Aorto-coronary artery bypass grafting.
Aorto-coronary bypass surgery is an surgical intervention performed to restore the blood supply to the myocardium below the site of atherosclerotic narrowing of the vessel. This creates a different path for blood flow (shunt) to the area of the heart muscle, the blood supply of which was impaired.
Surgical intervention is performed in severe angina (III-IV functional class) and narrowing of the lumen of the coronary arteries> 70% (according to the results of coronary angiography ). The main coronary arteries and their large branches are subject to bypass surgery. Previously suffered myocardial infarction is not a contraindication to this operation. The scope of the operation is determined by the number of affected arteries supplying a viable myocardium with blood. As a result of the operation, blood flow should be restored in all areas of the myocardium where blood circulation is impaired. In 20-25% of patients who underwent aorto-coronary bypass surgery, angina pectoris resumes within 8-10 years. In these cases, the issue of reoperation is considered.
Drug therapy.
1. Medicines that improve the prognosis (recommended for all patients with angina pectoris in the absence of contraindications):
- These are antiplatelet drugs (acetylsalicylic acid, clopidogrel ). They prevent platelet aggregation, that is, prevent thrombosis at its earliest stage. Long-term regular intake of acetylsalicylic acid (aspirin) by patients with angina pectoris, especially those who have had myocardial infarction, reduces the risk of recurring heart attack by an average of 30%.
- This Beta-blockers ( metoprolol , atenolol , Bisaprolol and others). By blocking the effects of stress hormones on the heart muscle, they reduce myocardial oxygen demand, thereby balancing the imbalance between myocardial oxygen demand and its delivery through the narrowed coronary arteries.
- These are Statins ( Simvastatin , Atorvastatin and others) . They reduce total cholesterol and low-density lipoprotein cholesterol, reduce mortality from cardiovascular disease and
- These are inhibitors of angiotensin- converting enzyme – ACE ( Perindopril , Enalapril , Lisinopril and others). Taking these drugs significantly reduces the risk of death from cardiovascular disease, as well as the likelihood of developing heart failure. ACE inhibitors should not be prescribed with diabetes mellitus type 1.
2. Antianginal (antiischemic) therapy , aimed at reducing the frequency and intensity of the angina attacks reduction:
- This Beta-blockers ( metoprolol , atenolol , Bisaprolol and others). Taking these drugs reduces heart rate, systolic blood pressure, the reaction of the cardiovascular system to physical activity and emotional stress. This leads to a decrease in myocardial oxygen consumption.
- These are calcium antagonists ( verapamil , diltiazem ). They reduce myocardial oxygen consumption. However, they can not be prescribed for sick sinus syndrome and atrioventricular conduction disorder.
- These are Nitrates (Nitroglycerin, Isosorbide dinitrate , Isosorbide mononitrate , Cardicet , Oligard , etc.). They carry out the expansion (dilatation) of the veins, thereby reducing the preload on the heart and, as a result, the myocardial oxygen demand. Nitrates eliminate spasm of the coronary arteries. Since nitrates can cause a headache, especially, at the beginning of treatment, small doses of caffeine should be taken at the same time (it dilates the cerebral vessels, improves outflow, prevents a stroke; 0.01-0.05 g simultaneously with nitrate).
- These are Cytoprotectors ( Preductal ). It normalizes myocardial metabolism , does not expand coronary vessels. The drug of choice in the X-form of angina pectoris. Do not prescribe for more than 1 month.