3. Every year, more than 600 000 coronary bypass operations are performed in the USA., an industry worth $100 billion. The American bypass surgery industry is worth $100 billion and an American cardiac surgeon may earn an annual income of $1million from bypass surgery alone.

4. In South Africa approximately 8 400 coronary bypass operations are performed per year, with the majority done in the private sector.

5. There is an alarming incidence of heart disease in South Africa: One in three men and one in four South African women will suffer a heart attack before their sixtieth birthday. Every year more than 50 000 South Africans suffer heart attacks. Of these 50 000, 25% - about 12 000 people – die immediately. Only Scotland, Finland and Northern Ireland have a higher heart disease mortality rate, according to data from the Heart Foundation of Southern Africa.

14. Coronary Artery Disease

15. Signs and Symptoms Signs & Symptoms None Chest Pain Shortness Of Breath Myocardial Infarction Arrhythmia

16. Screening and Diagnosis StressTestmeasuresblood supply to heart Coronary CoronaryAngiography specificshowscoronaries Narrowing in Sites of Electro-cardiogrammeasureselectrical impulses

17. Screening and Diagnosis Coronary CoronaryAngiography specificshowscoronaries Narrowing in Sites of

18. Blood tests: used to evaluate kidney and thyroid function as well as to check cholesterol levels and the presence of anemia. Chest X-ray: for cardiomegaly and for COPD and efussions. Echocardiogram: For heartfuction and to acess valvular patholog Ejection fraction (EF): plus minus 55%

19. Medical - manage coronary artery disease with lifestyle changes and medications. Intervention- severe coronary artery disease may need angioplasty or surgery.

20. Indication For Ischemia Purpose Relieve Symptoms Prolong Live

22. Treatment (continued) 1) Stenting a stent is introduced into a blood vessel on a balloon catheter and advanced into the blocked area of the artery the balloon is then inflated and causes the stent to expand until it fits the inner wall of the vessel, conforming to contours as needed the balloon is then deflated and drawn back The stent stays in place permanently, holding the vessel open and improving the flow of blood.

23. Treatment (continued) 2) Angioplasty a balloon catheter is passed through the guiding catheter to the area near the narrowing. A guide wire inside the balloon catheter is then advanced through the artery until the tip is beyond the narrowing. the angioplasty catheter is moved over the guide wire until the balloon is within the narrowed segment. balloon is inflated, compressing the plaque against the artery wall once plaque has been compressed and the artery has been sufficiently opened, the balloon catheter will be deflated and removed.

24. Treatment (continued) 3) Bypass surgery healthy blood vessel is removed from leg, arm or chest blood vessel is used to create new blood flow path in your heart the “bypass graft” enables blood to reach your heart by flowing around (bypassing) the blocked portion of the diseased artery. The increased blood flow reduces angina and the risk of heart attack.

25. Treatment (continued) 3) Bypass surgery healthy blood vessel is removed from leg, arm or chest blood vessel is used to create new blood flow path in your heart the “bypass graft” enables blood to reach your heart by flowing around (bypassing) the blocked portion of the diseased artery. The increased blood flow reduces angina and the risk of heart attack.

26. PROCEDURE

35. High blood cholesterol High blood pressure Smoking Obesity Lack of physical activity

36. Risk Factors Uncontrollable Sex Hereditary Race Age Controllable High blood pressure High blood cholesterol Smoking Physical activity Obesity Diabetes Stress and anger

43. Get regular medical checkups. Control your blood pressure. Check your cholesterol. Don’t smoke. Exercise regularly. Maintain a healthy weight. Eat a heart-healthy diet. Manage stress.