• When commonly referring to ‘Heart Disease’, we mean ‘Coronary Artery Disease’ (CAD). This happens when blockages develop up in the coronary arteries.
• These blockages are called Atherosclerotic Plaques as they develop by a process called Atherosclerosis. Atherosclerosis is the process through which Cholesterol & Calcium is deposited inside the arteries.
• Other forms of heart disease include, valvular heart disease, heart failure, & disorders of heart rhythm.

A heart attack can most commonly be described as an injury or death of part of heart muscle. It is also called ‘Myocardial Infarction’ (MI). 2 common reasons why heart attack can occur are:

• Worsening of blockages: As the blockages increase, the flow of blood to the heart muscle reduces leading to a situation that the heart muscle does not receive any blood & oxygen that it needs to function. In the event that blood supply completely stops for 30 minutes or more, the heart muscle supplied blood by that blocked Coronary Artery dies.
• Cracking of Atherosclerotic Plaque: The most common cause of heart attack is due to ‘Cracking’ or ‘Rupture’ of the plaque (Blockage). The plaque can become unstable & crack, forming a blood clot which can travel & completely block flow of blood through an artery causing a heart attack.

When there are significant blockages in Coronary Arteries & the individual performs any Exertional Activity, there is mismatch in demand & supply of blood & oxygen to the heart muscles. This mismatch in demand & supply causes chest pain or discomfort usually on the left side of the chest. This is commonly referred to as “Angina on Exertion”. The discomfort can also present as a radiating to neck, jaw, shoulders, arms and back. 

• In some cases discomfort is only felt in these areas and not in the chest at all.
• Occasionally, Angina may present itself as an upper abdominal pain similar to bloating or acidity.

• Chest Pain that often radiates to one or both the arms, jaw, back & is accompanied by profuse sweating and/or nausea.
• Occasionally, some patients may experience heartburn, acidity not related to food intake nor relieved by antacids. 
• Sometimes patients may experience breathlessness at rest which may or may not be associated with chest pain.

If your doctor suspects a possibility of Coronary Artery Disease, certain tests are performed with an intention to confirm the diagnosis & plan the treatment.

• Electrocardiogram (ECG): ECG is a non invasive test to measure the electrical activity of the heart at rest. In case of any heart disease, there is a change in electrical activity of the heart which may change ECG pattern. Usually, types of changes can be observed.
  1. Changes in ECG pattern suggestive of blockages in coronary arteries.
  2. Changes in ECG pattern which suggest a problem with the rhythm of the heart beats.
• Stress Test/Stress ECG/Treadmill Test (TMT): An ECG at rest has limitations & may miss the diagnosis of a blockage in Coronary Artery Disease. A mismatch of demand supply of blood is hence induced by making a patient run on a treadmill in a controlled environment under medical supervision & changes in ECG are noted. A positive Stress Test/TMT is highly indicative of Coronary Artery Disease.
• Echocardiography (2D Echo): While ECG measures the electrical activity of the heart, 2D Echo uses ultra-sonography to provides images of the heart. Through this test, information regarding the heart’s pumping function, heart’s valve status, condition of its chambers & any heart dysfunction can be ascertained.
• Coronary Angiography (CAG): Incase of positive results in ECG, TMT & 2D Echo, a CAG, which is an invasive test, is performed. CAG is performed by injecting dye (contrast) directly in the arteries of the heart in a Cathlab. CAG displays the exact location & severity of blockages in Coronary Arteries. Depending on various factors such as number of blockages; and their severity & location; further line of treatment is determined. A decision can now be made whether the patient requires “Angioplasty” (PTCA) or “Bypass Surgery” (CABG). 

• Bypass Surgery is a surgical procedure in which a healthy blood vessel (artery or vein) is harvested from other location of the patient & used to form a detour (bypass) around a blockage in a coronary (heart) artery.
• This new blood vessel is called a ‘graft’ & hence the procedure is correctly termed as ‘Coronary Artery Bypass Graft’ (CABG) surgery. The original blockage in the Coronary Artery is left untouched.
• The Graft now provides adequate blood supply to the heart muscle while bypassing the blockage & eliminates the demand supply mismatch. Coronary Artery Bypass Grafting is by far the most frequently performed surgical procedure.

• In the past, CABG was performed by cardiac surgeons using a heart-lung machine. This machine allowed temporary stoppage of the heart while connecting the graft to the Coronary Artery. 
• Latest advances in Cardiac Surgery have allowed some trained Cardiac Surgeons to perform CABG without using the heart-lung machine. This revolutionary technique is called “Beating Heart” or “Off-Pump Surgery”. 
• Though technically more demanding on the Cardiac Surgeon, the benefits to the patient are significant. Almost all our CABG procedures are performed with “Beating Heart” technique. As a result, the patients spends less time in the ICU; requires less blood transfusions; avoiding complications; & significantly shorter hospital stay.

• Angioplasty (PTCA/PCI) is a procedure to mechanically widen narrowed or blocked Coronary Arteries.
• The procedure begins with the insertion of a Guide Wire across the blocked Coronary Artery. A collapsed balloon is then passed over this guide wire & inflated inside the blocked Coronary Artery. The inflated balloon forces the blocked Coronary Artery to open. A stent (Wired Mesh) is then inserted which ensures that the Coronary Artery remains open.

• Patients who have undergone Angioplasty are prescribed medicines (combination of Clopidogrel and Aspirin) with an intention to prevent clotting of blood inside the stent. Clotting of blood inside the stent causes sudden stoppage of blood flow across the Coronary Artery leading to Heart Attack (Myocardial Infarction) Hence, these medicines have to be consumed daily for life time to prevent such mishaps.

• Once the dressing on you chest operation site is removed and  operation wound site is healthy patient can take bath after taking advice from the doctor.

• If there is an elevator there is no need to climb staircase just for the sake of exercising. If there no elevator, you can climb staircase as soon you are discharged from the hospital.
• While climbing, pace yourself. Take rest after every 10 – 12 steps and the restart climbing during the first week after the discharge. As your capacity increases there is no restriction on climbing steps, as long as you run out of breaths.

• It is wise to wait for 3 months after your surgery, before driving on your own. Before starting please consult with your surgical team.
• This is the amount of time it takes for the healing of your sternum (breast bone), which was cut open during surgery. Any chance injury, with the steering wheel can cause damage if driving is started too early.

• Yes. You may travel by car as soon as you are discharged. However, for the first few weeks, it is advisable to restrict the driving time, to less than two hours. If the drive is going to be longer, then you should take a break every two hours and walk around for a few minutes.

• There is no reason for you to ‘speak less’ after surgery. However, during the first few days of your recovery, you might feel short of breath on speaking for a long period of time. If so, your body is telling you to rest, and you may keep silent for some time.