Understanding Coronary Artery Disease (CAD)
Ischaemic Heart disease is the third most common cause of death in Singapore according to the National Health Statistics in 2015 and in 2018 its accounts to 18.1% of death in Singapore.
Coronary Artery disease is caused by “clogging” of the coronary arteries due to buildup of cholesterol and fatty deposits (Atherosclerosis). These deposits cause limitation of blood flow to the muscles of the heart causing the heart to starve to its much-needed oxygen contained in our blood (Ischemia) leading to symptoms (Angina). Think of it as like running, when you run and your calf muscle doesn’t receive enough oxygen, you will have cramps. Therefore the heart in a way cramped up when not enough blood flow (oxygen) reaches it.
Anginal symptoms are most of the time exertional. It means whenever you do something (walking, climbing up staircases, carrying a load) the symptoms appear and it usually resolve with resting.
The most common symptom is chest pain. The pain can be felt as squeezing like, tightness, heaviness, burning, pressure and aching feeling across the chest lasting from minutes to hours. This pain may spread to the neck, arms, shoulders and jaw.
As a person grows older and especially those with Type 2 Diabetes. The symptoms may not be the typical chest pain as described above. You may experience the “Anginal equivalent” symptoms such as fatigue, nausea, dizziness, cold sweats, weakness and shortness of breath.
Heart attack is an emergency and is vital to be aware of the above symptoms for early detection and lifesaving treatment. If you have the above symptom and left untreated it may lead to permanent heart muscle damage and death.
Certain medications are given to those with heart blockage and symptoms like antiplatelets (e.g. Aspirin), beta blockers (e.g. Bisoprolol), Nitrates (ISMN) and ACE inhibitors (e.g. Lisinopril) to name a few depending on a person’s clinical condition. These medications will not cure the condition but will reduce the risk and control the disease.
In cases of an emergency, Coronary angiogram and Angioplasty (balloon and stenting) can be done to suitable people. If the blockages are very severe, Coronary artery bypass surgery (CABG) may be the best option for treatment.
The most important in the management of these problem is prevention and controlling the risks that the person has. Quitting smoking is a cornerstone preventive measure in people with heart blockages. Controlling a person’s high blood pressure, high cholesterol and Diabetes by being compliant with medications are also very important.