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Understanding Coronary Artery Disease

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What is coronary artery disease?

Simply put, it describes a disease process where arteries of the heart become progressively narrowed, most commonly due to the presence of atherosclerosis. A very important outcome of coronary artery disease is a “Heart Attack” which occurs when these narrowed blood vessels become blocked enough to impede blood flow to the heart. Based on Malaysian statistics from 2014, heart attacks account for 20-25% of all deaths in public hospitals, a trend which has been consistent for the past 10 years.

The most common symptom of CAD is

  • Chest pain, mainly at the central or left side of chest and can spread (or “radiate”) to the shoulder, arm, back, neck or jaw. 
    • The pain can sometimes be confused for heartburn or peptic ulcer disease. 
  • Sweating
  • Nausea
  • Palpitation
  • Giddiness
  • For elderly and people with diabetes, they might have only mild symptoms and most of them presented late at the hospital because of it.

If you do have symptoms  as described above, the best thing you can do, would be to go to the nearest hospital immediately. In the hospital, your doctor will perform an electrocardiogram (ECG) of the heart and will check your blood for clues that a heart attack is occurring. These blood tests are commonly known as “Cardiac Markers” and many consists of some, or all of the following

  • Cardiac Troponin
  • CKMB
  • Myoglobin

Together, these tests give your doctor confirmation of heart attack (or myocardial infarction) as well as the nature and severity of the condition. Prompt treatment can then be given to limit further damage to the heart. It is extremely important that these processes occur as rapidly as possible as time if of the essence (“TIME IS TISSUE”) in preventing further cardiac damage. 

These are broadly 2 categories of treatment;

  • Medical Treatment
    • uses “clot-buster” medications such as Streptokinase or Tenecteplase in an attempt to reopen the blocked blood vessels. 
    • blood thinning medications or  “antiplatelet” agents such as Clexane, Fondaparinux, Aspirin and Clopidogrel also will be used. 
  • Invasive Treatment
    • refers to an Angiogram. In this procedure, your cardiologist will examine your coronary with the use of a special x-ray. If blockage is found, a different procedure called an Angioplasty might be performed. 
    • An Angioplasty refers to the process of opening blocked blood vessels with the use of special devices (your cardiologist may also opt to use a “balloon” to open up the blockage  or a “stent” to keep the blood vessel open). 
    • Some patients have such severe obstructions in their blood vessels that neither Medical nor Invasive Treatment can be performed. Such patients may be a candidate for Coronary Artery Bypass Graft (CABG) Surgery. 

The nature of the treatment to be given will depend upon the type of CAD as well as the overall medical condition of the patient. 

Controlling the causes of CAD are equally important. Your doctor will prescribe medications to treat conditions such as High Blood Pressure (Hypertension) and High Blood Glucose (Diabetes) if they are present. Patients will also be counseled to achieve a heart healthy weight as well as practice a healthy lifestyle. After being diagnosed with Coronary Artery Disease, it is essential that patients understand the importance of continuing to take their medications to ensure their heart remains healthy and to regularly follow up with their doctors. 

 

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