Bypass Surgery, CABG, Coronary Artery Bypass Graft, Heart Bypass Surgery
Coronary artery bypass surgery uses blood vessels from other areas of the body to bypass narrowed heart arteries. Learn about this surgery.
Coronary Bypass Surgery
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Coronary Artery Bypass Surgery
New Connections
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New Connections
Image by TheVisualMD
Coronary Artery Bypass Surgery
In coronary artery disease (CAD), the arteries that supply blood and oxygen to your heart muscle grow hardened and narrowed. You may try treatments such as lifestyle changes, medicines, and angioplasty, a procedure to open the arteries. If these treatments don't help, you may need coronary artery bypass surgery.
The surgery creates a new path for blood to flow to the heart. The surgeon takes a healthy piece of vein from the leg or artery from the chest or wrist. Then the surgeon attaches it to the coronary artery, just above and below the narrowed area or blockage. This allows blood to bypass (get around) the blockage. Sometimes people need more than one bypass.
The results of the surgery usually are excellent. Many people remain symptom-free for many years. You may need surgery again if blockages form in the grafted arteries or veins or in arteries that weren't blocked before. Lifestyle changes and medicines may help prevent arteries from becoming clogged again.
Source: NIH: National Heart, Lung, and Blood Institute
Additional Materials (24)
How coronary artery bypass graft (CABG) surgery is carried out
Video by Bupa Health UK/YouTube
How Does Heart Bypass Surgery Work? Coronary Artery Bypass Graft Procedure Animation - CABG Video
Video by AniMed/YouTube
NUHCS - Coronary Artery Bypass Surgery
Video by National University Heart Centre, Singapore (NUHCS)/YouTube
Coronary Artery Bypass Surgery
Video by Cleveland Clinic/YouTube
British Heart Foundation - Having a heart bypass, Len's story
Video by PreOp.com Patient Engagement - Patient Education/YouTube
Life after bypass surgery: Frank's Story
Video by British Heart Foundation/YouTube
Life after quintuple bypass surgery - Medical Minute
Video by Avera Health/YouTube
Mary, Triple Bypass Surgery at age 58
Video by Heart Foundation/YouTube
Diabetes to heart bypass surgery - Mark's story
Video by British Heart Foundation/YouTube
This browser does not support the video element.
What is Coronary Bypass Surgery?
Watch this video to learn what coronary bypass surgery entails and how it is performed.
Video by TheVisualMD
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Bypass Surgery: Part 1
A case study of Steven Hanford and his bypass surgery. When arteries are narrowed or blocked in multiple areas, coronary bypass surgery may be necessary instead of angioplasty. Steven's angiogram ( x-ray of blood vessels ) reveals angina, the most common sign of heart attack. Visible in the angiogram that Steven's 4 coronary arteries, the arteries that deliver blood to the heart itself, are severely blocked. Family history, unhealthy diet, and smoking are the factors that contribute to Steven's heart disease. Doctor explains that for the treatment to be successful, Steven should stop smoking.
Video by TheVisualMD
This browser does not support the video element.
Bypass Surgery: Part 2
A case study of Steven Hanford and his bypass surgery. Like what Doctor has advised, Steven together with his wife Ginger, stopped smoking a month before the operation. On the day of the surgery, Ginger is quietly waiting in the hospital. In the operating room, the procedure started by getting a vein from Steven's leg. His chest is opened and his heart is stopped. The coronary arteries with blockage are bypassed using the veins from Steven's leg. Doctor's team closes Steven's chest, doctor reports back to Ginger that the operation is a success. Four days later, Steven is recovering. Doctor gave Steven some advice and Steven told him that he is willing to continue his lifestyle changes like eating healthy, having exercise and never to go back in smoking.
Video by TheVisualMD
Coronary Artery Bypass Graft, Double Bypass
Coronary Artery Bypass Graft, Double Bypass.
Image by BruceBlaus/Wikimedia
What To Expect Before Coronary Artery Bypass Grafting
Coronary Artery Bypass Surgery Coronary bypass surgery is a procedure to allow blood to flow to the heart muscle despite blocked arteries. Coronary bypass uses a healthy vessel from the leg, arm or chest and connects it other arteries in the heart so that blood is bypassed around the blocked artery.
Image by TheVisualMD
Coronary Artery Bypass Surgery
Heart Bypass Surgery
Image by Blausen Medical Communications, Inc.
Coronary Artery Bypass Graft, Single Bypass
Coronary Artery Bypass Graft, Single Bypass
Image by BruceBlaus/Wikimedia
Coronary Artery Bypass Graft, Quadruple Bypass
Coronary Artery Bypass Graft, Quadruple Bypass
Image by BruceBlaus/Wikimedia
Coronary Artery Bypass Graft, Triple Bypass
Coronary Artery Bypass Graft, Triple Bypass
Image by BruceBlaus/Wikimedia
Bypass Background
Image by TheVisualMD
Bypass Background
Image by TheVisualMD
Bypass Background
Image by TheVisualMD
2:26
How coronary artery bypass graft (CABG) surgery is carried out
Bupa Health UK/YouTube
1:01
How Does Heart Bypass Surgery Work? Coronary Artery Bypass Graft Procedure Animation - CABG Video
AniMed/YouTube
7:55
NUHCS - Coronary Artery Bypass Surgery
National University Heart Centre, Singapore (NUHCS)/YouTube
4:43
Coronary Artery Bypass Surgery
Cleveland Clinic/YouTube
1:48
British Heart Foundation - Having a heart bypass, Len's story
Life after quintuple bypass surgery - Medical Minute
Avera Health/YouTube
2:01
Mary, Triple Bypass Surgery at age 58
Heart Foundation/YouTube
2:01
Diabetes to heart bypass surgery - Mark's story
British Heart Foundation/YouTube
2:36
What is Coronary Bypass Surgery?
TheVisualMD
3:55
Bypass Surgery: Part 1
TheVisualMD
Sensitive content
This media may include sensitive content
3:10
Bypass Surgery: Part 2
TheVisualMD
Coronary Artery Bypass Graft, Double Bypass
BruceBlaus/Wikimedia
What To Expect Before Coronary Artery Bypass Grafting
TheVisualMD
Coronary Artery Bypass Surgery
Blausen Medical Communications, Inc.
Coronary Artery Bypass Graft, Single Bypass
BruceBlaus/Wikimedia
Coronary Artery Bypass Graft, Quadruple Bypass
BruceBlaus/Wikimedia
Coronary Artery Bypass Graft, Triple Bypass
BruceBlaus/Wikimedia
Bypass Background
TheVisualMD
Bypass Background
TheVisualMD
Bypass Background
TheVisualMD
What Is
What Is Coronary Artery Bypass Grafting?
Image by National Heart Lung and Blood Institute (NIH)
What Is Coronary Artery Bypass Grafting?
Figure A shows the location of the heart. Figure B shows how vein and artery bypass grafts are attached to the heart.
Image by National Heart Lung and Blood Institute (NIH)
What Is Coronary Artery Bypass Grafting?
Coronary artery bypass grafting (CABG) is a procedure to improve poor blood flow to the heart. It may be needed when the arteries supplying blood to heart tissue, called coronary arteries, are narrowed or blocked. This surgery may lower the risk of serious complications for people who have obstructive coronary artery disease, a type of ischemic heart disease. CABG may also be used in an emergency, such as a severe heart attack.
CABG uses blood vessels from another part of the body and connects them to blood vessels above and below the narrowed artery, bypassing the narrowed or blocked coronary arteries. One or more blood vessels may be used, depending on the severity and number of blockages. The blood vessels are usually arteries from the arm or chest, or veins from the legs. Risks and possible complications may occur with this procedure. After CABG, your doctor may recommend medicines and heart-healthy lifestyle changes to further reduce your symptoms, treat your disease, and help prevent complications such as blood clots.
Source: National Heart, Lung, and Blood Institute (NIH)
Additional Materials (1)
Coronary Artery Bypass Surgery
Video by Cleveland Clinic/YouTube
4:43
Coronary Artery Bypass Surgery
Cleveland Clinic/YouTube
Who May Benefit
Coronary Artery Bypass Graft (CABG)
Image by Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014
Coronary Artery Bypass Graft (CABG)
Coronary Artery Bypass Graft (CABG)
Image by Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014
Who May Benefit From Coronary Artery Bypass Grafting
People who have certain conditions may benefit from CABG, such as those who have obstructive coronary artery disease, a type of ischemic heart disease. Obstructive coronary artery disease occurs when plaque builds up in the coronary arteries that supply the heart with oxygen-rich blood.
Your heart care team will work with you to decide if CABG is right for you. Your team includes your heart doctor, called a cardiologist, and a cardiothoracic surgeon, who specializes in heart, lung, and chest surgeries.
During an emergency, such as a heart attack or sudden cardiac arrest, CABG or another procedure may be performed with consent from a heart care team. If it is not an emergency, the team will evaluate your symptoms, medical history, the severity of your condition, your overall health, and how treatment will help you. The team will also consider your preferences after discussing the risks and benefits of CABG with you and your family.
When is CABG recommended?
