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Do You Really Need Bypass Surgery?

What to consider if it's not an emergency and your coronary artery disease is stable.
By Sonya Collins
WebMD Feature

It's the news you don't want to hear from your cardiologist: One or more of your coronary arteries -- the blood vessels that supply blood to your heart -- is blocked. You have coronary artery disease, the No. 1 killer of U.S. adults.

So does this mean you're headed for bypass surgery? Maybe not, if your situation isn't an emergency.

You might have other options -- including less drastic procedures to reopen those arteries, medication alone, or even radical lifestyle change.

What's your best option? What risks and benefits would you face from the options available to you?

People with coronary artery disease should know what to ask their doctors in order to decide which treatment is best for them. They should also know that if their heart disease is stable, they may have more time than they think to make the decision.

Phone's Ringing

Cullen Morris, MD, is talking to WebMD about those options when he gets an urgent call. A woman whose coronary artery is blocked in a place that’s too difficult to stent is being rushed to bypass surgery.

“She’s not doing well. We have to get blood flow to the heart quickly,” says Morris, a cardiothoracic surgeon and assistant professor at Emory School of Medicine.

But that's not always the case.

“If your chest pain is stable and you have no new symptoms, we don’t have to drop everything and do bypass surgery like I’m doing for this woman,” Morris says. “But you must be followed closely by your doctor.”

Coronary Artery Disease

Coronary artery disease (CAD) happens when plaque builds up in the coronary arteries, hampering blood flow to the heart muscle. The most common symptom is chest pain (angina), which can be severe, although some people are more bothered by breathlessness or even unusual fatigue

Coronary artery disease predisposes people to develop a heart attack and is also the most common cause of heart failure, in which the heart has trouble pumping enough blood to the body.

CAD can block one or more coronary arteries. The plaque may be limited to a small segment of the artery or may be more widespread.

There are several effective treatments for CAD, which can reduce chest pain, make a heart attack less likely, and may prolong life. Generally, the most severe cases warrant the most aggressive treatment, which can also carry the highest risks.

Whether one of these treatments is better than another has long been debated by experts. Here is what each option involves.

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