Coronary Artery Disease

I. INTRODUCTION

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The heart muscle needs a constant supply of oxygen-rich blood. The coronary arteries, which branch off the aorta just after it leaves the heart, deliver this blood. Coronary artery disease can block blood flow, causing chest pain (angina) or a heart attack (also called myocardial infarction, or MI). Coronary artery disease was once widely thought to be a man's disease. On average, men develop it about 10 years earlier than women because, until menopause, women are protected by high levels of estrogen. However, after menopause, coronary artery disease becomes more common among women. Among people aged 75 and older, a higher proportion of women have the disease, because women live longer.

In developed countries, coronary artery disease is the leading cause of death in both men and women. Coronary artery disease, specifically coronary atherosclerosis (literally “hardening of the arteries,” which involves fatty deposits in the artery walls and may progress to narrowing and even blockage of blood flow in the artery), occurs in about 5 to 9% (depending on sex and race) of people aged 20 and older. The death rate increases with age and overall is higher for men than for women, particularly between the 2

ages of 35 and 55. After age 55, the death rate for men declines, and the rate for women continues to climb. After age 70 to 75, the death rate for women exceeds that for men who are the same age. Coronary artery disease affects people of all races, but the incidence is extremely high among blacks and Southeast Asians. The death rate is higher for black men than for white men until age 60 and is higher for black women than for white women until age 75.

II. OBJECTIVES

A. GENERAL OBJECTIVES

At the end of the presentation, students are expected to gain the necessary information regarding Coronary Artery Disease for them to determine the appropriate nursing care management they should provide to those patients having this kind of illness B. SPECIFIC OBJECTIVES

3

Student Nurse Centered 1. To improve students ability in handling patients with coronary artery disease. 2. To extend our understanding regarding the disease. 3. To be able to identify the major risk factors for development of coronary artery disease. 4. To

implement

the

proper

intervention

and

prevent

further

complication. Client’s Centered

1. To educate the client about the possible development of the disease complication. 2. To educate the client about the disease and treatment needs.

3. To encourage the client to seek medical assistance regarding their health status III. PATIENT’S PROFILE

Name: JGM Address: Block C, Marcos Village, Palayan City

4

Age: 50 Sex: Female Birthday: July 30, 1959 Civil Status: Widow Nationality: Filipino Religion: Roman Catholic Occupation: Baranggay Councilor Educational Attainment: Vocational graduate

FAMILY HISTORY

The client stated that they don’t have any history of the disease.

HEALTH HISTORY

In her younger years she was very workaholic and has no time for relaxation. Mrs. JC had great fun of eating fatty and salty foods, and also smoking since 30 years old. These unhealthy lifestyles contribute a lot for her to develop high blood pressure. HISTORY OF PAST ILLNESS

5

The client stated that when she was 40 years old she was check up at Bongabon District Hospital and diagnose having hypertension.

She was

given medication and despite of her illness she continues working hard.

HISTORY OF PRESENT ILLNESS

Mrs. JC and other Brgy. Officials had attended a seminar in Baguio last March 2008, and after three days of staying she felt a severe chest pain, shortness of breath, headache and blurry vision. When she was on her way to the terminal riding on a taxi and suddenly taxi driver noticed her face and neck was red in appearance. And the taxi driver decided to bring her in Baguio General Hospital. At the emergency room she was given oxygen inhalation and medication. After a few hours when she was already on good condition she went home. Mrs. JC experienced again the same manifestations last August 2008 and was brought to Bongabon District Hospital and diagnose of Coronary Artery Disease. The patient is presently taking medications such as Avastat 20mg., Anoion 200mg., Imdur 60mg., Isordil 5mg., Aspirin, Losartan.

