CORONARY ARTERY BYPASS GRAFT

SINACA, MA. JESSWA E.

CINCO, CHERRY ANNE
BSPT-IV

DEFINITION
Type of surgery that improves blood flow to the heart
Used to treat people who have severe CHD
One way to treat blocked/narrowed arteries is to bypass the blocked
portion of the coronary artery with another piece of blood vessel
Blood vessels/grafts used for bypass procedure may be a piece of vein
from the legs (saphenous), chest (internal mammary), or wrist (radial).
One end of the graft is attached above the blockage, and one end is
attached below the blockage. Thus the blood is rerouted around or
bypasses the blockage through the new graft to reach the heart muscle.

 Steps (in order to bypass the coronary artery)

1. The chest is opened and the heart is stopped for a time in order to perform the
bypass.
2. In order to open the chest, the sternum is cut in half (sternotomy), and spread apart.
3. Once the heart is exposed, tubes are inserted into the heart, so that the blood can be
pumped through the body during the surgery by a cardiopulmonary bypass machine.
4. One tube is placed on the Aorta, and the second tube is place on the atrium of the
heart.
5. 1-2 smaller tubes is are connected into the heart to preserve the hearts temperature.
6. A clamp is placed on the Aorta when the heart has cooled so that the heart can safely
stop and be repaired.
7. 2 drainage tubes are placed in the chest cavity to prevent fluid from draining down
the heart during the healing process.

PROCEDURE:

The chest is opened and the heart is stopped for a time in order to
perform the bypass.

In order to open the chest, the sternum is cut in half (sternotomy), and
spread apart.

Once the heart is exposed, tubes are inserted into the heart, so that the
blood can be pumped through the body during the surgery by a
cardiopulmonary bypass machine.
One tube is placed on the Aorta, and the second tube is place on the atrium
of the heart.

A clamp is placed on the Aorta when the heart has cooled so that the
heart can safely stop and be repaired.

2 drainage tubes are placed in the chest cavity to prevent fluid from
draining down the heart during the healing process.

ANATOMY

PATHO-PHYSIOLOGY

EPIDEMIOLOGY
In the US, heart disease is the leading cause of death for males, females,
white, blacks, Asians, American Indians, and Hispanics
An estimated 13.7 million people have CHD in the US
More common in smokers
Obesity
Sedentary Lifestyle

ETIOLOGY
Coronary Artery Disease (CAD) narrowing of the lumina of the coronary arteries,
resulting in ischemia to the myocardium, can progress to injury and death
Atherosclerosis disease of moderate and large arteries, not limited to the coronary
arteries. Characterized by thickening of the intimal layer of the blood vessel wall from
focal accumulation of lipids, platelets, monocytes, plaque, and other debris
Nonmodifiable Risk Factors

Modifiable Risk Factors

Age

Cigarette Smoking

Sex

High Blood Pressure

Race

Elevated cholesterol levels and LDL

levels

Family history of CAD

Elevated blood homocystine

Obesity
Inactivity
Stress

SI & SX
1. Chest Pain
2. Fatigue
3. Palpitations
4. Abnormal Heart Rhythms
5. Shortness of Breath

CLINICAL MANIFESTATIONS
SIGNS ASSOCIATED WITH RIGHT-SIDED HEART FAILURE
Nausea

Jugular Venous Distention

Anorexia

+hepatojugular reflux

Weight Gain

Right ventricular heave

Ascites

Hepatomegaly

Angina Pectoris

Murmur of tricuspid insufficiency

Hepatomegaly
Peripheral Edema

CLINICAL MANIFESTATIONS
SIGNS ASSOCIATED WITH LEFT-SIDED HEART FAILURE
Fatigue

Tachycardia

Cough

S3 Gallop

Shortness of Breath

Crackles

Orthopnea

Murmur of mitral insufficiency

Diaphoresis

Left ventricular heave

Pulsus Alterans
Cheyne-Stokes respirations

MEDICAL ASSESSMENT
ECG (Electrocardiogram) or EKG
- HR, rhythm, conduction delays, & coronary perfusion

MEDICAL MANAGEMENT
Medical Therapy
- Nitrates (Nitroglycerin)
- Beta adrenergic blocking agents (Propanolol)
- Calcium channel blocking agents (Diltiazem)
- Antiarrhythmetics (Guinidine)
- Antihypertensives (Propanolol)
- Digitalis (Digoxin)
- Diuretics (Lasix)
- Aspirin
- Tranquilizers
- Hypolipidemic agents (Mecavor?