The heart care team may recommend CABG to relieve symptoms and to improve your chance of living longer. Surgery is not always the best option for everyone. Depending on your overall health and other conditions, your care team may recommend an alternative procedure called percutaneous coronary intervention (PCI), which may include placing a stent. This procedure is also known as coronary angioplasty.
CABG may be recommended when you have:
A need for open-heart surgery for other reasons
Diabetes
Heart attack due to coronary artery disease that cannot be treated properly with PCI
Ischemic heart disease with angina that has not gone away with medicine, or with a history of sudden cardiac arrest related to heart arrhythmia
Multiple blocked coronary arteries or large amounts of plaque in the left main coronary artery that would be difficult to treat with PCI
Severe or advanced heart failure that affects your heart’s ability to pump blood
Source: National Heart, Lung, and Blood Institute (NHLBI)
Additional Materials (4)
What is Coronary Artery Disease - Mechanism of Disease
Video by Thrombosis Adviser/YouTube
Coronary Artery Disease: Causes
Video by AFMSCEMMTube/YouTube
What is coronary artery disease? | Circulatory System and Disease | NCLEX-RN | Khan Academy
Video by khanacademymedicine/YouTube
Coronary Artery Disease - Signs & Symptoms
Video by SingHealth/YouTube
2:38
What is Coronary Artery Disease - Mechanism of Disease
Thrombosis Adviser/YouTube
1:41
Coronary Artery Disease: Causes
AFMSCEMMTube/YouTube
13:39
What is coronary artery disease? | Circulatory System and Disease | NCLEX-RN | Khan Academy
khanacademymedicine/YouTube
2:19
Coronary Artery Disease - Signs & Symptoms
SingHealth/YouTube
Before Surgery
Heart angiography of Coronary Artery Blockage
Image by TheVisualMD
Heart angiography of Coronary Artery Blockage
Heart angiography of Coronary Artery Blockage
Image by TheVisualMD
Before Surgery Coronary Artery Bypass Grafting
Your doctor may use diagnostic tests or procedures before CABG to determine how serious your ischemic heart disease is and where the coronary arteries are narrowed. If you need CABG, talk to your doctor about how to prepare for the procedure.
Diagnostic tests and procedures
Tests and procedures may include the following:
Electrocardiogram (ECG or EKG) to record the electrical activity of the heart. An EKG can show signs of heart damage.
Stress tests to measure how well your heart works during physical stress. The stress may be physical exercise, such as walking on a treadmill, or it may be a medicine given to have the same effect.
Echocardiogram to assess heart function. This includes whether the valves or pumping is abnormal.
Coronary angiography to see how blood flows through your arteries. It is performed along with cardiac catheterization. The angiogram shows how severe the disease is, which arteries are affected, and the location of the affected arteries.
CT angiography to take pictures of your blood vessels. This is an alternative to cardiac catheterization that uses an injection of dye in the arm along with computed tomography (CT) imaging. Because it does not involve threading a catheter into the heart as cardiac catheterization does, CT angiography may be safer for some patients.
Coronary calcium scan to get images of the calcium in the walls of your coronary arteries, which is linked to coronary artery disease. This test uses CT imaging.
Preparing for surgery
CABG may be planned ahead of time, or it may be performed in an emergency situation, such as after a heart attack that leads to severe heart failure. If your surgery is scheduled, talk to your doctor about what to expect and how to prepare, such as:
Which medicines you should stop taking and when to stop. Ask about all the medicines you take, even if they are not prescription, as well as supplements.
Which medicines you should begin taking and when to start them.
How to bathe before surgery. You may be told to use a special soap to wash your body.
When to stop eating and drinking before surgery.
When to arrive at the hospital and where to go.
What to expect after surgery and during the recovery period.
Your doctor will also discuss treatment options with you, including the risks and possible complications during and after surgery. Ask your doctor any questions you have so you can make the best decision about your treatment.
Source: National Heart, Lung, and Blood Institute (NIH)
Additional Materials (6)
Preparing for Surgery Coronary Artery Bypass Graft CABG | Heart Care Video Series
British Heart Foundation - Your guide to ECG (electrocardiogram), heart disease test
British Heart Foundation/YouTube
2:42
What is a Stress Test?
Henry Ford Allegiance Health/YouTube
3:38
British Heart Foundation - Your guide to an exercise ECG (stress test), heart disease test
British Heart Foundation/YouTube
0:31
Stress Test Animation
Blausen Medical Corporate/YouTube
Electrocardiogram
Electrocardiogram
Also called: EKG, ECG
An electrocardiogram (EKG) is a test that measures electrical signals in your heart. An abnormal EKG can be a sign of heart damage or disease.
Electrocardiogram
Also called: EKG, ECG
An electrocardiogram (EKG) is a test that measures electrical signals in your heart. An abnormal EKG can be a sign of heart damage or disease.
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Use the slider below to see how your results affect your
health.
Your result is Normal.
EKG results are normal with a consistent heartbeat and rhythm.
Related conditions
An electrocardiogram (EKG) test is a simple, painless, and quick test that records your heart's electrical activity. Each time your heart beats, an electrical signal travels through your heart. The signal triggers your heart's four chambers to contract (squeeze) in the proper rhythm so that your heart can pump blood to your body.
An EKG recording of these signals looks like wavy lines. Your provider can read these lines to look for abnormal heart activity that may be a sign of heart disease or damage.
An EKG can show:
How fast your heart is beating
Whether the rhythm of your heartbeat is steady or irregular
The strength and timing of the electrical signals passing through each part of your heart
Sometimes information from an EKG can help measure the size and position of your heart's chambers.
An EKG is often the first test you'll have if you have signs of a heart condition. It may be done in your provider's office, an outpatient clinic, in a hospital before surgery, or as part of another heart test called a stress test.
An EKG test is also called an ECG. EKG is based on the German spelling, elektrokardiogramm. EKG may be preferred over ECG to avoid confusion with an EEG, a test that measures brain waves.
An EKG test is used to help diagnose and monitor many types of heart conditions and their treatment. These conditions include:
Arrhythmia
Cardiomyopathy
Coronary artery disease
Heart attack
Heart failure
Heart valve diseases
Congenital heart defects
EKG tests are mainly used for people who have symptoms of a heart condition or have already been diagnosed with a heart condition. They are not generally used to screen people who don't have symptoms unless they have an increased risk of developing heart disease. Your provider can explain your risk for heart disease and let you know if need to have an EKG test. In certain cases, your provider may have you see a cardiologist, a doctor who specializes in heart diseases.
You may need an EKG test if you have symptoms of a heart condition, including:
Chest pain
Rapid or irregular heartbeat
Shortness of breath
Dizziness
Fatigue
A decrease in your ability to exercise
You may also need an EKG to:
Find out if you had a heart attack in the past but didn't know it
Monitor your heart if you have a known heart condition
Check how well your heart treatment is working, including medicine and/or a pacemaker
Check your heart health:
Before having surgery
If you have an increased risk for developing heart disease because:
Heart disease runs in your family
You have another condition, such as diabetes, that makes your risk higher than normal
An EKG test only takes a few minutes. It generally includes these steps:
You will lie on an exam table.
A provider will place several electrodes (small sensors that stick to your skin) on your arms, legs, and chest. The provider may need to shave body hair to make sure the electrodes stay on.
The electrodes are attached by wires to a computer or a special EKG machine
You will lie very still while your heart's electrical activity is recorded on a computer or printed on paper by an EKG machine.
You don't need any special preparations for an EKG test.
There is very little risk to having an EKG. You may feel a little discomfort or skin irritation after the electrodes are removed. The EKG doesn't send any electricity to your body. It only records electrical signals from your heart, so there's no risk of electric shock.
Your provider will check your EKG results for a steady heartbeat and rhythm. If your results are not normal, it may be a sign of a heart condition. The specific condition depends on which part of your EKG wasn't normal.
You may need to have other heart health tests before your provider can make a diagnosis. Your provider can explain what your test results mean for your heart health and treatment.
An EKG is a "snapshot" of your heart's activity over a very short time. If you have heart symptoms that come and go, a regular EKG may not catch the problem. In that case, your provider may recommend that you wear a small portable EKG monitor that can record your heart for days or longer while you do your normal activities. You may also need a longer EKG recording if your provider wants to check how well your heart is working after a heart attack or to see if treatment is helping you.
There are many types of long-term EKG monitors. The two main groups are Holter monitors, which can be worn for up to two days, and event monitors, which may record your heart activity for weeks to years depending on the type.
A Holter monitor is about the size of a small camera. You usually wear it on a belt or strap around your neck for a day or two. Wires under your clothes attach to electrodes that stick to your chest. The monitor records your heart's electrical signals the whole time you're wearing it. You may be asked to keep a diary of your symptoms during the test period. After the test period, you remove the monitor and return it according to the instructions. A provider will review the recording of your heart's electrical activity from the monitor.
An event monitor records your heart's electrical activity when you press a button or when the device detects abnormal heart activity. There two main types of event monitors:
Event monitors that you wear or carry with you. You wear some monitors on your chest or wrist. Other monitors are designed to carry. If you have symptoms, you hold the monitor to your chest. These event monitors may be used for weeks to months. Some of them wirelessly transmit information about your heart to a provider. Others must be returned so a provider can examine the recorded information.
