Super Safi’s Monday Morning Musings 70 – Coronary Artery Bypass Graft (CABG)

Morning Musically-Minded, Medically-Minded, Masticators!

(Today’s post is sponsored by the letter “M”)

Over the past 600+ episodes, The Simpsons has taken us on an amazing journey involving music, science, and food to name a few concepts.

And what better way to start your week, than by discussing some of these concepts Monday morning?

So let’s get started this week by talking about a lifesaving medical intervention.

In the seventieth episode of The Simpsons, Homer’s Triple Bypass (Season 04, Episode 11), Homer’s poor diet and stress catch up to him. After years of opting for bacon over oatmeal, Homer’s heart is in trouble. Things only get worse when Mr. Burns calls Homer in to his office and really gives it to Homer.

It results in Homer suffering a heart attack.

Dr. Hibbert: “Homer, I’m afraid you’ll have to undergo a coronary bypass operation.”
Homer: “Say it in English, Doc.”
Dr. Hibbert: “You’re going to need open heart surgery.”
Homer: “Spare me your medical mumbo jumbo.”
Dr. Hibbert: “We’re going to cut you open, and tinker with your ticker.”
Homer: “Could you dumb it down a shade?”

When Dr. Hibbert tells Homer the surgery will cost $30,000, Homer suffers another heart attack at the sound of the price, the price goes up to $40,000. But the family’s worries about the price come to a halt when they see an ad for Dr. Nick Riviera who will do any surgery for $129.95.

While Dr. Nick has some memory issues recalling how to perform a coronary artery bypass graft, he manages to help Homer with some important input from Lisa in the peanut gallery.

Nurse: “Doctor, do you not know what to do?”
Dr. Nick: “Come on Nick, think back to medical school.”
Has a flashback to a younger Nick putting the moves on a college coed at a party. Younger Nick: “Seriously, baby, I can prescribe anything I want.”
Dr. Nick: “I know I’m supposed to cut something, but what? And where?”
Lisa from the amphitheater: “Hey! The incision should be made below the blockage! Below!”
Dr. Nick: “Thanks, little girl!”

But have you ever wondered what a bypass is?

Coronary Artery Bypass Graft (CABG)

While almost everyone knows the heart is responsible for pumping blood containing oxygen and nutrients all around the body, many people either don’t know or often forget that the heart is a muscle that also needs it own blood supply containing oxygen and nutrients. This blood is provided by the coronary arteries. There are 4 main coronary arteries – the right main coronary artery, the left main coronary artery, the left anterior descending coronary artery, and the left circumflex coronary artery.

Coronary artery disease (CAD) is the narrowing of these coronary arteries. CAD is caused by a build-up of fatty material within the walls of these arteries. This build-up narrows the inside of the arteries, limiting the supply of oxygen-rich, nutrient-rich blood to the heart muscle.

As John Hopkins medicine describes, one way to treat the blocked or narrowed arteries is to bypass the blocked portion of the coronary artery with a piece of a healthy blood vessel from elsewhere in your body. Blood vessels, or grafts, used for the bypass procedure may be pieces of a vein from your leg or an artery in your chest. An artery from your wrist may also be used. Your doctor attaches one end of the graft above the blockage and the other end below the blockage. Blood bypasses the blockage by going through the new graft to reach the heart muscle. This is called coronary artery bypass surgery.

At the time of the airing of this episode, using the Great Saphenous (one of my old nicknames) vein in the leg was the most preferred vessel to use in a bypass. However, these days it is more common to use an artery in the chest.

Symptoms of coronary artery disease may include:

• Chest pain
• Fatigue (severe tiredness)
• Palpitations
• Abnormal heart rhythms
• Shortness of breath
• Swelling in the hands and feet
• Indigestion

Possible risks of coronary artery bypass graft surgery (CABG) include:

• Bleeding during or after the surgery
• Blood clots that can cause heart attack, stroke, or lung problems
• Infection at the incision site
• Pneumonia
• Breathing problems
• Pancreatitis
• Kidney failure
• Abnormal heart rhythms
• Failure of the graft
• Death

WARNING: DESCRIPTIVE MATERIAL AHEAD. ONLY PROCEED TO READ IF YOU’RE NOT SQUEAMISH!!!

Here are the steps of a coronary artery bypass graft procedure using a pump, again from John Hopkins medicine:

1. To sew the grafts onto the very small coronary arteries, your doctor will need to stop your heart temporarily. Tubes will be put into the heart so that your blood can be pumped through your body by a heart-lung bypass machine.
2. Once the blood has been diverted into the bypass machine for pumping, your doctor will stop the heart by injecting it with a cold solution.
3. When the heart has been stopped, the doctor will do the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery just below the blockage. If your doctor uses the internal mammary artery inside your chest as a bypass graft, the lower end of the artery will be cut from inside the chest and sewn over an opening made in the coronary artery below the blockage.
4. You may need more than one bypass graft done, depending on how many blockages you have and where they are located. After all the grafts have been completed, the doctor will closely check them as blood runs through them to make sure they are working.
5. Once the bypass grafts have been checked, the doctor will let the blood circulating through the bypass machine back into your heart and he or she will remove the tubes to the machine. Your heart may restart on its own, or a mild electric shock may be used to restart it.
6. Your doctor may put temporary wires for pacing into your heart. These wires can be attached to a pacemaker and your heart can be paced, if needed, during the initial recovery period.
7. Your doctor will sew the sternum together with small wires (like those sometimes used to repair a broken bone).
8. He or she will insert tubes into your chest to drain blood and other fluids from around the heart.
9. Your doctor will sew the skin over the sternum back together.
10. Your doctor will put a tube through your mouth or nose into your stomach to drain stomach fluids.
11. He or she will then apply a sterile bandage or dressing.

Now that we’ve learned more about coronary artery bypass grafts, be sure to come back next week when we continue our Monday morning musings with the next episode of The Simpsons.

Did you remember the episode? What’s your favourite Homer in the hospital episode of The Simpsons? What about your favourite Simpsons medical reference? Were you familiar with CABG? Were you familiar with the coronary arteries? Do you know anyone who’s ever had a bypass? Sound off in the comments below. You know we love hearing from you.