Emergency CABG in Acute MI

Esthar Rani S1

1Nursing Superintendent, Kauvery Heartcity, Trichy, India

Abstract

A 60-year-old male, was admitted to Kauvery Heartcity Hospital for Coronary Artery Bypass Graft surgery, and LV function was adequate. His Coronary Angiogram revealed Left main + Triple Vessel Disease.

Background

The patient had complaints of chest pain on 26.06.2023 and he went to his family doctor and was advised to do Coronary Angiogram (CAG). The next day it was done for him at a hospital.

He had chest pain again and was referred to Kauvery Heartcity Hospital for CABG.  After coming to Kauvery Hospital Heartcity he was admitted to CCU for observation, his chest pain decreased and he became stable. He was transferred to GW and posted for CABG on 30.06.2023. When he was in GW he again developed chest pain and this was informed to the Cardiologist, Anesthetist and Cardio Thoracic surgeon, and taken for CABG immediately.

Definition

Coronary Artery Bypass Grafting is a major surgical operation where atheromatous blockages in a patient’s coronary arteries are bypassed with harvested venous or arterial conduits.  The bypass restores blood flow to the ischemic myocardium, which in turn, restores function, viability, and relieves angina symptoms.

Purpose of CABG

  1. Restores blood flow to the heart
  2. Relieves chest pain & ischemia
  3. Improves the patient’s quality of life.
  4. Enables the patient to resume a normal life cycle
  5. Lowers the risk of a heart attack

Indications of CABG

  1. Left main coronary artery disease
  2. Triple Vessel Disease
  3. Patient having Angina
  4. Patients who cannot tolerate PTCA
  5. Failed PTCA
  6. Immediately after Myocardial infarction
  7. Severe Coronary Artery Disease
  8. Life threatening arrhythmias

Contra Indications of CABG

  1. Aneurysms
  2. Valvular disease
  3. Congenital diseases
  4. Disease of blood

Sign & Symptoms

  1. Chest pain

Diagnostic Evaluation

  1. ECG
  2. Echocardiography
  3. CT Angiogram
  4. Coronary Angiography

ECG Pre OP admission ECG

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Pre OP during chest pain ECG

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Post OP 1st ECG

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Chest X- Ray

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Surgery Diagram

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ECHO Report

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Nursing Management Pre – Operative

  1. Routine blood investigation like – CBC, RFT, etc., done for surgery
  2. Informed consents are obtained after counselling the patient and attender
  3. Blood was arranged for surgery
  4. IPSG goals assessed
  5. WHO surgical safety checklist was done
  6. Patient was hemodynamically monitored
  7. Skin preparation was done and povidone bath was given.
  8. NPO explained and maintained

Post – Operative

  • Patient was stabilized and transferred to the post-operative ward and connected to the mechanical ventilator
  • Bi lateral air entry level checked.
  1. Transferred to specialized cot with sterile equipment’s& clothes
  2. Monitored vital signs hourly and recorded.
  3. Monitored ICD drainage level and check for inside operation site drains are clotted or bleeding.
  4. Bundles care rendered properly.
  5. Placed under warmer for thermoregulation, according to patient demand at least for initial 4thhrs.
  6. Chest X – ray was taken to obtain the baseline lung assessment.
  7. On IInd POD patient developed Atrial Fibrillation and managed with Inj.Cordarone
  8. Vitals are stable, BP maintained.  Patient was extubated after being conscious & oriented.

Patient Health Education

    1. Personal Hygiene
    2. Wound care
    3. Active and passive exercise
    4. Breathing exercise
    5. Avoid strenuous activity
    6. Watch for Intake and urine output.
    7. Diet advice – High fiber, protein rich in Vitamin C
    8. Avoid strain during defecation
  • Regular follow up and medication

Outcome

On discharge, he was stable. Patient and attender were highly satisfied with our doctor treatment and nursing care.

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Ms. Esthar Rani S

Nursing Superintendent, Kauvery Heartcity

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