Event monitors that are inserted under the skin of your chest. These are called implantable event monitors. They are put under your skin during minor surgery that's often done in a doctor's office. These monitors can track your heart's electrical activity for years. You may need this type of EKG monitor if you had a stroke or frequent fainting, and your provider hasn't found the cause. Implantable monitors wirelessly transmit the information they record so your provider can regularly check it.
Electrocardiogram: MedlinePlus Medical Test [accessed on Mar 09, 2023]
Electrocardiogram: MedlinePlus Medical Encyclopedia [accessed on Feb 04, 2019]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (35)
How to Read an Electrocardiogram (ECG): Introduction – Cardiology | Lecturio
Video by Lecturio Medical/YouTube
Major Types of Heart Block
Video by Jeff Otjen/YouTube
How An ECG Works
Video by LivingHealthyChicago/YouTube
This browser does not support the video element.
What are Arrhythmias?
Your heart is electric. In this video you'll see how your heart's electrical system works, and what happens when it malfunctions. Voyage inside the human body as Dr. Mehmet Oz and others explain the dangers of heart arrhythmias, including tachycardia, bradycardia, and atrial fibrillation.
Video by TheVisualMD
12 Lead ECG Explained, Animation
Video by Alila Medical Media/YouTube
Bundle Branch Block, Animation.
Video by Alila Medical Media/YouTube
QRS Transitional Zone. See link for real voice update in description!
Video by Alila Medical Media/YouTube
ECG Interpretation Basics - ST Segment Changes. See link for real voice update in description!
Video by Alila Medical Media/YouTube
Cardiac Axis Interpretation. See link for real voice update in description!
Video by Alila Medical Media/YouTube
Electrical system of the heart | Circulatory system physiology | NCLEX-RN | Khan Academy
Video by khanacademymedicine/YouTube
Cardiovascular | EKG Basics
Video by Ninja Nerd/YouTube
Cardiovascular | EKG's
Video by Ninja Nerd/YouTube
Normal sinus rhythm on an EKG | Circulatory System and Disease | NCLEX-RN | Khan Academy
Video by khanacademymedicine/YouTube
Cardiac Conduction System and Understanding ECG, Animation.
Video by Alila Medical Media/YouTube
Willem Einthoven and the ECG - Stuff of Genius
Video by Stuff of Genius - HowStuffWorks/YouTube
Electrocardiogram (ECG)
A useful tool for determining whether a person has heart disease, an electrocardiogram (ECG) is a test that records the electrical activity of the heart. An ECG, which is painless (no electricity is sent through the body), is used to measure damage to the heart, how fast the heart is beating and whether it is beating normally, the effects of drugs or devices used to control the heart (such as a pacemaker), and the size and position of the heart chambers.
Image by TheVisualMD
Cardiac cycle
Cardiac Cycle vs Electrocardiogram
Image by OpenStax College
Medical Checkups
Image by TheVisualMD
Electrocardiogram
Electrocardiograms (EKGs) are the most commonly given test used to diagnose coronary artery disease. They record the heart's electrical activity and show evidence of angina or heart attack.
Image by TheVisualMD
electrocardiogram-illustration made up from Medications
A normal tracing shows the P wave, QRS complex, and T wave. Also indicated are the PR, QT, QRS, and ST intervals, plus the P-R and S-T segments.
Image by CNX Openstax
What To Expect After an Electrocardiogram
Normal ECG/EKG complex with labels
Image by Derivative: Hazmat2 Original: Hank van Helvete
Cardiac Stress Test
The image shows a patient having a stress test. Electrodes are attached to the patient's chest and connected to an EKG (electrocardiogram) machine. The EKG records the heart's electrical activity. A blood pressure cuff is used to record the patient's blood pressure while he walks on a treadmill.
Image by National Heart Lung and Blood Institute
Relationship between the Cardiac Cycle and ECG
Initially, both the atria and ventricles are relaxed (diastole). The P wave represents depolarization of the atria and is followed by atrial contraction (systole). Atrial systole extends until the QRS complex, at which point, the atria relax. The QRS complex represents depolarization of the ventricles and is followed by ventricular contraction. The T wave represents the repolarization of the ventricles and marks the beginning of ventricular relaxation.
Image by CNX Openstax
The Electric Heart
Image by TheVisualMD
Electrocardiogram (EKG)
Electrocardiogram (EKG) is a test used to measure the electrical activity of the heart.
Image by U.S. National Library of Medicine
Comparison of Arrhythmia and Normal ECG
As the muscle tissue in an overstressed heart expands, it tears and scars. The resulting tissue - hardened and marred - does not conduct electricity well. The result is that the system can no longer be relied on to deliver the carefully synchronized pattern of jolts needed to keep the heart pumping smoothly. Doctors call it \"arrhythmia.\" The heart is literally \"skipping a beat.\" This can be measured by an electrocardiogram (ECG). In some cases, arrhythmia can mean simply that the heartbeat is too fast or too slow - a bothersome but not necessarily life-threatening condition. In the worst cases, the arrhythmia indicates a potentially lethal instability in the heart's electric system. The signals that control the heart's contractions get crossed and the heart spasms. If not corrected immediately, this fibrillation of the heart is often fatal. In the U.S., more than 1,000 people die every day from sudden cardiac death, or cardiac arrest.
Image by TheVisualMD
Heart Revealing Chamber and Valve
Your heart beats faster or slower depending on information from your brain, which monitors your body's need for blood. However, the basic rhythm of your heart is automatic; it does not depend on signals from your brain. Your heart cells can generate their own electrical signals, which trigger the contractions and cause the entire heart to pump in synchrony. A specialized bundle of muscle and nerve cells called the sinoatrial node (SA node) sits at the top of the right atrium and is the pacemaker of the heart. It generates the signal for the atria to contract and send blood to the ventricles. A similar node - the atrioventricular or AV node - sits at the atrioventricular septum near the bottom of the right atrium and relays the signal from the SA node to the ventricles to contract and pump blood out of the heart. An electrocardiogram (ECG) measures the electrical signals given off by these two nodes and their conduction through the heart. By looking at the frequency and the height of the peaks and valleys of these signals on an ECG, healthcare professionals get a very good idea of how well the electrical system of your heart is working.
Image by TheVisualMD
Electrocardigram
An electrocardiogram (EKG) detects and records the heart's electrical activity. When the electrical impulse passes through the atria a small peak is recorded (P), followed by a steep spike as it erupts through the ventricles (R), and then another small peak (T) as the wave passes through and the heart repolarizes (recharges) itself for the next beat.
Image by TheVisualMD
Electro- cardiogram
Electrocardiograms, or EKGs, record the electrical activity of the heart. Since injured heart muscle conducts electrical impulses abnormally, the EKG shows if the patient has had or is having a heart attack. It is usually the first test performed.
Image by TheVisualMD
SinusRhythmLabels
Schematic diagram of normal sinus rhythm for a human heart as seen on ECG. In atrial fibrillation, however, the P waves, which represent depolarization of the atria, are absent.
Image by Agateller (Anthony Atkielski)
How To Use an Automated External Defibrillator
The image shows a typical setup using an automated external defibrillator (AED). The AED has step-by-step instructions and voice prompts that enable an untrained bystander to correctly use the machine.
Image by National Heart Lung and Blood Institute
Who Needs an Implantable Cardioverter Defibrillator?
Lead II (2) ECG EKG strip of an AICD ICD converting a patient back into thier baseline cardiac ryhthm. The AICD fires near the end of the strip, where the straight line is seen.
Image by Public Domain
Cardiac Cycle
CG Animated Human Heart cut section showing the atria, ventricles and valves, synced with wiggers diagram.
Image by DrJanaOfficial/Wikimedia
Mammalian Heart and Blood Vessels
The beating of the heart is regulated by an electrical impulse that causes the characteristic reading of an ECG. The signal is initiated at the sinoatrial valve. The signal then (a) spreads to the atria, causing them to contract. The signal is (b) delayed at the atrioventricular node before it is passed on to the (c) heart apex. The delay allows the atria to relax before the (d) ventricles contract. The final part of the ECG cycle prepares the heart for the next beat.
Image by CNX Openstax
9:53
How to Read an Electrocardiogram (ECG): Introduction – Cardiology | Lecturio
Lecturio Medical/YouTube
9:23
Major Types of Heart Block
Jeff Otjen/YouTube
2:45
How An ECG Works
LivingHealthyChicago/YouTube
3:27
What are Arrhythmias?
TheVisualMD
3:27
12 Lead ECG Explained, Animation
Alila Medical Media/YouTube
3:48
Bundle Branch Block, Animation.
Alila Medical Media/YouTube
3:50
QRS Transitional Zone. See link for real voice update in description!
Alila Medical Media/YouTube
1:24
ECG Interpretation Basics - ST Segment Changes. See link for real voice update in description!
Alila Medical Media/YouTube
3:32
Cardiac Axis Interpretation. See link for real voice update in description!
