IMAGINE the chaos a blocked pipe causes in your home plumbing system. Water flow is affected, often to a trickle and household chores are affected.
It's problematic; things don't function as they should and ultimately, daily life is impacted.
A blocked artery results in similar problems to your health and as with a pipe, we need to clear the blockage as soon and as effectively as possible.
Coronary artery disease or CAD happens when plaque forms in your coronary arteries, which are basically the arteries that supply oxygen-rich blood to the muscles of the heart.
There are three main coronary arteries, two on the left and one on the right side of the heart, and each artery supplies oxygen-rich blood to different parts of the heart muscles, explains Pantai Hospital Kuala Lumpur consultant cardiologist Dr Faizal Khan.
"Some arteries are more important than others and when the important arteries are affected, the impact or consequences to the heart are greater."
When it comes to CAD, there are some risk factors which we, as individuals, can control or alter, and others which are non-modifiable.
Among the non-modifiable factors are age and family history.
Dr Faizal says as age progresses our arteries become more stiff and calcium builds up in them. This build-up of calcium is an indication of how much plaque is present in the arteries.
"Over a period of time, due to plaque formation, you may start to have mild blockages which eventually progress to being significant ones."
Gender is also a factor in CAD. Men are more at risk than women and individuals with a family history of the disease are more likely to experience it.
If a person has a heart attack before the age of 55, then his offspring may have a similar outcome, says Dr Faizal.
Modifiable factors are related to diet and exercise, avoiding smoking and taking steps to address weight gain or obesity.
Dr Faizal adds that those with high blood pressure also need to ensure their condition is kept under control as it can cause arteries to become hard and stiff and this promotes plaque formation.
According to the National Health and Morbidity Survey 2023 (NHMS2023), one in three adults in Malaysia have hypertension.
Similarly, high levels of bad cholesterol will also promote plaque formation.
NHMS2023 indicates that the prevalence of hypercholesterolaemia among adults in Malaysia is 33.3 per cent, while around 54.4 per cent of the population is overweight or obese.
If not effectively addressed, CAD can lead to a heart attack. Dr Faizal says research indicates that in Malaysia, heart attacks happen to much younger people compared with those in Western countries. The age at the onset of the first heart attack is generally 65 years in such countries, but is 55-58 years in Malaysia.
Once a person has been diagnosed with CAD, treatment options would depend on a variety of factors, including age, the individual's general health status and the extent of the blockage (or blockages) and the location of these blockages.
If the blockage is less than 50 per cent with no significant impact to the patient's health, then he or she may be managed with medication and lifestyle adjustments.
For blockages which are between 50 and 70 per cent or more, intervention is called for.
A coronary angioplasty is a common option offered to many patients. Dr Faizal says it's an "awake procedure" and generally takes between one and two hours.
"Most patients are able to leave the hospital the next day and in two weeks are back to their normal activities."
But patients undergoing angioplasty must be able to tolerate blood thinners, he adds.
Generally, if patients are old and frail (75 years and above) or have other comorbidities, doctors would recommend an angioplasty instead of a heart bypass as the patient's health condition may not ensure he's strong enough to endure major surgery.
However, if the patient has multiple severe blockages or has both CAD and valve disease, doctors would recommend a bypass as the valve replacement can be done at the same time as treatment for CAD.
As a heart bypass is a complex and major procedure, patients would be in the intensive care unit for about a week after the procedure. Full recovery can take between six and 12 weeks.
The treatment options for CAD should always be discussed with the treating physician.
Dr Faizal says there are many new advances in techniques of coronary angioplasty nowadays.
"What was considered a case of bypass surgery 10 years back can now be done with coronary angioplasty with the help of newer devices and techniques."
Cardiologists also have meetings with heart surgeons from time to time, discussing the best treatment options for patients.
CAD
• Onset or progression can be delayed or controlled with lifestyle adjustments.
• Most cases are diagnosed late, with symptoms often dismissed as gastritis.
• Undiagnosed and untreated cases can result in a heart attack.
• Staying active, eating healthy and keeping weight in check is crucial.
• Aim for 150-300 minutes of mild to moderate exercise a week or 75-150 minutes of aerobic exercise a week.
• Keep diabetes, hypertension and high cholesterol in check.