Coronary Artery Disease - Surgeon John Ikonomidis Video

Coronary artery disease occurs when fat and cholesterol build up in the wall of the arteries that supply the heart with blood. These blockages can limit blood flow to the heart.
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Dr. John Ikonomidis: Coronary artery disease is a disease that occurs when fat and cholesterol build up in the wall of the arteries that supply the heart with blood and cause them to become narrow. The heart like all other organs in the body requires a blood supply for normal function. The heart is a muscle. It has pretty high oxygen requirements. Under normal resting circumstances, the oxygen requirements aren't as high. But when someone beings to exercise or exert themselves, the oxygen requirements increase the amount of blood flow required increases and if you impose the blockage on some of those coronary arteries, the situation will arise when those blockage has limited the blood flow to the point where heart is not getting enough to meet the demand and that's when the majority of patients develop what I want to call chest tightness or chest pain indicative of a lack or insufficient blood supply to the heart. When that happens, that signals, the requirement for an intervention. And those interventions can be, they can vary anywhere from medicines to percutaneous through the skin intervention that cardiologists do, dilating up blockages and putting stents across them. But in certain patient sub populations that have many blockages in whom their heart functions already impaired or in certain sub-populations for example, diabetics tend to do better with surgery than with interventions. Then cardiac surgeon is required to do coronary bypass which is clearly more basic procedure. If we operate for chest pain, like we talked about, there is a 97% chance that the chest pain will be relieved with the surgery. In other words, coronary bypass surgery works very good for Angina as we call it. There is a percentage of patients, that present not with Angina but with heart failure and what happens there, as usually happens in diabetics and the reason for that is that diabetes is a systemic disease. It doesn't just have to do with the blood sugar. Diabetics develop a nerve disorder, a nerve disease and the nerves around the heart get affected, so that those impulses when the heart is not getting enough blood supply, those impulses that translate into chest tightness don't happen. And it's not unusual, especially in the diabetic population for patients to have numerous small heart attacks that they are not, they are not at all aware of because they never have chest pain. And those numerous small heart attacks result in numerous small areas of the heart dying and being replaced by a scar. But when that happens over time, the heart muscle begins to dilate and become less efficient in pumping and these patients develop heart failure symptoms. So the initial presentation of coronary artery disease in this population is not just pain but it shortens the breath. It's heart failure. It's easy to understand therefore that not all patients will benefit from coronary bypass in this particular instance, because a lot, fairly large proportion of the heart muscle is dead and this is a kind of convoluted way of me saying, that if the patients undergo coronary bypass for heart failure, for shortness of breath, no chest pain, shortness of breath, it's a virtually a conflict whether or not they are going to get better. So 97% accurate, 97% efficient for Angina for chest pain, about 50% benefit for heart failure.

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