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IV. PHYSICAL EXAMINATION

Vital Signs

September

September

September 9 September

Blood Pressure

1, 2009 140/100

8, 2009 140/90

,2009 140/100

22, 2009 140/100

Temperature Pulse Rate Respiratory Rate

mmHg 36.6 °C 62 bpm 24 cpm

mmHg 36.8 °C 70 bpm 26 cpm

mmHg 36.6 °C 68 bpm 25 cpm

mmHg 36.7 °C 66 bpm 22 cpm

Summary Abnormal findings 1. Wrinkled and dry skin 2. Thin hair 3. Difficulty of reading newsprint 4. Fatigue, inability to sleep 5. Dry lips 6. Limited range of motion 7. Decreased, weak, thready pulsations 8. Smooth yellow enamel, dark pink gums

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NUTRITION AND METABOLIC PATTERN

Usual Food Intake: •

Breakfast: Bread and coffee

•

Lunch: Rice with vegetable

•

Dinner: Rice with fried fish

Usual Fluid Intake: • 3-5 glasses/day • Preferences: water and juices

Any Food Restriction: •

Salty and fatty foods

Any Problem In Eating: •

None

Any Supplements: •

None

Elimination Pattern Per Day: •

Bladder

Usual frequency: 5-6 times/ day Color: Light yellow •

Bowel Time: No specific Frequency: Once a day Color: Brownish Consistency: Semi-form

Activity Exercise Pattern: •

None

Sleep Pattern: •

Usual Sleep Pattern at bed time: 9-10pm

•

Maximum hours sleep: 2-3 times/day

V. CASE DISCUSSION

A. DEFINITION OF DISEASE

Coronary artery disease (CAD), also called coronary heart disease, is a condition in which plaque builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood. Plaque is made up of fat, cholesterol calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis. Atherosclerosis

Figure A shows a normal artery with normal blood flow. Figure B shows an artery with plaque buildup. Plaque narrows the arteries and reduces blood flow to your heart muscle. It also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow. Overview When your coronary arteries are narrowed or blocked, oxygen-rich blood can't reach your heart muscle. This can cause angina or a heart attack. Angina is chest pain or discomfort that occurs when not enough oxygen-rich blood is flowing to an area of your heart muscle. Angina may feel like pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back. A heart attack occurs when blood flow to an area of your heart muscle is completely blocked. This prevents oxygen-rich blood from reaching that area of heart muscle and causes it to die. Without quick treatment, a heart attack can lead to serious problems and even death. Over time, CAD can weaken the heart muscle and lead to heart failure and arrhythmias. Heart failure is a condition in which your heart can't

pump enough blood throughout your body. Arrhythmias are problems with the speed or rhythm of your heartbeat. Outlook CAD is the most common type of heart disease. Lifestyle changes, medicines, and/or medical procedures can effectively prevent or treat CAD in most people. Other Names for Coronary Artery Disease •

Atherosclerosis

•

Coronary heart disease

•

Hardening of the arteries

•

Heart disease

•

Ischemic heart disease

•

Narrowing of the arteries

B. ANATOMY AND PHYSIOLOGY

THE HEART Your heart is located under the ribcage in the center of your chest between your right and left lung. It’s shaped like an upsidedown pear. Its muscular walls beat, or contract, pumping blood continuously to all parts of your body.

The size of your heart can vary depending on your age, size, or the condition of your heart. A normal, healthy, adult heart most often is the size of an average clenched adult fist. Some diseases of the heart can cause it to become larger.

 The heart is the muscle in the lower half of the picture. The heart has four chambers. The right and left atria are shown in purple. The right and left ventricles are shown in red.  Connected to the heart are some of the main blood vessels— arteries and veins—that make up your blood circulatory system.  The ventricle on the right side of your heart pumps blood from the heart to your lungs. When you breathe air in, oxygen passes from your lungs through blood vessels where it’s added to your

blood. Carbon dioxide, a waste product, is passed from your blood through blood vessels to your lungs and is removed from your body when you breathe air out.  The atrium on the left side of your heart receives oxygen-rich blood from the lungs. The pumping action of your left ventricle sends this oxygen-rich blood through the aorta (a main artery) to the rest of your body.