Alila Medical Media/YouTube
9:43
Electrical system of the heart | Circulatory system physiology | NCLEX-RN | Khan Academy
khanacademymedicine/YouTube
52:29
Cardiovascular | EKG Basics
Ninja Nerd/YouTube
20:37
Cardiovascular | EKG's
Ninja Nerd/YouTube
8:53
Normal sinus rhythm on an EKG | Circulatory System and Disease | NCLEX-RN | Khan Academy
khanacademymedicine/YouTube
3:45
Cardiac Conduction System and Understanding ECG, Animation.
Alila Medical Media/YouTube
1:46
Willem Einthoven and the ECG - Stuff of Genius
Stuff of Genius - HowStuffWorks/YouTube
Electrocardiogram (ECG)
TheVisualMD
Cardiac cycle
OpenStax College
Medical Checkups
TheVisualMD
Electrocardiogram
TheVisualMD
electrocardiogram-illustration made up from Medications
GDJ
Electrocardiogram
CNX Openstax
What To Expect After an Electrocardiogram
Derivative: Hazmat2 Original: Hank van Helvete
Cardiac Stress Test
National Heart Lung and Blood Institute
Relationship between the Cardiac Cycle and ECG
CNX Openstax
The Electric Heart
TheVisualMD
Electrocardiogram (EKG)
U.S. National Library of Medicine
Comparison of Arrhythmia and Normal ECG
TheVisualMD
Heart Revealing Chamber and Valve
TheVisualMD
Electrocardigram
TheVisualMD
Electro- cardiogram
TheVisualMD
SinusRhythmLabels
Agateller (Anthony Atkielski)
How To Use an Automated External Defibrillator
National Heart Lung and Blood Institute
Who Needs an Implantable Cardioverter Defibrillator?
Public Domain
Cardiac Cycle
DrJanaOfficial/Wikimedia
Mammalian Heart and Blood Vessels
CNX Openstax
Stress Tests
Stress Tests
Also called: Cardiac Stress Test, Cardiac Diagnostic Test
Stress tests shows how well your heart works when it's pumping hard. They can find problems with blood flow to your heart muscle and other heart conditions. Reduced blood flow can be a sign of a serious heart disease.
Stress Tests
Also called: Cardiac Stress Test, Cardiac Diagnostic Test
Stress tests shows how well your heart works when it's pumping hard. They can find problems with blood flow to your heart muscle and other heart conditions. Reduced blood flow can be a sign of a serious heart disease.
Stress tests show how well your heart works when it's pumping hard. Some heart diseases are easier to find when your heart is working its hardest to pump blood through your body. So stress tests check your heart while you exercise on a treadmill or stationary bicycle. If you're not able to exercise, medicine can be used to make your heart work harder , as if you were exercising.
There are different types of stress tests. They all check:
Blood flow in your heart
Your blood pressure
The rate and rhythm of your heartbeat
The strength of the electrical signals that control your heartbeat
Some stress tests also take pictures of your heart at rest and when it's working hard. The pictures provide more detail about how your heart is working.
Stress tests are most often used to find the cause of symptoms that may be from a heart problem.
The tests can help diagnose certain heart conditions, including:
Coronary artery disease (CAD)
Angina
Arrhythmia
Heart failure
Heart valve diseases
Cardiomyopathy
Stress testing is also used:
To find out how serious a known heart condition is, including the chance that you'll have a heart attack in the future.
To help make treatment decisions for a heart condition.
You may need a stress test if you have symptoms that could be from a heart condition. Symptoms may include:
Chest pain or discomfort without a known cause
Shortness of breath
Irregular or rapid heartbeat that may feel like a fluttering in your chest
Feeling dizzy or lightheaded
You may also need a stress test to check your heart health if you:
Have a heart condition with new or worsening symptoms.
Are going to have surgery. Your health care provider may want to see if your heart is strong enough for the operation.
Are being treated for heart disease. The test can show how much treatment is helping, including heart surgery.
Have a high risk for heart disease. Your risk may be higher than normal if you have a family history of heart disease and/or certain conditions, such as diabetes, that are linked to heart disease.
Plan to start an exercise program. If you have a heart condition or a high risk for a heart condition, a stress test can show what level of exercise is safe for you. (Always talk with your provider before starting any strenuous, new exercise.)
Stress tests may be done with or without imaging (pictures of your heart). The most common type of test is an exercise stress test. It doesn't include pictures. But the main steps of an exercise stress test are part of all stress tests:
You'll have a blood pressure cuff on your arm to check your blood pressure.
Electrodes will be placed on your body for an electrocardiogram test (also called EKG or ECG). Electrodes are small sensors that stick to your skin. Wires connect the electrodes to a computer or an EKG machine that records the electrical activity in your heart during the stress test.
If you're unable to exercise: An intravenous (IV) line will be inserted into a vein in your arm. You'll get medicine through the IV. The medicine will make your heart work harder for 10 to 20 minutes while an EKG records your heart's electrical activity. Medicine can be used instead of exercise for all types of stress tests.
If you can exercise: You'll walk on a treadmill or ride a stationary bicycle. On a treadmill, the speed will slowly increase. The treadmill may also tilt so you feel like you're walking uphill. On a bicycle, the resistance will slowly increase, so it's harder to pedal.
You'll exercise for about 10 to 15 minutes until you reach a target heart rate based on your age and fitness level. But you may stop the test sooner if:
You develop chest pain, shortness of breath, dizziness, fatigue or other symptoms
The EKG shows a problem with your heart
After all types of stress tests, you'll be monitored for 10-15 minutes or until your heart rate returns to normal.
Stress tests with pictures include stress echocardiograms, nuclear stress tests, and cardiac (heart) MRI stress tests. These tests have extra steps:
A stress echocardiogram or "echo" takes moving pictures of your heart using doppler ultrasound. The pictures show the size and shape of your heart and blood flow through your heart. Pictures will be taken before and after your heart has worked its hardest. You'll lie on your left side on a table as a provider moves an ultrasound device on your chest. If you exercise on a bicycle, the second set of pictures may be taken while you're pedaling.
A nuclear stress test takes pictures of your heart using a small amount of a radioactive substance called a "tracer" and a special camera that scans your heart. A provider injects the tracer into your bloodstream through an IV line that's placed in a vein. Your heart and blood vessels absorb the tracer, which makes them show up more clearly in the pictures.
Pictures are taken while you lie on a table before and after your heart has worked its hardest. After the test, the tracer naturally leaves your body in your urine (pee). Drinking lots of water will help remove it faster.
A cardiac MRI stress test takes the most detailed pictures of your heart using radio waves, magnets, and a computer. It is a newer test that's mostly used for very serious heart problems. For an MRI stress test:
A provider may inject dye into your bloodstream through an IV line placed in your arm. Some cardiac MRIs, but not all, use dye to help show very small details on the pictures.
Pictures of your heart may be taken before and after your heart has worked hard. To take the pictures, you'll lie on a table that slides into a large, tunnel-like MRI machine. You'll hear loud sounds as the machine takes pictures. If you're exercising for the test, you may use a treadmill near the MRI, or you may exercise while lying in the MRI machine using special devices to move your arms or legs.
Wear comfortable shoes and clothing for exercise. Your provider will tell you what else to do before a stress test. You'll usually need to fast (not eat or drink) and stop smoking for at least a few hours before the test. You may need to avoid drinks with caffeine, such as coffee, tea, and colas, for a longer period of time.
If you take medicines or supplements, ask your provider if you should take them as usual. Don't stop taking any medicine unless your provider tells you to. If your test uses MRI, tell your provider about any metal you have in your body. An MRI can heat certain metal and cause burns.
Stress tests are usually safe. You will be closely watched during the test. If a problem develops, you'll be treated quickly. Medicines that make your heart work harder sometimes cause symptoms such as chest pain, dizziness, or nausea. An IV may bruise your arm.
The tracers and dyes used in nuclear and MRI stress tests may cause an allergic reaction, but this is rare. If you are or could become pregnant or are breastfeeding, talk with your provider before you have these tests.
A normal test result means no blood flow problems were found. Your heart is working well.
If your test result was not normal, it may mean you have heart disease. Ask your provider to explain what condition you may have. You may need more tests to find out how serious your condition is.
Stress Tests: MedlinePlus Medical Test [accessed on Mar 09, 2023]
Exercise Tolerance Test
Exercise Tolerance Test
Also called: Treadmill Stress Testing, Exercise Stress Test, Cardiopulmonary Exercise Test, CPX Test
Exercise tolerance testing is a form of cardiac stress testing that uses treadmill exercise with electrocardiogram (EKG) and blood pressure monitoring. The test is used to determine a patient’s functional capacity, assess the probability and extent of coronary artery disease (CAD) as well as assess risks, prognosis and effects of therapy.
Exercise Tolerance Test
Also called: Treadmill Stress Testing, Exercise Stress Test, Cardiopulmonary Exercise Test, CPX Test
Exercise tolerance testing is a form of cardiac stress testing that uses treadmill exercise with electrocardiogram (EKG) and blood pressure monitoring. The test is used to determine a patient’s functional capacity, assess the probability and extent of coronary artery disease (CAD) as well as assess risks, prognosis and effects of therapy.
