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Coronary Artery Disease

Coronary Artery Disease:  Symptoms, Causes and Risk Factors, Diagnosis, Treatments | National Heart Centre Singapore

Coronary Artery Disease - What it is

Coronary artery disease (CAD) occurs when the arteries that supply blood to the heart muscle (the coronary arteries) become hardened and narrowed. The arteries harden and narrow due to build-up of fatty deposits called plaque on their inner walls. The hardening of the artery walls is known as arteriosclerosis, while the build-up of plaque is known as atherosclerosis. As the plaque increases in size, the insides of the coronary arteries get narrower and less blood can flow through them. Eventually, blood flow to the heart muscle is reduced and can cause chest pain (angina). A sudden, complete blockage can lead to a heart attack.

Many people with this disease are not aware they have it, as it develops slowly and silently over decades. It can go virtually unnoticed until it produces a heart attack.

Coronary Artery Disease - Symptoms

Coronary Artery Disease varies in signs and symptoms and in severity. 
  • No symptoms - Referred to as silent ischaemia, you do not have any symptoms although blood supply to your heart may be restricted.
  • Chest pain (Angina) – Usually brought about by physical or emotional stress. It feels like a heavy weight on your chest.
  • Shortness of breath - Occurs when the heart fails due to damage of heart muscles
  • Heart attack - Caused by a blood clot or rupture in a narrowed coronary artery. The part of the heart muscle fed by that artery dies. Pain from a heart attack is often described as a crushing pain and may feel similar to angina, but lasts longer.

Coronary Artery Disease - How to prevent?

Coronary Artery Disease - Causes and Risk Factors

Coronary artery disease (CAD) is caused by atherosclerosis or hardening of the arteries due to old age. In atherosclerosis, plaque build-up in the arteries is made up of fat, cholesterol, calcium, and other substances from the blood.

Plaque build-up in the arteries often begins in childhood. Over time, plaque build-up in the coronary arteries can:
  • narrow the arteries, reducing the amount of blood and oxygen reaching the heart muscles
  • block the arteries completely which stops the flow of blood to the heart muscle, 
  • cause blood clots to form which can block the arteries that supply blood to the heart muscle.

Coronary Artery Disease - Diagnosis

Diagnosis normally starts with a physical examination by a doctor, assessing your medical history and routine tests. Other tests recommended may include:

Coronary Artery Disease - Treatments

You can prevent or slow down coronary artery disease by improving the health of your heart and blood vessels. Drugs and surgical techniques can open up narrowed coronary arteries. Making lifestyle choices to control the risk factors for coronary artery disease is the best long-term measure. 

While many people are able to manage this disease with lifestyle changes and medications, others with severe coronary artery disease may need coronary angioplasty or surgery. There are various procedures to improve coronary blood flow (revascularisation):
  • Percutaneous Coronary Intervention (PCI): A common treatment for severe blockage of the coronary arteries, it is also known as coronary or balloon angioplasty / percutaneous transluminal coronary angioplasty (PTCA) with coronary stent placement. 

    In PTCA, a small balloon or stent is used to help keep the part of the artery that is blocked open. The latest option within PTCA is the use of drug-eluting stents, which are stents covered with a drug, which supposedly has been shown to reduce the rate of re-narrowing of the arteries. If percutaneous coronary intervention does not widen the artery or if complications occur, you may need coronary artery bypass surgery.

  • Coronary Artery Bypass Surgery: This is an open heart surgery where a new route is created for blood to go around a blocked part of a coronary artery to supply your heart with enough blood to relieve chest pain.

Coronary Artery Disease - Preparing for surgery

Coronary Artery Disease - Post-surgery care

Coronary Artery Disease - Other Information

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