Cardiac surgery

Coronary artery disease

The heart muscle receives its blood supply from the coronary arteries, which come from the aorta. There are three main coronary arteries:

• Right coronary artery
• Left anterior descending artery
• Circumflex artery

Sometimes these arteries can become narrowed by a disease process known as atherosclerosis. This is when fatty deposits are gradually laid down inside the vessel wall causing the artery to become narrowed over time.

The risk factors for coronary artery disease include high blood pressure, diabetes, smoking, high cholesterol and being overweight. Having a strong family history of coronary artery disease can also be a strong contributor.

The narrowing of the coronary arteries reduces the blood supply and the oxygen delivered to the heart muscle. When the demand for oxygenated blood is greater than the supply, patients may develop chest pain or other symptoms, which are known as angina. Occasionally, some people may not get any symptoms.

If a coronary artery becomes completely blocked, usually by a blood clot occurring at the site of the narrowing, it results in a heart attack (myocardial infarction). This causes damage to the heart muscle. If treated early, the blood supply to the heart can be restored. If not treated, the damage to the heart muscle will be irreversible, reducing the function of the heart.

A coronary angiogram is an investigation performed by your cardiologist, which will provide a clear picture of the arteries and show any narrowings in order to help plan the surgery.

Any unwell adult admitted to hospital is at risk - that is most adults. Other factors that put people at greater risk include:

• A previous clot.
• A recent diagnosis of cancer.
• Certain ‘sticky blood' conditions such as antiphospholipid syndrome or Factor V Leiden.
• Being overweight.
• Being immobile.
• Oestrogen-containing contraceptives and hormone replacement.
• Having an operation.
• Significant injury or trauma.
• During and after pregnancy.

Stockings

In hospital, you might be measured and fitted with antiembolism stockings for your legs. You should be shown how to wear them and told to report any new pain or discomfort in your feet or legs to a health professional. Your stockings will be removed for a short time every day so that you can have a wash and check for any skin problems.

Inflatable sleeves

The clinical team may ask you to wear special inflatable sleeves around your legs while you are in bed or sat still in a chair. These will inflate automatically and provide pressure at regular intervals,
increasing blood flow out of your legs.

Blood thinners

Most patients at risk will be prescribed a small dose of an anticoagulant (blood thinner). These reduce the chance of having a blood clot by thinning your blood slightly. If you need to take these medicines when
you leave hospital, you will be told how long to take them for. The blood thinner most often used is a type of heparin, which is given by injection.

To be effective, these methods of prevention must be used correctly. If you have any questions or concerns, please ask your doctor or nurse.

Before coming into hospital:

• Talk to your doctor about contraceptive or hormone replacement therapy. Your doctor may consider stopping them in the weeks before an operation and will provide advice on temporary use of other methods if your usual contraceptive is stopped.
• Keep a healthy weight.
• Do regular exercise.

When in hospital

• Keep moving or walking and get out of bed as soon as you can after an operation - ask your nurse or physiotherapist for more information.
• Ask your doctor or nurse: “What is being done to reduce my risk of clots?”
• Drink plenty of fluid to keep hydrated, if your fluid intake is not restricted as part of your treatment.
• Advise staff on the ward if you experience pain, discomfort, or notice redness associated with the wearing of stockings.

Until you return to your usual level of activity, you may need to wear anti-embolism stockings after you go home.  Your nurse will tell you how to put them on and what you should check your skin for.  You should continue to remove daily to inspect and wash your skin. The team will advise on how long you will need to wear them for.

If you need to continue anticoagulation injections at home, your nursing team will teach you how to do this.  If you have any concerns make sure you speak to a nurse before you leave.

If you develop any sign or symptoms of a clot at home, then seek medical advice immediately, either from your General Practitioner (GP) or your nearest hospital’s emergency department.

Please ask your doctor or nurse for more information.

NHS website

Patient information on blood clots via the NHS website.

Patient Advice and Liaison Service (PALS)

To make comments or raise concerns about the Trust’s services, please contact PALS. Visitors can contact PALS via a member of staff or by phoning 01223 638896.

NHS 111

Offers health information and advice from specially trained nurses over the phone 24 hours a day.  Telephone 111

Lifeblood

The Thrombosis (UK) Charity also has more information.  Visit their website here.