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Related conditions
This test allows your doctor to learn how your heart reacts to exercise. As you walk on the treadmill, an EKG (electrocardiogram) will check your heart’s electrical activity. The EKG may show if your heart lacks blood flow or has abnormal heartbeats during exercise. The stress test also helps your doctor decide if you need further tests to evaluate your heart.
Before the test begins, your nurse or doctor will explain it to you. Feel free to ask questions and voice concerns at this time. When you understand what will happen, you will be asked to sign a consent for the test to be performed.
To monitor your heart during exercise, adhesive patches, called electrodes, will be put on your chest. Your chest will be cleansed with alcohol and shaved in some areas (if necessary) before these electrodes are placed.
You will be asked about symptoms you have had with exercise in the past. Describe, as completely as you can, any chest discomfort, breathing problems, lightheadedness or dizziness, fluttering in the chest, weakness, fatigue, or anything else you think may be relevant. Also, mention anything you feel while you are being prepared for the test.
A nurse or doctor will be with you throughout the test. Your heart rate and rhythm and your blood pressure will be checked during the test.
Generally, the treadmill’s pace and incline will increase every 3 minutes. It is important that you describe anything you feel as you exercise. If you become short of breath, the nurse may ask you to rate it as “mild,” “moderate,” or “severe.” If you have chest discomfort, you will be asked to describe it as best you can and rate it on a scale of 1 to 10 (1 is very mild; 10 is very severe). There is no right or wrong number. This helps your doctor know how you are doing and gives us a better way to compare how you feel before and after the test.
Keep walking until you are told to stop or until you cannot walk any longer. Let the nurse know when you need to slow down. Keep walk-ing as the treadmill slows. Do not jump off.
While you rest, your heart will continue to be monitored.
Inform the doctor or nurse about any temporary or permanent condition that could affect your ability to move, walk, bear weight, or keep your balance. If possible, discuss this when you are first scheduled for the test. It is also important that the doctor and/or nurse conducting the test have this information.
Carefully follow your doctor’s instructions about medications. Some medications should be stopped for 48 hours before the test; others should not be stopped. If you do not have clear instructions about all your medications (including those for your heart, blood pressure, or other medications), contact your doctor or nurse a few days before the test.
Avoid caffeine, alcohol, and nicotine 8 hours before the test. Do not eat 2 hours before the test, and do not drink liquids 1 hour before the test. If your exercise test is combined with heart imaging (such as a thallium scan), follow the specific instructions for that test.
Try to be as well rested as possible. You may need to reschedule the test if you feel unwell (for example, if you have a cold). If you do not feel you can give your maximum exercise effort, contact your nurse or doctor before the test.
Wear loose, comfortable clothing with a separate top and bottom. Women should wear bras. Wear comfortable, flat shoes that will not slip off while you are walking.
After the procedure:
You can eat and drink as usual.
Depending on how you feel, you may go about your normal routine or take it easy if the test tired you.
Do not take a hot shower for at least an hour after the test. Your blood vessels expand with exercise and need time to return to normal. A hot shower may expand them more, causing low blood pressure and dizziness.
Procedures/Diagnostic Tests. Exercise tolerance test. National Institutes of Health Clinical Center. [accessed on Dec 11, 2018]
Vilcant V, Zeltser R. Treadmill Stress Testing. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. [accessed on Dec 11, 2018]
Am Fam Physician. 2017 Sep 1;96(5):293-299. Exercise Stress Testing: Indications and Common Questions. Garner KK, Pomeroy W, Arnold JJ. [accessed on Dec 11, 2018]
Am Fam Physician. 1999 Jan 15;59(2):401-10. Ordering and understanding the exercise stress test. Darrow MD. [accessed on Dec 11, 2018]
Harvard Men's Health. Cardiac exercise stress testing: What it can and cannot tell you. [accessed on Dec 11, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Stress Echocardiography
Stress Echocardiography
Also called: Echocardiography Stress Test, Stress Echo
Stress echocardiography, or echo, is a test that uses sound waves to create moving pictures of your heart. A stress echo is done as part of a stress test. Some heart problems, such as coronary heart disease, are easier to diagnose when the heart is working hard and beating fast.
Stress Echocardiography
Also called: Echocardiography Stress Test, Stress Echo
Stress echocardiography, or echo, is a test that uses sound waves to create moving pictures of your heart. A stress echo is done as part of a stress test. Some heart problems, such as coronary heart disease, are easier to diagnose when the heart is working hard and beating fast.
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Use the slider below to see how your results affect your
health.
Your result is Normal.
A normal result means that blood flow through the coronary arteries is probably normal.
Related conditions
https://medlineplus.gov/ency/article/007150.htm [accessed on Feb 23, 2022]
https://medlineplus.gov/lab-tests/stress-tests/ [accessed on Feb 23, 2022]
https://www.nhlbi.nih.gov/health-topics/echocardiography [accessed on Feb 23, 2022]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Coronary Calcium Scan
Coronary Calcium Scan
Also called: Coronary CT calcium scan, Calcium scan test, Cardiac CT for calcium scoring, Cardiac CT scan, Heart CT scan
A coronary calcium scan is a CT scan of your heart that detects and measures the amount of calcium in the walls of your coronary arteries. Buildup of calcium, or calcifications, are a sign of atherosclerosis, coronary heart disease, or coronary microvascular disease.
Coronary Calcium Scan
Also called: Coronary CT calcium scan, Calcium scan test, Cardiac CT for calcium scoring, Cardiac CT scan, Heart CT scan
A coronary calcium scan is a CT scan of your heart that detects and measures the amount of calcium in the walls of your coronary arteries. Buildup of calcium, or calcifications, are a sign of atherosclerosis, coronary heart disease, or coronary microvascular disease.
https://www.nhlbi.nih.gov/health-topics/coronary-calcium-scan [accessed on Apr 09, 2020]
https://medlineplus.gov/ency/article/007344.htm [accessed on Apr 09, 2020]
Additional Materials (13)
DENSITY OF CORONARY ARTERY CALCIUM MAY HELP PREDICT RISK OF HEART ATTACK AND STROKE
Video by TheJAMAReport/YouTube
Calcium Score: Detecing Heart Disease EARLY!
Video by HeartSmartMD/YouTube
Detecting Heart Disease with Calcium Score - Scottsdale Medical Imaging
Video by SMILLTD/YouTube
Coronary Artery Disease
Image by TheVisualMD
Coronary catheterization
Coronary angiography of a critical sub-occlusion of the common trunk of the left coronary artery and the circumflex artery. (See arrows).
Image by Maria A Pantaleo, Anna Mandrioli, Maristella Saponara, Margherita Nannini, Giovanna Erente, Cristian Lolli and Guido Biasco
Living With Coronary Heart Disease
Low magnification micrograph of the distal right coronary artery with complex atherosclerosis and luminal narrowing : Micrograph of the distal right coronary artery, which supplies the heart, showing significant atherosclerosis and marked luminal narrowing (the space where blood can flow is narrower than normal).
Image by Nephron
Atherosclerosis
Illustration of Atherosclerosis and plaque that may lead to Angina.
Image by OpenStax College
Coronary Calcium Scan
Coronary Calcium Scan. Figure A shows the position of the heart in the body and the location and angle of the coronary calcium scan image. Figure B is a coronary calcium scan image showing calcifications in a coronary artery.
Image by NHLBI/NIH
Dr Henson's Calcium Score
Video by Executive Health/YouTube
What Does Cardiac CT (Computer Tomography) Show?
The illustration shows the major signs and symptoms of coronary heart disease.
Image by National Heart Lung and Blood Insitute (NIH)
Angiograms Can Detect Blockages
If someone has symptoms or risk factors for heart disease, a doctor can use different tests to evaluate heart function and detect blockages. Electrocardiograms, or EKGs, can show if the heart has been damaged. Exercise tolerance tests, also know as stress tests, measure the heart's ability to supply the body with oxygen. But for pinpointing blockages, X-ray images called angiograms are essential.
Image by TheVisualMD
Chest Radiograph
Medical X-rays
Image by Nevit Dilmen
What To Expect During a Coronary Calcium Scan
3D reconstruction of the thin multislice CT, covering human heart and lungs
Image by Semnic
2:00
DENSITY OF CORONARY ARTERY CALCIUM MAY HELP PREDICT RISK OF HEART ATTACK AND STROKE
TheJAMAReport/YouTube
1:37
Calcium Score: Detecing Heart Disease EARLY!
HeartSmartMD/YouTube
3:51
Detecting Heart Disease with Calcium Score - Scottsdale Medical Imaging
SMILLTD/YouTube
Coronary Artery Disease
TheVisualMD
Coronary catheterization
Maria A Pantaleo, Anna Mandrioli, Maristella Saponara, Margherita Nannini, Giovanna Erente, Cristian Lolli and Guido Biasco
A cardiac CT scan is an imaging test that uses X-rays to take many detailed pictures of your heart and its blood vessels. This test can help diagnose or evaluate ischemic heart disease, calcium buildup in the coronary arteries, problems with the aorta, problems with heart function and valves, and pericardial disease.
