The tube that supplies blood to the wall of the heart is called the coronary artery. Cholesterol or fatty deposits in the coronary arteries turn into solids. These accumulated substances are called atheromatous plaques. This process is called arteriosclerosis. Coronary bypass is done through on-pump or off-pump or beating heart surgery. Doctors perform coronary bypass considering the patient’s age, coronary artery problems, symptoms, other problems, etc.

(i) Keeping the patient under close observation in the Intensive Care Unit (ICU) after open heart surgery.
(ii) 2-3 tubes should be inserted to drain the fluid accumulated in the patient’s thorax.
(iii) Regular walking and movement should be done.
(iv) Avoidance of fatty foods and smoking.
(v) Diabetes should be kept under control.
(vi) Keeping blood pressure normal or controlling high blood pressure.

(i) Patient’s heart rate, blood pressure and diabetes are controlled before starting open heart surgery.
(ii) The patient is rendered unconscious by applying anesthesia to prevent pain.
(iii) Heparin is injected to keep the patient’s blood fluid.
(iv) Breast meat and sternum are separated by cutting.
(v) The heart is removed by opening a special instrument.
(vi) The heart is attached to the tube of the Heart-Lung machine. Blood flow is controlled by the Heart-Lung machine by cutting off the blood flow in the aorta.
(vii) Heart surgery or valve replacement if the Heart-Lung machine is fully functional.

Open heart surgery is mainly done in three ways.
1. On-pump surgery: In this type of surgery, the blood supply to the heart and the heartbeat are stopped. Blood is pumped through the body by the Heart-Lung machine.
2. Off-Pump or Beating Heart Surgery: In this type of surgery, the heart rate is reduced by drugs or other means.
3. Robot-assisted surgery: In this type of surgery, a robot’s mechanical arm is used. The doctor performs the surgery precisely by watching the three-dimensional view on the computer.

Opening the heart by cutting open the patient’s chest is called open heart surgery. Open heart surgery is performed for congenital heart defects, transplants, valve repair, pacemaker placement, or blockages in arteries.

1. Regular pulse rate monitoring and medication should be taken.
2. Running, jumping and exercise should not be done for at least eight weeks after implantation of an artificial pacemaker.
3. Do not put pressure on the chest where the pacemaker is attached.
4. Do not keep a cellular phone near the pacemaker.
5. Receiving a mobile phone from the side opposite to the side of the chest where the pacemaker is placed.
6. Always carry a known pacemaker card for safety.
7. Be careful when using microwave ovens and electric generators.
8. Be careful while examining the body with X-ray and MRI machines.

Pacemakers are generally of three types. namely-
1. Single chamber pacemaker: It paces any one chamber of the heart.
2. Two chamber pacemaker: It paces the two chambers of the heart. atrium and ventricle.
3. A three-chamber or rate-responsive pacemaker responds to the patient’s physical activity and automatically adjusts the heart rate. These three wires carry electrical impulses to the right atrium, right ventricle, and left ventricle.

A pacemaker is an airtight closed pacing device. A small device placed under the skin of the chest or abdomen is called an artificial or mechanical pacemaker to normalize the abnormal heartbeat. An artificial pacemaker is a metal box made of titanium. Inside the metal box are lithium batteries, generators and sensors wired to the top. The sensors are called electrodes. The generator is connected to the heart by wires or leads. The pacemaker has two leads, one to the right atrium and the other to the right ventricle. Pacemaker placement takes 30-60 minutes. Lithium batteries can last up to 15 years.
Artificial pacemakers have sense enhancers. Its battery supplies power to the generator. Generators produce electrical impulses. Electrical stimulation is delivered through leads or wires to the right atrium and right ventricle of the heart. The heartbeat is normal. As a result dangerous heartbeat long QT syndrome (LQTS) is controlled. Today, more advanced devices such as ICDs are used to treat long-term heart problems.

Between the superior vena cava and the right atrium of the heart, the automatically conducting organ or sino-atrium node (SAN) is called the pacemaker. SAN or SA Node is the natural pacemaker. Aging, congenital heart disease, heart attack, open heart surgery, etc. can cause the natural pacemaker to become damaged or unusable. An artificial or mechanical pacemaker is used when the natural pacemaker is damaged. Irregular heartbeat is called arrhythmia. American scientists William Chardack and Wilson Greatbatch (1969) invented the implantable pacemaker.

1. X-ray: Ki X-ray of the chest shows the location of the heart.
2. ECG (Electrocardiogram): ECG is used to diagnose primary heart disease.
3. ETT (Exercise Tolerance Test): The condition or performance of the heart is known by ETT.
4. Blood BNP (Brain Natriuretic Peptide): Heart failure is known by BNP.
5. MRI (Magnetic Resonance Imaging): The condition of the heart muscle is known by MRI.
6. Coronary Angiogram: A coronary angiogram is used to diagnose the blockage of blood vessels.