The Right Side of the Heart

 The superior and inferior vena cavae are in blue to the left of the muscle as you look at the picture. These veins are the largest veins in your body. They carry used (oxygen-poor) blood to the right atrium of your heart. “Used” blood has had its oxygen removed and used by your body’s organs and tissues. The superior vena cava carries used blood from the upper parts of your body, including your head, chest, arms, and neck. The inferior vena cava carries used blood from the lower parts of your body.  The used blood from the vena cavae flows into your heart’s right atrium and then on to the right ventricle. From the right ventricle, the used blood is pumped through the pulmonary arteries (in blue in the center of picture) to your lungs. Here,

through many small, thin blood vessels called capillaries, your blood picks up oxygen needed by all the areas of your body.  The oxygen-rich blood passes from your lungs back to your heart through the pulmonary veins (in red to the left of the right atrium in the picture).

The Left Side of the Heart

 Oxygen-rich

blood

from

your

lungs

passes

through

the

pulmonary veins (in red to the right of the left atrium in the picture). It enters the left atrium and is pumped into the left ventricle. From the left ventricle, your blood is pumped to the rest of your body through the aorta.  Like all of your organs, your heart needs blood rich with oxygen. This oxygen is supplied through the coronary arteries as it’s pumped out of your heart’s left ventricle. Your coronary arteries are located on your heart’s surface at the beginning of the aorta. Your coronary arteries (shown in red in the drawing) carry oxygen-rich blood to all parts of your heart. HEART INTERIOR

The

Septum

 The right and left sides of your heart are divided by an internal wall of tissue called the septum. The area of the septum that divides the two upper chambers (atria) of your heart is called the atrial or interatrial septum. The area of the septum that divides the two lower chambers (ventricles) of your heart is called the ventricular or interventricular septum. Heart Chamber

 The picture shows the inside of your heart and how it’s divided into four chambers. The two upper chambers of your heart are called atria. The atria receive and collect blood. The two lower

chambers of your heart are called ventricles. The ventricles pump blood out of your heart into the circulatory system to other parts of your body.

Heart Valves

 The

picture

shows

your

heart’s

four

valves.

Shown

counterclockwise in the picture, the valves include the aortic valve, the tricuspid valve, the pulmonary valve, and the mitral valve or Bicuspid.

Blood Flow

 The arrows in the drawing show the direction that blood flows through your heart. The light blue arrows show that blood enters the right atrium of your heart from the superior and inferior vena cavae. From the right atrium, blood is pumped into the right ventricle. From the right ventricle, blood is pumped to your lungs through the pulmonary arteries.  The light red arrows show the oxygen-rich blood coming in from your lungs through the pulmonary veins into your heart’s left atrium. From the left atrium, the blood is pumped into the left

ventricle, where it’s pumped to the rest of your body through the aorta.  For the heart to function properly, your blood flows in only one direction. Your heart’s valves make this possible. Both of your heart’s ventricles has an “in” (inlet) valve from the atria and an “out” (outlet) valve leading to your arteries. Healthy valves open and close in very exact coordination with the pumping action of your heart’s atria and ventricles. Each valve has a set of flaps called leaflets or cusps, which seal or open the valves. This allows pumped blood to pass through the chambers and into your arteries without backing up or flowing backward.

Suferior Vena Cava Right Atrium

Tricuspid Valve

Right Ventricle Inferior Vena Cava Pu lmonary Artery

Different

Systems

Lungs

Aorta Left Ventricle Pulmonary Vein

Bicuspid

Left Atrium

C. PATHOPHYSIOLOGY Modifiable Risk Factors High blood cholesterol level Cigarette smoking, tobacco use Hypertension Diabetes mellitus Lack of estrogen in women Physical inactivity Obesity

Non-modifiable Risk Factors Family history of coronary heart disease Increasing age Gender (heart disease occurs three times more often in men than in premenopausal women) Race (higher incidence of heart disease in African Americans than in Caucasians)

Cholesterol

Foam Cells

Oxidized LDL

Plaque Formation

Blood Vessels Are Blocked

Affects Blood Supply

Reduces Oxygen And Nutrients In The Heart And Affects The Supply Of Oxygen To The Vital Organs Death of Tissue Within These Organs And Their Eventual Failure