A cardiac CT scan is an imaging test that uses X-rays to take many detailed pictures of your heart and its blood vessels. This test can help diagnose or evaluate ischemic heart disease, calcium buildup in the coronary arteries, problems with the aorta, problems with heart function and valves, and pericardial disease.
A cardiac CT scan is a painless imaging test that uses x rays to take many detailed pictures of your heart and its blood vessels. Computers can combine these pictures to create a three-dimensional (3D) model of the whole heart.
This imaging test can help doctors detect or evaluate ischemic heart disease, calcium buildup in the coronary arteries, problems with the aorta, problems with heart function and valves, and pericardial disease. This test also may be used to monitor the results of coronary artery bypass grafting or to follow up on abnormal findings from earlier chest x rays. Different CT scanners are used for different purposes. A multidetector CT is a very fast type of CT scanner that can produce high-quality pictures of the beating heart and can detect calcium or blockages in the coronary arteries. An electron beam CT scanner also can show calcium in coronary arteries.
Many x-ray pictures are taken during a cardiac CT scan. A computer puts the pictures together to make a three-dimensional (3D) picture of the whole heart. This picture shows the inside of the heart and the structures that surround the heart.
Doctors use cardiac CT to detect or evaluate:
Coronary heart disease (CHD). In CHD, a waxy substance called plaque narrows the coronary arteries and limits blood flow to the heart. Contrast dye might be used during a cardiac CT scan to show whether the coronary arteries are narrow or blocked. When contrast dye is used, the test is called a coronary CT angiography, or CTA.
Calcium buildup in the walls of the coronary arteries. This type of CT scan is called a coronary calcium scan. Calcium in the coronary arteries may be an early sign of CHD.
Problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from the heart to the body. Cardiac CT can detect two serious problems in the aorta:
Aneurysm (AN-u-rism). An aneurysm is a diseased area of a blood vessel wall that bulges out. An aneurysm can be life threatening if it bursts.
Dissection. A dissection is a split in one or more layers of the artery wall. The split causes bleeding into and along the layers of the artery wall. This condition can cause pain and may be life threatening.
A pulmonary embolism (PE). A PE is a sudden blockage in a lung artery, usually due to a blood clot.
Problems in the pulmonary veins. The pulmonary veins carry blood from the lungs to the heart. Problems with these veins may lead to an irregular heart rhythm called atrial fibrillation (AF). The pictures that cardiac CT creates of the pulmonary veins can help guide procedures used to treat AF.
Problems with heart function and heart valves. In some cases, doctors may recommend cardiac CT instead of echocardiography or cardiac MRI (magnetic resonance imaging) to look for problems with heart function or heart valves.
Pericardial disease. This is a disease that occurs in the pericardium, the sac around your heart. Cardiac CT can create clear, detailed pictures of the pericardium.
Results of coronary artery bypass grafting (CABG). In CABG, arteries from other areas in your body are used to bypass (that is, go around) narrow coronary arteries. A CT scan can help determine whether the grafted arteries remain open after the surgery.
Doctors also might recommend cardiac CT scans before or after other heart procedures, such as cardiac resynchronization therapy. A CT scan can help your doctor pinpoint the areas of the heart or blood vessels where the procedure should be done. The scan also can help your doctor check your heart after the procedure.
Because the heart is in motion, a fast type of CT scanner, called multidetector computed tomography (MDCT), might be used to take high-quality pictures of the heart. MDCT also might be used to detect calcium in the coronary arteries.
Another type of CT scanner, called electron-beam computed tomography (EBCT), also is used to detect calcium in the coronary arteries.
Cardiac CT is done in a hospital or outpatient office. A doctor who has experience with CT scanning will supervise the test.
The doctor may want to use an iodine-based dye (contrast dye) during the cardiac CT scan. If so, a needle connected to an intravenous (IV) line will be put in a vein in your hand or arm.
The doctor will inject the contrast dye through the IV line during the scan. You may have a warm feeling when this happens. The dye will make your blood vessels visible on the CT scan pictures.
The technician who runs the cardiac CT scanner will clean areas on your chest and apply sticky patches called electrodes. The patches are attached to an EKG (electrocardiogram) machine. The machine records your heart's electrical activity during the scan.
The CT scanner is a large machine that has a hollow, circular tube in the middle. You will lie on your back on a sliding table. The table can move up and down, and it goes inside the tunnel-like machine.
The table will slide slowly into the opening in the machine. Inside the scanner, an x-ray tube moves around your body to take pictures of different parts of your heart. A computer will put the pictures together to make a three-dimensional (3D) picture of the whole heart.
The technician controls the CT scanner from the next room. He or she can see you through a glass window and talk to you through a speaker.
Moving your body can cause the pictures to blur. You'll be asked to lie still and hold your breath for short moments, while each picture is taken.
A cardiac CT scan usually takes about 15 minutes to complete. However, it can take more than an hour to get ready for the test and for the medicine to slow your heart rate.
Your doctor will tell you how to prepare for the cardiac CT scan. He or she may tell you to avoid caffeine and not eat anything for 4 hours before the scan. You’re usually allowed to drink water before the test.
If you take medicine for diabetes, talk with your doctor about whether you'll need to change how you take it on the day of your cardiac CT scan.
Tell your doctor whether you:
Are pregnant or might be pregnant. Even though cardiac CT uses a low radiation dose, the x rays may harm your fetus.
Have asthma or kidney problems or are allergic to any medicines, iodine, or shellfish. These problems can increase your chance of having an allergic reaction to the contrast dye that's sometimes used during cardiac CT.
A technician will ask you to remove your clothes above the waist and wear a hospital gown. You also will be asked to remove any jewelry from around your neck or chest.
If you don't have asthma, COPD (chronic obstructive pulmonary disease), or heart failure, your doctor may give you medicine to slow your heart rate. A slower heart rate will help produce better quality pictures. The medicine will be given by mouth or injected into a vein.
Cardiac CT involves radiation, although the amount used is considered small. Depending on the type of CT scan you have, the amount of radiation is similar to the amount you’re naturally exposed to over 1–5 years.
There is a small chance that cardiac CT will cause cancer because of the radiation. The risk is higher for people younger than 40 years old. New cardiac CT methods are available that reduce the amount of radiation used during the test.
Cardiac CT scans are painless. Some people have side effects from the contrast dye that might be used during the scan. An itchy feeling or a rash may appear after the contrast dye is injected. Normally, neither side effect lasts for long, so medicine often isn't needed.
If you do want medicine to relieve the symptoms, your doctor may prescribe an antihistamine. This type of medicine is used to help stop allergic reactions.
Although rare, it is possible to have a serious allergic reaction to the contrast dye. This reaction may cause breathing problems. Doctors use medicine to treat serious allergic reactions.
People who have asthma, COPD (chronic obstructive pulmonary disease), or heart failure may have breathing problems during cardiac CT if they're given beta blockers to slow their heart rates.
https://www.nhlbi.nih.gov/health-topics/cardiac-ct-scan [accessed on Aug 25, 2021]
Additional Materials (8)
Cardiac CT scan
Video by UHP_NHS/YouTube
Having a Cardiac CT Scan in Hospital
Video by Oxford AHSN/YouTube
DENSITY OF CORONARY ARTERY CALCIUM MAY HELP PREDICT RISK OF HEART ATTACK AND STROKE
Video by TheJAMAReport/YouTube
Calcium Score: Detecing Heart Disease EARLY!
Video by HeartSmartMD/YouTube
Dr Henson's Calcium Score
Video by Executive Health/YouTube
Coronary Calcium Scan
Coronary Calcium Scan. Figure A shows the position of the heart in the body and the location and angle of the coronary calcium scan image. Figure B is a coronary calcium scan image showing calcifications in a coronary artery.
Image by NHLBI/NIH
Human Heart
Composited image profile of a heart as seen through various rendering techniques. With volume rendering software, slices of Magnetic Resonance Imagery (MRI), and Computer Tomography (CT) scans can be compiled to produce a three-dimensional (3D) model of an organ such as a heart. Models can be viewed in various ways. As individual slices, as is seen along the left or as enhanced color, gray scale volume and 3D transparency, as is seen along the right.
Image by TheVisualMD
Computed tomography of the heart
Contrast enhanced dual-source CT-angiograph.
Image by Scheffel H, Alkadhi H, Plass A, Vachenauer R, Desbiolles L, Gaemperli O, Schepis T, Frauenfelder T, Schertler T, Husmann L, Grunenfelder J, Genoni M, Kaufmann PA, Marincek B, Leschka S.
5:04
Cardiac CT scan
UHP_NHS/YouTube
4:59
Having a Cardiac CT Scan in Hospital
Oxford AHSN/YouTube
2:00
DENSITY OF CORONARY ARTERY CALCIUM MAY HELP PREDICT RISK OF HEART ATTACK AND STROKE
TheJAMAReport/YouTube
1:37
Calcium Score: Detecing Heart Disease EARLY!
