When you rest or are asleep, there is less demand and the heart beats slower.

The heart muscle needs a constant supply of oxygen. The coronary arteries are blood vessels that supply the heart muscle with oxygen rich blood. There are two main arteries, the left main artery and right coronary artery. The left main coronary artery branches off into two vessels, the left anterior descending and circumflex arteries. They feed the front, left side and back of the heart. The right coronary artery supplies blood to the right side, bottom and back of the heart muscle.

The inside of the heart is divided into four chambers. Blood returning from the body enters the heart into the right atrium. It then passes through the tricuspid valve into the right ventricle. The right ventricle sends the blood to the lungs through the pulmonary artery to receive oxygen. The blood then returns to the heart into the left atrium via the pulmonary vein. It then passes through the mitral valve into the left ventricle. The left ventricle then sends the oxygen rich blood to the body through the aortic valve into the aorta. The aorta is a large blood vessel that carries the blood to the body via its numerous branches.

What is Cardiovascular Disease?
Cardiovascular disease occurs when normally healthy smooth elastic arteries become damaged and the blood flow is restricted. As we age our arteries “harden” and become less elastic. Fatty deposits called plaque can build up inside the artery wall. As the plaque builds up the arteries narrow and it is harder for the blood to get through. Sometimes the plaque can rupture. If this happens blood clots can develop at the rupture site that can occlude the artery and block the flow. This can result in a heart attack or stroke.  

Risk Factors for Cardiovascular Disease
Risk factors are characteristics that predispose you to developing cardiovascular disease. Some risk factors can be changed or modified. Some such as age and a family history of cardiovascular disease cannot.

Modifiable risk factors include:

  • Smoking & tobacco use- The chemicals in tobacco increase your blood pressure and heart rate causing your heart to work harder. These chemicals can also damage the inside of the artery wall, lower the good cholesterol (HDL) and raise the bad cholesterol (LDL).
  • Cholesterol- Cholesterol is made in your body in the liver. It is also in the foods you eat such as meats. You do need a certain amount of cholesterol, but too much can cause a buildup of plaque in your body. LDL cholesterol is used by your cells to perform important functions. Excess LDL stays in the blood stream and tends to form plaque. HDL cholesterol helps carry the excess cholesterol out of the body. Lower LDL levels are better. The higher the HDL level, the better. Triglycerides are another form of fat in the body. They help supply energy to the body. Higher levels of triglyceride can lead to higher levels of LDL and may be harmful to the body.
  • Lipids- Lipids are fats in the bloodstream. They include cholesterol, cholesterol esters (compounds), phospholipids and triglycerides. They are transported in the blood as part of large molecules called lipoproteins.
  • Diabetes- Diabetes occurs when your pancreas does not make insulin or makes too little insulin for the body’s needs. This can result in high levels of glucose in the blood. Higher levels of glucose can damage blood vessels and other tissues. If you have diabetes, controlling your blood sugar can lower your risk. 
  • High Blood Pressure (Hypertension)- Blood pressure is the force of the blood pushing against artery walls as the heart beats. When your blood pressure is too high it damages the artery walls and causes the heart to work harder.
  • Stress-When you are under stress it causes the body to release chemicals, which make your heart work harder. It can also cause your blood pressure to rise.
  • Obesity- Being overweight makes your heart work harder. It also may lead to high blood pressure, elevated lipids and diabetes.

Cardiac Procedures for Heart Disease
Coronary Angioplasty
With this procedure, a catheter is used to create a bigger opening in the vessel to increase blood flow. Although angioplasty is performed in other blood vessels, Percutaneous Transluminal Coronary Angioplasty (PTCA)/ or Percutaneous Coronary Intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart.

There are several types of PTCA procedures, including:

  • Balloon Angioplasty - A small balloon is inflated inside the blocked artery to open the blocked area.
  • Atherectomy - The blocked area inside the artery is "shaved" away by a tiny device on the end of a catheter.
  • Laser angioplasty - A laser used to "vaporize" the blockage in the artery.
  • Coronary Artery Stent - A tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.

Coronary Artery Bypass
Commonly referred to as simply "bypass surgery," this surgery is often performed in people who have angina (chest pain) and coronary artery disease (where plaque has built up in the arteries). During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction. Veins are usually taken from the leg, but arteries from the chest or the forearm may also be used to create a bypass graft.

Heart Valve Repair
A surgical procedure in which a damaged valve is repaired by loosening stiff valve leaflets or tightening loose valve leaflets. Minimally invasive options available.

Heart Valve Replacement
In this surgical procedure, a mechanical or tissue valve is transplanted into the heart to replace the damaged valve. Minimally invasive options available.

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