Coronary Artery Bypass Graft - Causes

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How does coronary artery disease develop?

Coronary artery disease (CAD) occurs when atherosclerotic plaque (hardening of the arteries) builds up in the wall of the arteries that supply the heart. This plaque is primarily made of cholesterol. Plaque accumulation can be accelerated by smoking, high blood pressure, elevated cholesterol, and diabetes. Patients are also at higher risk for plaque development if they are older (greater than 45 years for men and 55 years for women), or if they have a positive family history for early heart artery disease.

The atherosclerotic process causes significant narrowing in one or more coronary arteries. When coronary arteries narrow more than 50 to 70%, the blood supply beyond the plaque becomes inadequate to meet the increased oxygen demand during exercise. The heart muscle in the territory of these arteries becomes starved of oxygen (ischemic). Patients often experience chest pain (angina) when the blood oxygen supply cannot keep up with demand. Up to 25% of patients experience no chest pain at all despite documented lack of adequate blood and oxygen supply. These patients have "silent" angina, and have the same risk of heart attack as those with angina.

When a blood clot (thrombus) forms on top of this plaque, the artery becomes completely blocked causing a heart attack.

Heart Attack illustration - Coronary Artery Bypass Graft Surgery
Heart Attack illustration - Coronary Artery Bypass Graft Surgery

When arteries are narrowed in excess of 90 to 99%, patients often have accelerated angina or angina at rest (unstable angina). Unstable angina can also occur due to intermittent blockage of an artery by a thrombus that eventually is dissolved by the body's own protective clot-dissolving system.

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Comment from: none, 55-64 Male (Patient) Published: January 03

Having a triple coronary artery bypass graft in 2011, I finally realized that stress in my job and the scary situations I experienced was the number one cause of heart disease, let alone smoking, which I think the number 3 cause. Ignoring blood pressure high was number 4. Now I have swelling in my feet, diuretic works good, but I feel chest pain from time to time.

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Comment from: Cassandra1, 55-64 Female (Patient) Published: July 07

I had coronary artery bypass graft (CABG) surgery in November 2013. I had an aneurysm, a tear or dissection in the left artery descending. I did not know what was wrong, but I kept feeling tired when I would walk across the campus to my office, or sometimes when I walked up stairs holding shopping bags or groceries. I was 25 pounds overweight. The aftermath of the surgery was challenging, but I was motivated. I lost 40 pounds, principally through exercise and cutting down on bread and sugar. But I do not punish myself. I eat like a real person, but I weigh myself every single day. My doctor says I am better than I was before the surgery. I feel really wonderful now, but the early days after the surgery are a challenge. They do pass.

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