HeartSmartMD/YouTube
5:59
Dr Henson's Calcium Score
Executive Health/YouTube
Coronary Calcium Scan
NHLBI/NIH
Human Heart
TheVisualMD
Computed tomography of the heart
Scheffel H, Alkadhi H, Plass A, Vachenauer R, Desbiolles L, Gaemperli O, Schepis T, Frauenfelder T, Schertler T, Husmann L, Grunenfelder J, Genoni M, Kaufmann PA, Marincek B, Leschka S.
During Surgery
Bypass Background
Image by TheVisualMD
Bypass Background
Image by TheVisualMD
During Surgery - Coronary Artery Bypass Grafting
During CABG, a surgical team will take one or more blood vessels from another part of your body and connect it to the blocked artery in your heart. CABG may be performed in one of three ways. In traditional CABG, the chest is cut open and a machine pumps your blood. In “off-pump” CABG, the chest is opened, but a machine for pumping blood is not used. With minimally invasive CABG methods, only small cuts are made in the chest, and a machine is not used.
Surgical team
Your surgical team will include a cardiothoracic surgeon, who will work on your heart. An anesthesiologist will give you medicine to make you sleep before the surgery, connect you to a breathing machine, and monitor your vital signs throughout the procedure. A perfusionist will manage the heart-lung pump, and nurses and other surgeons may help throughout the surgery.
Traditional CABG surgery
Traditional CABG is the most common type of CABG surgery. This surgery takes about three to six hours, depending on how many arteries need to be bypassed. Learn more about how to prepare before surgery.
You will be given an intravenous (IV) line for fluids and medicines that will make you sleep before the surgery. You will be connected to a ventilator to support your breathing. The surgeon makes a cut down the middle of the chest, through the breastbone. The bone is split and the rib cage separated so the surgeon can reach the heart.
You will receive medicines to temporarily stop your heart from beating. This makes it easier for the surgeon to connect the healthy blood vessels, called grafts, into the coronary arteries. This requires a heart-lung bypass machine, which adds oxygen to your blood and pumps it throughout your body during surgery while your heart is not beating.
How a heart-lung bypass machine works during surgery. The heart-lung bypass machine adds oxygen and pumps blood throughout the body while the heart is stopped during surgery. The blood supply is connected to the machine through tubes. First, blood that needs oxygen leaves the heart and goes into the machine, bypassing the lungs. Oxygen is added to the blood in the machine. Then the machine pumps the oxygen-rich blood to the rest of the body.
The surgeon will then take an artery or a vein from your leg, arm, stomach, or chest. The graft is connected to the blocked coronary artery. The new blood vessel bypasses the blocked portion to create a new path for blood flow to the heart muscle. The number of grafts depends on how many coronary arteries need to be bypassed.
When the grafting is finished, the surgeon will restart the heart and restore blood flow. The heart usually starts beating on its own, but sometimes mild shocks are used to start it. Surgeons will sew the breastbone back together with a wire.
Off-pump CABG
Sometimes CABG can be done without stopping the heart and using a heart-lung bypass machine. This is called off-pump CABG because the heart-lung bypass machine, or pump, is not used. The heart is steadied with a mechanical device. It is more difficult for surgeons because the heart is beating, and surgeons do not have easy access to blood vessels. However, it may be safer for certain people, such as those who have a higher risk of complications from using a heart-lung bypass machine. These include older adults and people who have ventricular dysfunction, diabetes, kidney disease, and chronic lung disease. This type of surgery is also sometimes called beating-heart bypass grafting.
Minimally invasive CABG
Sometimes, CABG surgery may not be done as open heart surgery. There are less-invasive methods, including:
Minimally invasive direct coronary artery bypass (MIDCAB). MIDCAB is a modified version of CABG where the chest bone is not cut open. Instead, the surgeon makes a smaller cut on the left side of the chest over the artery that needs to be bypassed and enters in between the ribs. It is also usually an off-pump procedure.
Robotic. Sometimes CABG surgery can be done using a robot to surgically place the graft. This is called robotic-assisted or robotic surgery. The surgeon controls the robot instead of doing the work by hand, and the machinery only needs small openings in the chest. A heart-lung bypass machine is sometimes used.
Hybrid. During a hybrid bypass surgery, the robotic bypass is done for one of the main arteries, but a stent is used for other blocked arteries. The stent is a rolled-up mesh tube-like structure that goes inside the blocked artery to hold it open. This procedure is typically used only if your doctor is unable to perform the traditional bypass procedure.
Source: National Heart, Lung, and Blood Institute (NIH)
Additional Materials (5)
This browser does not support the video element.
What is Coronary Bypass Surgery?
Watch this video to learn what coronary bypass surgery entails and how it is performed.
Video by TheVisualMD
How coronary artery bypass graft (CABG) surgery is carried out
How Does Heart Bypass Surgery Work? Coronary Artery Bypass Graft Procedure Animation - CABG Video
AniMed/YouTube
After Surgery
Recovery from Bypass
Image by TheVisualMD
Recovery from Bypass
After surgery, the patient is taken to the cardiac surgery intensive care unit. Here specially trained personnel continually monitor all vital functions, including the patient's EKG, blood pressure, and the force of blood ejected from the heart. Medications to make the heart beat more quickly or more slowly may be administered. Infusions will be given to maintain fluid balance and regulate blood pressure. Any tubes that have been placed in the chest to drain blood or air will be watched. Laboratory tests will be taken to assess organ function.
Image by TheVisualMD
After Surgery - Coronary Artery Bypass Grafting
After CABG surgery, you will need time to recover. There are also potential complications from surgery.
Recovery in the hospital
You will stay in the hospital for about one week. You may stay longer if you had other procedures done as well or if you have a complication. You will stay in an intensive care unit (ICU) for a day or two, where medical staff may do the following:
Apply bandages on your chest and wherever the graft was removed.
Attach tubes to drain fluid from your chest and urine from your bladder.
Connect you to an electrocardiogram (ECG) to monitor your heart rhythm.
Implant a temporary pacemaker, and, in some cases, an implantable cardioverter defibrillator (ICD), while you are recovering in the ICU.
Give you compression stockings to wear on your legs to help maintain proper blood flow and avoid venous thromboembolism.
Give you medicines. Some medicines you may take for only a short time, while others you may need to keep taking. These medicines may help with pain during recovery, prevent blood clots or irregular heart rhythms, control cholesterol and fats in the blood, and lower your risk of complications.
Give you oxygen therapy, which delivers oxygen into your nose through nasal prongs or a mask.
Monitor your vital signs, such as your heart rate, blood pressure, and oxygen levels.
Recovery at home
After you leave the hospital, you will need to continue taking medicines. Some common side effects from surgery, which should go away in four to six weeks, include the following:
Chest pain around the site of the surgical cut
Constipation
Discomfort or itching from healing cuts
Fatigue, mood swings, or depression
Muscle pain or tightness in the shoulders and upper back
Problems sleeping or loss of appetite
Swelling of the area where an artery or vein was removed for grafting
After you leave the hospital, you will need about six to 12 weeks to recover completely. People who undergo minimally invasive CABG need less time to recover than for traditional CABG.
Possible surgery-related complications
All surgeries have risks. The risk is generally higher for certain people, such as those who get CABG in an emergency situation, have plaque in other arteries throughout the body, or have other medical conditions, such as major heart failure, or lung or kidney disease. Potentially serious complications may include:
Arrhythmia,or irregular heartbeat. The most common type is called atrial fibrillation, which may occur after the surgery but usually goes away on its own.
Bleeding, which may require more surgery to control it
Confusion or problems thinking clearly, temporary memory loss, vision problems, and slurred speech can occur for a short time right after surgery. This is also known as postoperative cognitive decline (POCD). Delirium, or intense confusion, is rare. The exact cause of POCD is not known. Many factors, including the health of the patient before surgery, likely play a role.
Heart attack
Infection, which can occur where the surgical cut was made or inside the chest where the surgery was performed. This may require additional surgeries.
Kidney failure
Stroke
Source: National Heart, Lung, and Blood Institute (NIH)
Additional Materials (9)
Incision for Open-Chest Bypass Surgery
Open-chest bypass surgery requires the surgeon to make an incision down the center of the chest, along the breastbone. The rib cage is spread open to expose the heart.
Image by TheVisualMD
Heart Bypass Recovery Time with Cardiovascular Surgeon Dr. Robert Johnson
Video by Singing River Health System/YouTube
Going Home Recovery after Open Heart Surgery | Heart Care Video Series
Video by Intermountain Healthcare/YouTube
Caring for Your Incision after Cardiac Surgery
Video by Beth Israel Deaconess Medical Center (BIDMC)/YouTube
Coronary Artery Bypass Surgery
Video by Cleveland Clinic/YouTube
This browser does not support the video element.
Bypass Surgery Procedure
This video follows Dr. Mehmet Oz and the procedure he goes through in performing bypass surgery on Steven Hanford. In the operating room, the procedure begins with the removal of a vein from the patient's leg. Steven's chest is opened and his heart is stopped. The coronary arteries with blockage are bypassed using the veins from the patient's leg. As Dr. Oz's team closes Steven's chest, Dr. Oz reports back to the patient's wife Ginger, that the operation is a success.
Video by TheVisualMD
This browser does not support the video element.
What is Coronary Bypass Surgery?