Heart Attack

Death

D. CAUSES Research suggests that coronary artery disease (CAD) starts when certain factors damage the inner layers of the coronary arteries. These factors include: •

Smoking

•

High amounts of certain fats and cholesterol in the blood

•

High blood pressure

•

High amounts of sugar in the blood due to insulin resistance or diabetes

When damage occurs, your body starts a healing process. Excess fatty tissues release compounds that promote this process. This healing causes plaque to build up where the arteries are damaged. The buildup of plaque in the coronary arteries may start in childhood. Over time, plaque can narrow or completely block some of your coronary arteries. This reduces the flow of oxygen-rich blood to your heart muscle. Plaque also can crack, which causes blood cells called platelets to clump together and form blood clots at the site of the cracks. This narrows the arteries more and worsens angina or causes a heart attack.

E. RISK FACTORS

 Smoking

–

Cigarette

smoking

contributes

to

the

development of severity of CAD in the following three ways: 1. The inhalation of smoke increases the blood carbon monoxide

level than with

oxygen.

A decrease

amount of available oxygen may decrease the heart’s ability to pump. 2. The nicotinic acid in Tobacco triggers the release of catecholamines, which raise the heart rate and blood pressure. 3. Use

of

tobacco

causes

a

detrimental

vascular

response and increases platelet adhesion, leading to a higher probability of thrombus formation.  Hypertension – Long standing elevated blood pressure may result in increased stiffness of the vessel walls leading to a vessel injury and a resulting inflammatory response within the intima.  Diabetes – High blood sugars are linked with accelerated development of atherosclerosis.  Age – As you get older, your risk for CAD increases. Genetic or lifestyle factors cause plaque to build in your arteries as you age. By the time you're middle-aged or older, enough plaque has built up to cause signs or symptoms.

o In men, the risk for CAD increases after age 45. o In women, the risk for CAD risk increases after age 55.  Overweight or obesity – Overweight is having extra body weight from muscle, bone, fat, and/or water.

Obesity is

having a high amount of extra body fat.  Family history of early heart disease–Your risk increases if your father or a brother was diagnosed with CAD before 55 years of age, or if your mother or a sister was diagnosed with CAD before 65 years of age.  Stress – Research shows that the most commonly reported "trigger" for a heart attack is an emotionally upsetting event—particularly one involving anger.  Alcohol – Heavy drinking can damage the heart muscle and worsen other risk factors for heart disease. Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day.  Unhealthy blood cholesterol levels –This includes high LDL cholesterol (sometimes called bad cholesterol) and low HDL cholesterol (sometimes called good cholesterol).

F. SIGNS AND SYPMTOMS According to book:

Manifested

•

Chest pain

patient: • Chest Pain

•

Shortness of Breath

•

Palpitations

•

Fatigue

•

Dizziness

•

Nausea

•

Weakness

•

Peripheral Edema

by

the

• Shortness of Breath • Palpitations • Fatigue • Dizziness • Nausea and Vomiting • Headache • Blurring of vision

G. DIAGNOSTIC TEST Your doctor will diagnose coronary artery disease (CAD) based on:

•

Your medical and family histories

•

Your risk factors

•

The results of a physical exam and diagnostic tests and procedures

Diagnostic Tests and Procedures No single test can diagnose CAD. If your doctor thinks you have CAD, he or she will probably do one or more of the following tests. ECG (Electrocardiogram)

An ECG is a simple test that detects and records the electrical activity of your heart. An EKG shows how fast your heart is beating and whether it has a regular rhythm. It also shows the strength and timing of electrical signals as they pass through each part of your heart.

