Nowadays, the myocardial infarction became the silent killer among the human around the world. Myocardial infarction can be defined as the death of heart muscles from a sudden blockage in coronary arteries by blood clot. It is an irreversible process. Coronary arteries are vital to supply heart muscles with nutrients and oxygen to maintain the pumping actions. A blockage in coronary arteries will deprive the heart muscles for blood supply and cause the heart to undergo anaerobic respiration that causes chest pain -angina. If the blood flow is not restored within 20 to 40 minutes, irreversible death of cardiac muscles will take place and scars will be formed. Thus, the heart will lose it's strength and cease to function effectively. Furthermore, the cardiac arrest which the heart ceased to function will occur if the blood flow does not restore after 4 to 6 hours.
The shorter the length of time the blood supply is blocked, the lesser the extent the cardiac muscles are weakened or suffer cell death5.
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Nevertheless, the myocardial infarction can be minimized with the advancements in medical treatments at the present. However, I choose to focus my intention on coronary bypass surgery in this report.
CUMULATIVE WORD COUNT: 194 *The dying heart muscles >
A Possible Treatment- Coronary Bypass Surgery
Coronary bypass surgery is a surgical treatment. It normally carries out when the coronary arteries are totally blocked by providing an alternative pathway to supply blood to the cardiac muscles. There are several techniques which are available to perform the surgery on either a stopped heart or a beating heart.
>*Coronary Artery Bypass Graft
According to the American Heart Association, 427000 coronary artery bypass graft (CABG) surgeries were performed in the United States in 2004, making it one of the most commonly performed major operations18.
CUMULATIVE WORD COUNT: 359 Hence, CABG is a surgery which works on the beating heart which is also known as off pump surgery. In contrast, the on pump surgery is the surgery which works on a stopped heart. In the coronary bypass surgery, a blood vessel from certain parts of body is removed to bypass the blockage or narrowing of the arteries and restore the blood circulation to the cardiac muscles. That blood vessel is called a graft which can be obtained from legs, chest or arms. Those vessels are indeed safe to use as there are other pathways to supply blood to those particular tissues after the removal of vessels. Certain factors such as locations of blockages, severity of blockages and others are taken into considerations to decide on which parts of graft are used. There are several parts of grafts which can be used in coronary bypass surgery:
Internal mammary artery
It is an artery that is located in the chest. It is also the most common bypass grafts used and had proven to have the best long term results. Besides, it is sewn adjacent to the blockage site on the arteries to restore the blood circulation.
It is a vein which is located in the leg. It will be a minimal invasive on the removal of this graft and results in less scarring with a faster rate of recovery.
Those arteries are located in lower part of arms which are known as ulnar and radial arteries. A careful test has to be taken to determine whether those arteries are suitable for the patients or not.
This artery located in the stomach and abdominal wall. It is less commonly used for grafting as it might causes significant internal bleeding in the process of operation.
^*The removal of Saphenous vein in the leg
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>*The location of endoscopic radial artery
>*The location of internal mammal artery
A person will have a higher risk to get heart attack if have damaged in the left region of heart muscles19.
In my view, this might due to the left region of cardiac muscles are vital to pump the blood to all parts of body to deliver oxygen and nutrients. Apart from that, the number of graft does not indicate anything about the heart condition of patient.
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Always on Time
Marked to Standard
The pie chart above is the sources from National Heart Institution (IJN), Malaysia which displays the coronary bypass surgery is the most common surgeries in the open heart surgeries with 46%. In my opinion, I believe that the coronary bypass surgery is a reliable treatment for myocardial infarction based on the statistic number from IJN.
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2. AnÂ anaesthetist injects an induction agent to render the patient to be unconscious.
1. The patient is moved on to the operating table.
5. The surgeon places devices to stabilize the heart in the case of off pump surgery.
3. AnÂ endotracheal tubeÂ is inserted and secured by the anaesthetist with mechanical ventilationÂ is started.
4. The chest is opened via aÂ median sternotomy. The heart is examined by the surgeon.
6. If the case is "on-pump", the surgeon instructs theÂ perfusionistÂ to startÂ cardiopulmonary bypass (CPB). Once CPB is done, the surgeon places theÂ aortic cross clampÂ across the aorta and the perfusionist will deliverÂ cardioplegiato stop the heart.
7. One end of each graft is sewn on to theÂ coronary arteriesÂ beyond theÂ blockagesÂ and the other end is attached to theÂ aorta.
8. Then, if in off-pump surgery, the stabilizing devices are removed. In contrast, in on pump surgery, the heart is restarted as suturing the grafts to the aorta is done.
10. The patient is moved to theÂ intensive care unitÂ (ICU) to recover. After stabilizing in the ICU, the person is transferred to the cardiac surgeryÂ wardÂ until ready to go home.
9. Later, theÂ sternumÂ is wired together and the incisions areÂ suturedÂ closed.
The Procedure of Coronary Bypass Surgery[6,7,14]
The Social and Economic Implications
In this modern and materialistic world, people tend to get cardiovascular diseases due to sedentary lifestyle such as less exercise, intake of fast food, and so on. Even though there are many available treatments, it will cost a lump sum of money. Hence, the financial issues have been raised which included operation fees, expensive medications, medical checkups and some follow-up treatments after the coronary bypass surgery. Moreover, the operation fees for coronary bypass surgery solely costs approximately RM 40000 in Damansara Specialist Hospital16. This indirectly will be a heavy burden for those poor patients. They might face difficulties to pay the bills if undergo the surgery. Thus, the government might have to subsidise for those poor patients. Some people might argue that those subsidies should invest in other fields such as healthcares and infrastructures rather than treatment for myocardial infarction. Nevertheless, I believe that this controversial argument can be overcome if the government can balance their investments. Although the fee is expensive, it is worth as it can relieve the symptoms of myocardial infarction such as angina in patients.