Watch this video to learn what coronary bypass surgery entails and how it is performed.
Video by TheVisualMD
Coronary Artery Bypass Graft
Coronary Artery Bypass Graft
Image by Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014"
What To Expect After Coronary Artery Bypass Grafting
Coronary Artery Bypass Surgery _ graft placement : The blocked artery is bypassed by creating a graft from either another blood vessel in the body or a synthetic tube. One end of the graft is attached above the blockage and the other end is attached below, creating a new route for the blood to flow.
Image by TheVisualMD
Incision for Open-Chest Bypass Surgery
TheVisualMD
1:04
Heart Bypass Recovery Time with Cardiovascular Surgeon Dr. Robert Johnson
Singing River Health System/YouTube
14:35
Going Home Recovery after Open Heart Surgery | Heart Care Video Series
Intermountain Healthcare/YouTube
3:15
Caring for Your Incision after Cardiac Surgery
Beth Israel Deaconess Medical Center (BIDMC)/YouTube
4:43
Coronary Artery Bypass Surgery
Cleveland Clinic/YouTube
1:17
Bypass Surgery Procedure
TheVisualMD
2:36
What is Coronary Bypass Surgery?
TheVisualMD
Coronary Artery Bypass Graft
Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014"
What To Expect After Coronary Artery Bypass Grafting
TheVisualMD
Life After
Incision for Open-Chest Bypass Surgery
Image by TheVisualMD
Incision for Open-Chest Bypass Surgery
Open-chest bypass surgery requires the surgeon to make an incision down the center of the chest, along the breastbone. The rib cage is spread open to expose the heart.
Image by TheVisualMD
Life After - Coronary Artery Bypass Grafting
CABG is a treatment but not a cure for ischemic heart disease. It is important to work with your doctor after CABG to help you stay healthy. This may include taking medicines prescribed by your doctor, making healthy lifestyle changes, getting regular medical checkups, and participating in cardiac rehabilitation.
Take your medicines as directed
Your doctor will likely discuss medicines with you shortly after your surgery. Some of them are important to start right away. You may need to take them for up to one year or even continuously throughout your life. These medicines may include:
Angiotensin-converting enzyme (ACE) inhibitors totreat high blood pressure, and for people who have had a heart attack, have diabetes or kidney disease, or whose heart does not pump properly.
Angiotensin receptor blockers (ARBs)totreat high blood pressure and for people who have had a heart attack or have diabetes or kidney disease. Your doctor may recommend an ARB if you cannot take an ACE inhibitor or for other reasons.
Beta blockers to decrease the chance of irregular heart rhythms after CABG, as well as to treat high blood pressure and other heart conditions. These medicines slow your heart rate and lower your blood pressure to decrease the amount of stress on your heart.
Blood thinners, or anti-platelet medicines, to keep your graft from developing a blockage and help prevent blood clots. One type is aspirin. Your doctor will likely start you on aspirin right away, even before you get CABG surgery. Your doctor may prescribe other types of anti-clotting medicines, such as clopidogrel. Possible side effects of this medicine can include bleeding, especially if you are taking other medicines that also thin your blood, such as aspirin.
Calcium channel blockers to treat high blood pressure when beta blockers and ACE inhibitors do not control it.
Diuretics, or medicines to reduce the amount of fluid in your body or to treat high blood pressure when beta blockers and ACE inhibitors do not control it.
Statins to lower the amount of lipids in your blood and manage the cholesterol levels that can cause plaque. If you do not already take statins for your coronary artery disease, your doctor may recommend that you take statins before and after surgery.
Monitor your condition
After surgery and after recovery, your doctor will want to schedule checkups to look for common complications of CABG or further problems from ischemic heart disease.
Even if you do not experience any signs or symptoms, you may need testing about five years after CABG surgery, or sooner if you have new symptoms or have other risk factors. You may take a stress test with an electrocardiogram or echocardiogram, or other heart and lung imaging. If you have symptoms such as chest pain, especially before or during the stress test, your doctor will likely recommend coronary angiography to check on the graft and other arteries.
Make healthy lifestyle changes
Your doctor will discuss heart-healthy lifestyle habits and changes that are important to maintaining your health and controlling risk factors, such as hypertension and diabetes. These include:
Aiming for a healthy weight.
Being physically active.
Heart-healthy eating.
Managing stress.
Quitting smoking.
Enroll in cardiac rehabilitation
Your doctor may refer you to cardiac rehabilitation to improve your heart health after a heart-related procedure or heart condition. Cardiac rehabilitation helps you maintain or adopt heart-healthy lifestyle practices to lower your risk for cardiovascular diseases. This program includes exercise training, education on heart-healthy living, and counseling to reduce stress and help you return to an active life. These rehabilitation programs are supervised by doctors and are usually offered in hospitals or community facilities.
Monitor your emotional health
Your doctor will likely ask if you have had any changes in your mood or other aspects of your well-being. It is important to be treated for depression to increase your chance of full recovery.
If you have symptoms of depression, your doctor may refer you to a mental health specialist. Treatment may include counseling and medicine.
Learn the warning signs of complications and have a plan
Complications can occur quickly or years after CABG. One possible complication is that the graft will become blocked with plaque and limit or stop blood flow to the heart. If your graft stops working, this may cause a heart attack or other problem with your heart, and you may need additional surgery or PCI.
If you think that you are or someone else is having the following symptoms, call9-1-1right away. Every minute matters.
Heart attack. Signs of heart attack include mild or severe chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, heartburn, or indigestion. There may also be pain down the left arm. For those who have had a heart attack in the past, the symptoms may be similar to the previous heart attack.
Stroke. If you think someone may be having a stroke, act F.A.S.T. and do the following simple test.
F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms: Ask the person to raise both arms. Does one arm drift downward?
S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
T—Time: If you observe any of these signs, call for help immediately. Early treatment is essential.
Source: National Heart, Lung, and Blood Institute (NIH)
Additional Materials (12)
Incision for Minimally Invasive Bypass Surgery
A surgeon may opt for minimally invasive bypass surgery, in which a smaller incision (3-5 inches/8-13 cm) is made in the chest. Often the bypass operation is performed with the help of robotics and video-imaging technology, enabling the surgeon to work in a small area.
Image by TheVisualMD
Recovery from Bypass
After surgery, the patient is taken to the cardiac surgery intensive care unit. Here specially trained personnel continually monitor all vital functions, including the patient's EKG, blood pressure, and the force of blood ejected from the heart. Medications to make the heart beat more quickly or more slowly may be administered. Infusions will be given to maintain fluid balance and regulate blood pressure. Any tubes that have been placed in the chest to drain blood or air will be watched. Laboratory tests will be taken to assess organ function.
Image by TheVisualMD
Life after bypass surgery: Frank's Story
Video by British Heart Foundation/YouTube
Your Activity Guide After Heart Surgery
Video by SingHealth/YouTube
Life After Heart Surgery
Video by CNN/YouTube
Coronary Artery Bypass Surgery
Video by Cleveland Clinic/YouTube
The Scoop on Statins: What Do You Need to Know?
Benefits and risks of statins, how statins work, and who should be using them.
Document by Million Hearts®, Centers for Disease Control and Prevention
Alkaline Phosphatase, Bypass Surgery
Alkaline phosphatase (ALP) is an enzyme made in liver cells. Elevated levels of ALP can be caused by many types of liver damage, including hepatitis, cirrhosis, liver cancer or drug toxicity. Heart bypass surgery or blood transfusions can cause temporary drops in ALP; persistently low levels of ALP may be caused by zinc deficiency or a rare genetic bone disorder.
Image by TheVisualMD
3D Medical Animation Vascular Bypass Grafting
3D Medical Animation still shot depicting the Vascular Bypass Grafting in legs.
Image by Scientific Animations, Inc.
Bypass Surgery Using Saphenous Vein
Coronary artery bypass grafts; three grafts are depicted here, a left internal mammary artery (LIMA) to left anterior descending (LAD) and two saphenous vein grafts - one to the right coronary artery (RCA) system and one to the obtuse marginal (OM) system. The LIMA graft is surrounded by yellow fatty tissue in the forefront of the diagram, the RCA graft departs the left side of the aorta and wraps around the heart on the left side of the diagram, the OM graft departs the right side of the aorta and wraps around the heart on the right side of the diagram.
Image by Patrick J. Lynch, medical illustrator
Heart Bypass Surgery
Heart Bypass Surgery
Image by Blausen Medical Communications, Inc.
Off-pump coronary artery bypass (OPCAB)
Off-pump coronary artery bypass (OPCAB)
Image by BruceBlaus
Incision for Minimally Invasive Bypass Surgery
TheVisualMD
Recovery from Bypass
TheVisualMD
2:08
Life after bypass surgery: Frank's Story
British Heart Foundation/YouTube
15:25
Your Activity Guide After Heart Surgery
SingHealth/YouTube
2:45
Life After Heart Surgery
CNN/YouTube
4:43
Coronary Artery Bypass Surgery
Cleveland Clinic/YouTube
The Scoop on Statins: What Do You Need to Know?
Million Hearts®, Centers for Disease Control and Prevention