Introduction

Coronary artery disease (CAD) occurs whenthe blood vessels that supply blood to the heart muscle become hardened and narrowed. The narrowing and hardening occur as a result of cholesterol and other materials building up in the inner wall of the vessels (plaque formation). As this progresses the blood supply to the heart muscle decreases. This may lead to chest pain. When the blood supply is critically cut off, a person gets heart attack. Heart attack leads to permanent heart damage.

Coronary artery disease is one of the leading causes of death in Malaysian government hospitals.

Major risk factors include,Cigarette smoking, high cholesterol level, high blood pressure, diabetes, advancing age.

Other risk factors are obesity, physical inactivity, family history of premature coronary artery disease and ethnic origin.

Symptoms

Patient may present with central chest pain and/or breathlessness during exercise or activity. Sometimes the pain may be felt in the shoulder, arms, neck, jaw or back.

In patient with heart attack, the chest pain may be sudden and quite severe, associated with sweating, nausea, palpitation and giddiness.

In certain conditions like diabetes and old age the symptoms may be mild, absent or atypical ( they may present with pain in the stomach area).

Complications

• Heart failure
• Abnormal heart rhythm
• Death

Treatment

Non drug treatment

• Healthy lifestyle:
  • Quit smoking
  • Healthy diet
  • Weight reduction

Drug Treatment

• Medicines are given to:
  • Reduce the tendency of the blood to clot
  • Reduce the heart rate and blood pressure thus decreasing the heart’s demand for oxygen
  • Expand the blood vessels thus increasing the oxygen supply
  • Optimize blood pressure in those with high blood pressure
  • Control of blood sugar level in those with diabetes
  • Dissolve the clot in acute heart attack, this is more effective only if it is administered within a few hours (< 6 hours) of developing symptoms
  • Interventional/surgical procedures
  • Angioplasty (procedure to clear the blockage in the blood vessel)or cardiac bypass surgery may be required in selected cases

Prevention

Aims at tackling the risk factors for coronary artery disease through;

• Early detection of risk factors by regular medical check up.
• Adopting healthy lifestyle, quit smoking, healthy diet, weight reduction and regular exercise.
• Optimizing blood pressure in those with high blood pressure.
• Control of blood sugar level in those with diabetes.
• Control of cholesterol level in those with high cholesterol.

Rehabilitation

Cardiac rehabilitation is a medically supervised program to help patients recover quickly and improve their overall physical, mental and social functioning. It is a multidisciplinary program involving:

• Counseling about disease process and importance of taking medications
• Exercise program
• Nutritional advice
• Helping the patients modify the risk factors
• Providing vocational guidance
• Emotional support