Coronary Artery Disease/Heart Attack

According to the latest WHO data published in 2017, Coronary Heart Disease Deaths in Malaysia reached 30,598 or 22.13% of total deaths. The age adjusted Death Rate is 137.02 per 100,000 of population ranks Malaysia number 63 in the world.

Coronary artery disease refers to a condition caused by the coronary arteries being blocked or constricted.

Causes of Coronary Artery Disease

Coronary artery disease is the result of a build-up of plaque around the interior wall of the arteries, causing the lining of the arteries to thicken and become constricted.

When this happens, the heart can’t pump as much oxygenated blood as required. Over time, if a patient develops coronary artery disease, his or her blood vessels will no longer be able to supply sufficient oxygenated blood to the heart muscle, which can lead to sudden and severe chest pains or heart attack.

If there is a sudden blockage of the arteries caused by deposits of plaque, a rupture or a blood clot may then develop, resulting in a potentially fatal heart attack and other serious related complications.

Risk Factors of Coronary Artery Disease

The risk factors of coronary artery disease can be divided into two main types, as outlined below:

Non modifiable risk factors
Modifiable risk factors
  • Family history: If you have a close family member who has suffered from coronary artery disease, then you are more likely to develop coronary artery disease.
  • Aging: As you grow older, the quality of your blood vessels will begin to deteriorate.
  • Gender: Men are more likely to develop coronary artery disease than women. However, women who have already reached menopause are at almost equal risk of developing coronary artery disease as men.
  • Overweight or obese
  • High blood pressure
  • Diabetes and abnormal blood sugar
  • Dyslipidaemia / High cholesterol
  • High blood pressure/ Hypertension
  • Stress
  • Sedentary Lifestyle
  • Smoking
  • Genetic – family history of heart diseases
  • Metabolic syndrome. This occurs when you have obesity, high blood pressure and high blood sugar. Having metabolic syndrome makes you twice as likely to develop heart disease than if you don’t have it.

Symptoms

  • Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back
  • Nausea, indigestion, heartburn or abdominal pain
  • Shortness of breath
  • Cold sweat
  • Fatigue
  • Light headedness or sudden dizziness

Complications

Complications are often related to the damage done to your heart during an attack, which can lead to:

 

Abnormal heart rhythms (arrhythmias)Electrical “short circuits” can develop, resulting in abnormal heart rhythms, some of which can be serious, even fatal.
Heart failureAn attack might damage so much heart tissue that the remaining heart muscle can’t pump enough blood out of your heart. Heart failure can be temporary, or it can be a chronic condition resulting from extensive and permanent damage to your heart.
Sudden cardiac arrestWithout warning, your heart stops due to an electrical disturbance that causes an arrhythmia. Heart attacks increase the risk of sudden cardiac arrest, which can be fatal without immediate treatment.

 Diagnosing Coronary Artery Disease

    Together with a physical examination, a review of the patient history should include the history of heart disease in the family, smoking history, diet, exercise, chronic illness, etc. This will help the doctor to know whether the patient is at risk of developing coronary artery disease.

Lab investigation and special examination, such as:

  • Electrocardiogram
  • Chest X-ray
  • Cardiac enzyme test
  • Exercise stress test
  • Echocardiogram
  • Computed tomographic angiography (CTA)
  • Cardiac catheterization or coronary angiogram

Guidelines for Treating Coronary Heart Disease

  1. Lifestyle modifications and diet changes
  2. Treatment using medication, such as antiplatelet and anticoagulant medicines, vasodilator medicines, antiarrhythmic medicines and beta blockers, weight loss pills.
  3. Treating coronary artery disease with angioplasty and stents is a way to expand the coronary artery by using a balloon combined with implant stents to prop up the artery wall.
  4. Coronary artery bypass surgery / coronary artery bypass grafting