Coronary Artery Disease

Coronary arteries are the name given to the vessels that supply the heart itself. 3-5% of the body's total blood flow passes through the coronary arteries. Coronary artery disease is the name given to the disease that occurs as a result of blockages in these vessels themselves. Myocardial infarction caused by coronary artery disease alone is responsible for 20-25% of deaths in the USA. Risk factors for coronary artery disease include abnormal blood lipid levels, hypertension, smoking, diabetes, a family history of coronary artery disease, being overweight, physical inactivity, a fatty diet, and age (men ≥45, women ≥55).

Symptoms and Signs

Although it may progress over many years without any symptoms, new-onset easy fatigue, chest, back or arm pain that occurs with exertion and limits physical activity, and newly developing shortness of breath related to exertion are common symptoms. In addition, the first sign of coronary artery disease may be a sudden heart attack or, in less fortunate patients, sudden death.

Chest pain is typical of coronary heart disease; this pain may radiate to the left arm, neck or upper abdomen. Sometimes, without pain, there may only be a feeling of pressure, burning or fatigue in the chest. In coronary artery disease, the severity of the disease does not necessarily correspond to its symptoms. A patient with very severe coronary disease may have no complaints at all.

Diagnostic Methods in Coronary Artery Disease

ECG, Exercise ECG, Scintigraphy, Echocardiography and Coronary Angiography methods are used.

Three treatment methods are applied in coronary artery disease.

• Drug therapy
• Angioplasty and stent (mesh tube) placement in the coronary arteries
• Coronary artery bypass grafting

​The goal in coronary artery disease is to relieve the patient's complaints while also minimizing the risk of death due to coronary artery disease.

Surgical Intervention

• In left main coronary artery disease
• In three-vessel disease
• In two-vessel disease accompanied by impaired contractile function of the heart
• Recurrent blockages in the left anterior descending artery despite repeated angioplasty and stent (mesh tube) procedures
• If the vessel becomes completely blocked and chest pain begins after an unsuccessful balloon and stent procedure

Today, the greatest difficulty patients with coronary artery disease face is that, after their coronary angiogram, some physicians recommend angioplasty and stent while others recommend bypass surgery. Patients become confused and do not know what to do. In such cases, the most accurate approach is a joint decision made at a center where cardiology and cardiovascular surgery hold a joint consultation. It should be remembered that the intervention to be performed is not only for relieving the patient's complaints. What matters is an intervention that keeps the risk of death due to coronary heart disease at the lowest possible level, including in the long term.

Coronary Artery Surgery

There are many different types of operations in coronary artery surgery.

• Coronary bypass operations performed using a heart-lung machine
• Coronary artery bypass operations performed on a beating heart
• Coronary bypass operation performed without any manipulation of the aorta.

The method to be applied among these 3 is determined according to the patient's condition. Here, additional conditions such as lung disease, a history of stroke, narrowing of the neck vessels and impaired kidney function are important in determining the appropriate method and minimizing the risk of surgery. In coronary artery bypass surgery, arteries taken from other areas of the patient's body [internal mammary artery (chest wall artery), radial artery (arm artery), gastroepiploic artery (stomach artery)] and saphenous veins

are placed so as to provide sufficient blood flow to the lower parts of the blocked coronary vessels.