^*The difference of normal and abnormal coronary arteries
CUMULATIVE WORD COUNT: 1110On the other hand, the social issues will also emerge as the patients undergo coronary bypass surgery. The quality of the family life will indirectly be affected because the family members are worrying about the financial problems and the condition of patients. There is also a burden for the family members to stay back in the hospital to take care the patients as they might need helps to perform daily tasks such as movements, drinking, excretions and eating after the surgery. Furthermore, some family members might even use illegal ways to get the money for the treatments which can jeopardize the harmony in society. Thus, it becomes a responsibility for the government to review the cost of operation fees and managements in hospital for the sake of citizens.
Personally, I think that the current cost of coronary bypass surgery need to be reviewed to ensure that all the citizens are able to afford the cost of surgery. Despite the financial aspect, I strongly believe that the advantages of coronary bypass surgery outweigh its disadvantages. Regarding the social implication, the family members can either take turn or hire a professional nurse to look after patients.
In a nutshell, those financial and social implications are also happened in many developing countries which do not have sufficient allocations to further improve the healthcare field.
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Benefits and Risks
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From my point of view, coronary bypass surgery is beneficial because it can reduce the risk from getting the myocardial infarction. Thus, the people who die from myocardial infarction can be decreased. Furthermore, the patients will not need to receive the life-long treatments in the hospital. The coronary bypass surgery will also relief the symptoms such as chest pain. Besides that, the success rate for the coronary bypass surgery is fairly high -about 98 percent19.
As is illustrated by the bar chart, the number of death due to heart diseases increases as the age group increases. It is clearly shown that the death in females eventually outnumbered than the death in males as age group increases. In my view, I can make a generalization about females are more prone to heart diseases as the age group increases compared to males. This is because all females will menopause at the age above 75 years old. Before menopause, there are certain hormones in females which can reduce the risk of getting cardiovascular diseases.
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There are also downsides to the coronary bypass surgery. The risk of failure in coronary bypass surgery will changes based on certain factors such as ages, health conditions, smoking, poor heart muscles' functions and others. For instance, smokers are more likely to get blood clot in narrowed artery than normal people. Apart from that, the wound infections and fluid collections can occur at the incisions and cause the incisions to open up again. Moreover, there might have some complications during the surgery operations and after the surgery such as excessive blood loss, kidney failure, infections and stroke.
All in all, I strongly believe that the benefits of coronary bypass surgery obviously outweigh its' risks. In spite of small percent of risks, coronary bypass surgery actually prevents the patients from suffering the symptoms of myocardial infarction. Last but not least, gastroepiploic artery has the most potential to cause adverse repercussions and rarely used for the grafting.
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Some people might not want to take risk to undergo surgery and therefore will decide on non surgical methods. I believe that those non-surgical methods can also slow down the progression to get myocardial infarction.
Angioplasty is a technique of widening a narrowed blood vessel manually. It performs when there is less severe blockages in the arteries. The procedure starts with catheter with its tip enclosed in stent inserted through a small cut in the skin into blood vessel. Low dose of X-ray is used to monitor the progress and the folded balloon is inflated using water pressure to squash the blockages. Then, a coronary stents is inserted and expands inside a coronary artery to prevent the artery from closing up again. However, the disadvantage of angioplasty is the probability for the artery to close up again is very high.
>*The oversimplification process of angioplasty
CUMULATIVE WORD COUNT: 1817It is also known as blood thinners to prevent blood clots which can block the blood vessel to reduce the risk for getting myocardial infarction. Anticoagulants such as heparin, warfarin and others are usually given during angina or myocardial infarction to prevent blood clot from getting bigger and block the whole coronary artery. If the clot enters the bloodstream, it can cause stroke or embolism. Besides that, anticoagulant drugs are also given after angioplasty to help reduce the ability of clot formation in the blood vessel. Nevertheless, the side effect of the drugs is severe internal bleeding in the body.
^*The anticoagulant drug- warfarin tablet
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Evaluation of References
I used a non-profit organization's website in United State - American Heart Association which is aimed to provide information about the myocardial infarction and available treatments to the users. The websites is always updated and most of the information are correct, factual and agreed with other sources. Thus, I definitely believe that the American Heart Association will provide reliable information to me to do the background research on myocardial infarction. Apart from that, the websites contain some internet trustable logos which indicate the reliability of information as shown at below:
>*The respectives logos which indicate the trusted websites
On the other hand, I used the encyclopedia, "The Human Body in Health & Diseases" as my reference before I start my research on coronary bypass surgery. It is written by a famous author, Thibodeau/Patton. On top of that, the information of that encyclopedia had been supported with scientific evidences. I also reaffirm the information in the book with other sources from Internet. Therefore, I think that my information in this report should be reliable as the websites and encyclopedias that I used are clearly determined and filtered before I do my research on coronary bypass surgery.