How do you define coronary artery disease (CAD)?

Coronary artery disease is plaque build-up in the coronary arteries, the arteries that supply blood to the heart and its coverings. Plaque is predominately fat from saturated products and choline-a nutrient traced in red meat, dairy and eggs.

What are the signs?

Unfortunately, most people do not notice the early signs of coronary artery disease because there are no early warning signs. Instead, it takes years for plaque to accumulate inside the arteries. As a result, symptoms may develop at a late stage. For some, it may be too late to seek treatment. Congestive heart failure is the endpoint of coronary artery disease, which means the heart is already weakened at this stage. Due to poor heart health, less blood is being pumped, which causes fluid to back into the lungs. In addition, you may also develop swelling in the ankles.

Common signs of CAD include the following:

• Difficulty breathing, especially when climbing stairs and performing light exercises.
• Chest pain

What causes the condition? 

Coronary artery disease can affect anyone. The time it takes for symptoms to develop varies from patient to patient. What you decide to consume can impact your heart health. It is important to follow a healthy heart diet by lowering your cholesterol levels and limiting the number of saturated fats and trans-fats you consume.

Plaque can build up in the inner walls of the coronary arteries. However, the body chooses to fight against this by signalling white blood cells to attack cholesterol, a potential invader. Unfortunately, the attack only increases inflammation which causes secondary cells to gather over the plaque, forming a cap. The cell cap can rupture due to rising blood pressure. As a result, platelets hover around the site of injury and form a blood clot that restricts space in the arteries. The blood clot can either break up on its own or obstruct blood flow via the artery. Ultimately, restricting blood flow can deprive the heart of oxygen and lead to a heart attack.

How do we diagnose CAD?

Suppose you are not suffering from a stroke or a heart attack. In that case, Dr Hassen will conduct a physical exam and ask questions concerning your medical history and family history of heart disease.

The following diagnostic tests may be performed:

• An electrocardiogram measures the heart’s electrical activity.
• An echocardiogram uses sound waves to compose visuals of the heart's structure, showcasing the muscle's function and overall health.
• Cardiac catheterisation is a test that involves inserting miniature tubes into the heart’s blood vessels to confirm or rule out coronary artery disease. The test is designed to assess the heart’s function.
• An angiogram may be done during cardiac catheterisation.

What does treatment involve?

Besides making healthy lifestyle changes and taking medication to lower blood pressure and prevent the formation of blood clots, surgical intervention is required when coronary artery disease reaches an advanced stage. So, like emptying a drain that becomes clogged, the arteries need a deep cleaning by removing harmful plaque obstructing blood flow. 

Interventions can be done in the following ways:

• Angioplasty & stenting is carried out through the use of a slender tube called a catheter. Then, Dr Hassen inserts the catheter into the blocked region of the coronary artery. Next, a surgical balloon is positioned and inflated to widen the space for blood to flow freely. Finally, a stent is left in place to keep the region open.
• Coronary artery bypass surgery using a graft creates an alternative channel for blood flow. Blood vessels are dissected from another part of the body, such as the legs, arm or chest and used to create another channel for oxygenated blood to flow to the heart.