Certain electrical patterns that the EKG detects can suggest whether CAD is likely. An EKG also can show signs of a previous or current heart attack. Stress Testing During stress testing, you exercise to make your heart work hard and beat fast while heart tests are performed. If you can't exercise, you're given medicine to speed up your heart rate. When your heart is beating fast and working hard, it needs more blood and oxygen. Arteries narrowed by plaque can't supply enough oxygenrich blood to meet your heart's needs. A stress test can show possible signs of CAD, such as: •

Abnormal changes in your heart rate or blood pressure

•

Symptoms such as shortness of breath or chest pain

•

Abnormal changes in your heart rhythm or your heart's electrical activity

During the stress test, if you can't exercise for as long as what's considered normal for someone your age, it may be a sign that not enough blood is flowing to your heart. But other factors besides CAD can prevent you from exercising long enough (for example, lung diseases, anemia, or poor general fitness).

Some stress tests use a radioactive dye, sound waves, positron emission tomography (PET), or cardiac magnetic resonance imaging (MRI) to take pictures of your heart when it's working hard and when it's at rest. These imaging stress tests can show how well blood is flowing in the different parts of your heart. They also can show how well your heart pumps blood when it beats Echocardiography

This test uses sound waves to create a moving picture of your heart. Echocardiography provides information about the size and shape of your heart and how well your heart chambers and valves are working.

The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.

Chest X-ray

A chest x ray takes a picture of the organs and structures inside the chest, including your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms that aren't due to CAD.

Blood Tests Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may show that you have risk factors for CAD. Electron-Beam Computed Tomography Your doctor may recommend electron-beam computed tomography (EBCT). This test finds and measures calcium deposits (called calcifications) in and around the coronary arteries. The more calcium detected, the more likely you are to have CAD. EBCT isn't used routinely to diagnose CAD, because its accuracy isn't yet known. Coronary Angiography and Cardiac Catheterization Your doctor may ask you to have coronary angiography (an-jee-OG-rafee) if other tests or factors show that you're likely to have CAD. This test uses dye and special x rays to show the insides of your coronary arteries. To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization . A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is then threaded into your coronary arteries,

and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through your coronary arteries. Cardiac catheterization is usually done in a hospital. You're awake during the procedure. It usually causes little to no pain, although you may feel some soreness in the blood vessel where your doctor put the catheter. VI. TREATMENT Treatment for coronary artery disease (CAD) may include lifestyle changes, medicines, and medical procedures. The goals of treatments are to: •

Relieve symptoms

•

Reduce risk factors in an effort to slow, stop, or reverse the buildup of plaque

•

Lower the risk of blood clots forming, which can cause a heart attack

•

Widen or bypass clogged arteries

•

Prevent complications of CAD

Lifestyle Changes Making lifestyle changes can often help prevent or treat CAD. For some people, these changes may be the only treatment needed:

•

Follow a heart healthy eating plan to prevent or reduce high blood pressure and high blood cholesterol and to maintain a healthy weight

•

Increase your physical activity. Check with your doctor first to find out how much and what kinds of activity are safe for you.

•

Lose weight, if you're overweight or obese.

•

Quit smoking, if you smoke. Avoid exposure to secondhand smoke.

•

Learn to cope with and reduce stress.

Therapeutic Lifestyle Changes (TLC). Your doctor may recommend TLC if you have high cholesterol. TLC is a three-part program that includes a healthy diet, physical activity, and weight management. With the TLC diet, less than 7 percent of your daily calories should come from saturated fat. This kind of fat is mainly found in meat and poultry, including dairy products. No more than 25 to 35 percent of your daily calories should come from all fats, including saturated, trans, monounsaturated, and polyunsaturated fats. You also should have less than 200 mg a day of cholesterol. The amounts of cholesterol and the different kinds of fat in prepared foods can be found on the Nutrition Facts label.

Foods high in soluble fiber also are part of a healthy eating plan. They help block the digestive track from absorbing cholesterol. These foods include: •