PT MANAGEMENT
Cardiac Rehabilitation
Phase 1: Inpatient Cardiac Rehabilitation (Acute)
1. Exercise/activity goals and outcomes.
a. Initiate early return to indep. in ADL; monitor activity tolerance.
b. Maintain muscle tone; maintain joint mobility.
c. Provide pt & family education.
d. Promote risk factor modification

PT MANAGEMENT
2. Exercise/activity guidelines.
a. Program components: ADLs, selected arm & leg exercises.
b. Initial activities: low intensity (2-3 METs) progressing to 3-5 METs by
discharge; RPE fairly light range; HR inc. of 10-20 bpm above resting,
depending on medications.
c. Short exercise sessions, 2-3 times a day(duration is lengthened,
frequency is decreased)

PT MANAGEMENT
3.Patient and family education goals.
a. improve understanding of cardiac disease
b. Teach self-monitoring procedures, warning signs of exertional
intolerance
c. Teach general activity guidelines, activity pacing, energy conservation
techniques, HEP
d. Teach CPR
e. Provide emotional support.

PT MANAGEMENT
4. Home exercise Program (HEP)
a. Upper and lover extremity exercises
b. Self-monitoring procedures
c. Family training in CPR

PT MANAGEMENT
Phase 2: Outpatient Cardiac Rehabilitation (Subacute)
1. Exercise/activity goals and outcomes.
a. Improve functional capacity.
b. Promote risk factor modification, counseling as to lifestyle challenges.
c. Encourage activity pacing, energy conservation

PT MANAGEMENT
2. Exercise/activity guidelines.
a. Frequency: 3-4 sessions/week.
b. Duration: 30-60 minutes w/ 5-10 minutes of warm up and cool down.
c. Programs may offer a single mode of training (e.g. walking) or
mulktiple modes using circuit training approach (e.g. treadmill, cycle
ergometer, arm ergometer)
d. Strength training
- begin with use of elastic bands and light weights (1-3 lbs)
- progress to mod. Loads, 12-15 comfortable repetitions.

PT MANAGEMENT
Phase 3: Community Exercise Programs (Post-acute, PostDischarge from Phase 2 Program)
1. Exercise/activity goals and outcomes.
a. Improve and maintain functional capacity.
b. Promote self-regulation of exercises programs.
c. Promote life-long commitment to risk factor modifications.

PT MANAGEMENT
2. Exercise/activity guidelines.
a. Location: community centre or clinical facilities.
b. Entry level criteria: functional capacity of 5 METs, clinically stable
angina, medically controlled arrhythmias during exercises.
c. Progression to 50-85% of functional capacity, 3-4 times/week, 45
minutes or more per session.
d. Discharge typically in 6-12 months.
e. Pt & family education goal: progression from Phase 1 goals

REFERENCES
http://www.hopkinsmedicine.org/healthlibrary/test_procedures/cardiovas
cular/coronary_artery_bypass_graft_surgery_cabg_92,P07967
/
http://www.hopkinsmedicine.org/healthlibrary/conditions/cardiovascular
_diseases/anatomy_and_function_of_the_coronary_arteries_85,P00196
/
Physical Rehabilitation by Susan B. OSullivan
Pollocks Textbook Cardiovascular Disease and Rehabiliation by J. Larry
Durstine
National Physical Therapy Examination by Susan B. OSullivan
Physical Medicine and Rehabilitation by Braddom