In some people, the coronary arteries become narrowed, usually by a process called atherosclerosis in which cholesterol and other substances are deposited in the arterial wall. With progressive narrowing, the blood supply to the heart muscle gradually decreases, and eventually becomes insufficient to supply the needs of the heart muscles. This usually results in chest pain or angina pectoris during exertion or stress, but may also manifest as breathlessness, irregular heart rhythm or fatigue. When a blood vessel suddenly obstructs completely, a full-blown heart attack occurs.
Coronary artery disease (CAD) is one of the most common diseases and is a major killer in Singapore.
Your doctor will diagnose CAD based on:
No single test can diagnose CAD.
Your doctor will advise you to do one or more of the following tests to confirm it:
The most common symptom is chest pain (also known as angina). Most will describe it as experiencing chest discomfort, heaviness, tightness, squeezing, pressure, aching, burning, numbness or fullness. Some could mistake it for heartburn or indigestion. Although it is usually felt in the chest, it may also be felt in the left shoulder, arms, neck, back or jaw.
There are various treatments for coronary artery disease (CAD).
Coronary artery narrowings may be treated using either medications that reduce the heart's demand for blood, or by procedures aimed at increasing the heart's blood supply. One of the two most common methods to increase the blood supply is Coronary Angioplasty, sometimes abbreviated as PTCA (Percutaneous Transluminal Coronary Angioplasty).
PTCA offers a non-surgical alternative to Coronary Artery Bypass Surgery.
In PTCA, a balloon mounted on a thin tube (a catheter) is advanced into your coronary artery until it lies within the narrow area. The balloon is then inflated at high pressure, often a few times, to dilate the narrowing. Upon balloon deflation, the arterial narrowing is often significantly reduced.
A stent is a small metal coil to provide support to the narrowed segment of the coronary artery after angioplasty, preventing the artery from collapsing and reducing the likelihood of a recurrence of the narrowing. Modern stents are made of stainless steel or a cobalt chromium alloy and are inert to the body. Some stents also have a medication coating and these may be preferred in certain situations to further reduce the chance of repeat narrowing of the heart arteries. Nowadays, stents are frequently placed directly over the narrowed segments (direct stenting) without prior balloon dilatation.
A stent is a small metal coil that provides support to the narrowed segment of the coronary artery after angioplasty.
Before going through a PTCA, a coronary angiogram is done first to provide a 'roadmap'. Undergoing PTCA is also very similar to having a Coronary Angiogram procedure.
During balloon inflation, you may experience some chest discomfort, and you should report this to your attending cardiologist. Stenting is carried out in a similar manner. The procedure may take 1 to 2 hours or more depending on the complexity of the diseased artery.
Following the successful PTCA, you will be monitored in a special monitoring ward. During this period, the sheath may be kept in your groin artery for 4 to 5 hours. However, the sheath may be removed immediately after the procedure if the situation allows. After the sheath is removed, the puncture site will be compressed for about 30 minutes to ensure that there is no bleeding.
You will have to remain in bed for several hours or until the following day to ensure the puncture site is sufficiently healed before walking. Your cardiologist will determine how long you need to stay in bed before you can walk around. Following that, some blood tests and ECGs will be performed to monitor your condition. If there are no complications, most patients can be discharged on the same day or the day after.
The success rate of Coronary Angioplasty is usually about 95%, depending on the nature of your coronary narrowing. However, in about 5% of cases, the procedure may be unsuccessful and the artery remains narrowed. In very few patients (about 1%), urgent bypass surgery may be required if the procedure is complicated.
There is a possibility of a recurrence of the narrowing of the coronary artery in the 6 months following the initial successful angioplasty or stenting, and you would usually feel a chest discomfort should it happen. If you feel a chest pain, you should seek medical attention immediately and inform your doctor.
Major complications like heart attacks, abnormal heart rhythm, stroke and death occurs in less than 1% of the patients undergoing PTCA.
Less serious complications like bleeding from the puncture site, bruising and swelling of the puncture site, and blood clot formation in the artery where the sheath is insert occurs in 1-3% of the patients.
Overall, the procedure is very safe and well-tolerated.
As a patient:
Coronary arteries are blood vessels that carry oxygen and nutrients to the heart.
Coronary artery bypass surgery is an operation that is carried out to improve the flow of blood to the heart muscle in people with coronary heart disease where the coronary arteries are severely narrowed or blocked.
The operation involves taking blood vessels from other parts of the body and attaching them to the coronary arteries past the blockage. The blood is then able to flow around, or "bypass" the blockage. If more than one artery is blocked, you may need more than one bypass.
You will require a Coronary Artery Bypass Surgery when the doctors determine that the blockage is too difficult to access by Angioplasty, or if the blockage is severe and occurs in several major vessels.
Call the doctor right away if:
Call the doctor during office hours if:
Unlike a traditional Coronary Artery Bypass Surgery, the Off-pump Coronary Artery Bypass Grafting does not require the use of the heart-lung machine. Instead of stopping the heart, surgeons can now hold portions of the heart stabilise during surgery due to technological advances and new kinds of operating equipment. The surgeon can now bypass the blocked artery in a highly controlled and stabilised environment while the rest of the heart continues pumping blood to the rest of the body.
Only certain patients with Coronary Artery Disease can receive this surgery. At present, this procedure can be performed on all the arteries of the heart.
It would be ideal for you if you are at an increased risk for complications from the traditional bypass. If you have
Dobutamine Stress Echocardiography
Exercise Stress Echocardiography
Transoesophageal Echocardiography (TEE)
Coronary Computered Tomography Angiography
Treadmill Exercise Stress Electrocardiography Test
Coronary Artery Bypass Surgery