Whole grain cereals such as oatmeal and oat bran

•

Fruits such as apples, bananas, oranges, pears, and prunes

•

Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima beans

A diet high in fruits and vegetables can increase important cholesterollowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber. Fish are an important part of a heart healthy diet. They're a good source of omega-3 fatty acids, which may help protect the heart from blood clots and inflammation and reduce the risk for heart attack. Try to have about two fish meals every week. Fish high in omega-3 fats are salmon, tuna (canned or fresh), and mackerel. You also should try to limit the amount of sodium (salt) that you eat. This means choosing low-sodium and low-salt foods and "no added salt" foods and seasonings at the table or when cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item. Try to limit alcoholic drinks. Too much alcohol will raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in

the blood.) Alcohol also adds extra calories, which will cause weight gain. Men should have no more than two alcoholic drinks a day. Women should have no more than one alcoholic drink a day. Dietary Approaches to Stop Hypertension (DASH) eating plan. Your doctor may recommend the DASH eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and lower in salt/sodium. This eating plan is low in fat and cholesterol. It also focuses on fat-free or low-fat milk and dairy products, fish, poultry, and nuts. The DASH eating plan is reduced in red meat (including lean red meat), sweets, added sugars, and sugar-containing beverages. It's rich in nutrients, protein, and fiber. Increase Physical Activity Regular physical activity can lower many CAD risk factors, including LDL ("bad") cholesterol, high blood pressure, and excess weight. Physical activity also can lower your risk for diabetes and raise your levels of HDL cholesterol (the "good" cholesterol that helps prevent CAD). Check with your doctor about how much and what kinds of physical activity are safe for you. Unless your doctor tells you otherwise, try to

get at least 30 minutes of moderate-intensity activity on most or all days of the week. You can do the activity all at once or break it up into shorter periods of at least 10 minutes each. Moderate-intensity activities include brisk walking, dancing, bowling, bicycling, gardening, and housecleaning. More intense activities, such as jogging, swimming, and various sports, also may be appropriate for shorter periods. Maintain a Healthy Weight Maintaining a healthy weight can decrease risk factors for CAD. If you're overweight, aim to reduce your weight by 7 to 10 percent during your first year of treatment. This amount of weight loss can lower your risk for CAD and other health problems. After the first year, you may have to continue to lose weight so you can lower your body mass index (BMI) to less than 25. BMI measures your weight in relation to your height and gives an estimate of your total body fat. A BMI between 25 and 29 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for preventing and treating CAD.

Quit Smoking If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk for CAD.

You also should avoid

exposure to secondhand smoke. Reduce Stress Research shows that the most commonly reported "trigger" for a heart attack is an emotionally upsetting event—particularly one involving anger. Also, some of the ways people cope with stress, such as drinking, smoking, or overeating, aren't heart healthy. Physical activity can help relieve stress and reduce other CAD risk factors. Many people also find that meditation or relaxation therapy helps them reduce stress. Medicines You may need medicines to treat CAD if lifestyle changes aren't enough. Medicines can: •

Decrease the workload on your heart and relieve CAD symptoms

•

Decrease your chance of having a heart attack or dying suddenly

•

Lower your cholesterol and blood pressure

•

Prevent blood clots

•

Prevent or delay the need for a special procedure (for example, angioplasty or coronary artery bypass grafting (CABG)

Medicines used to treat CAD include anticoagulants, aspirin and other antiplatelet medicines, ACE inhibitors, beta blockers, calcium channel blockers, nitroglycerin, glycoprotein IIb-IIIa, statins, and fish oil and other supplements high in omega-3 fatty acids.

Medical Procedures:

Angioplasty Opens

blocked

or

narrowed

coronary

arteries.

During

angioplasty, a thin tube with a balloon or other device on the end is

threaded through a blood vessel to the narrowed or blocked coronary artery. Once in place, the balloon is inflated to push the plaque outward against the wall of the artery. This widens the artery and restores the flow of blood. Angioplasty can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a small mesh tube called a stent is placed in the artery to keep it open after the procedure.

CABG

Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. Arteries or veins from elsewhere in the patient's body are grafted to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle). This surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass; techniques are available to perform CABG on a beating heart, so-called "off-pump" surgery.

Cardiac Rehabilitation Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after CABG, angioplasty, or a heart attack. Cardiac rehab, when combined with medicine and surgical treatments, can help you recover faster, feel better, and develop a healthier lifestyle. Almost everyone with CAD can benefit from cardiac rehab. The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians, and psychologists or other behavioral therapists.