THINGS TO KNOW ABOUT CORONARY ARTERY DISEASE (CAD)

1. WHAT IS CORONARY ARTERY DISEASE?

- The arteries that nourish the heart muscle, called the coronary arteries, narrow, reducing blood flow through the narrowed area, leading to a lack of blood supply to the heart muscle.

- The disease can progress slowly with gradually worsening symptoms or without symptoms.

- The disease can manifest suddenly due to acute blood vessel blockage causing myocardial infarction with symptoms of severe chest pain, shortness of breath, sweating, if severe can lead to sudden death. Or leave sequelae of heart failure, arrhythmia, heart valve regurgitation.

2. WHAT ARE THE RISK FACTORS FOR CORONARY ARTERY DISEASE?

- Smoking

- High blood pressure

- Lipid disorders (increased LDL, Triglycerides, decreased HDL)

- Diabetes

- Family background

- Passive lifestyle, stress

3. HOW TO DETECT CORONARY ARTERY DISEASE BEFORE SUCH A MI?

- Screening for risk factors (YTNC).

- Electrocardiogram

- Echocardiography

- Based on clinical symptoms: chest pain, or fatigue when exerting. The cardiologist will ask about the nature, intensity, direction, time of pain, duration, onset and end of pain, triggers, accompanying symptoms to determine whether chest pain is due to coronary artery disease or not. However, chest pain has many different causes, not just coronary artery disease.

4. WITH NORMAL BLOOD TESTS, ELECTROCARDIOGRAPHY, ECHOCARDIOGRAPHY ARE ALSO NORMAL, CAN ATYPICAL PAIN SYMPTOMS OR NO SYMPTOMS EXCLUDE CORONARY ARTERY DISEASE?

- Cannot be ruled out.

- So what should we do? To further screen the patient, we need to do stress tests such as: stress electrocardiogram (the patient's electrocardiogram is monitored while jogging on a treadmill or cycling), stress echocardiogram... to look for signs of myocardial ischemia when the heart is working under stress.

- Another paraclinical method for diagnosis is contrast-enhanced coronary CT angiography, which can detect lesions causing narrowing of the lumen even when the narrowing is only 30% of the lumen diameter. Usually, narrowing of more than 70% of the lumen diameter causes symptoms and requires stent intervention.

- However, in patients with acute MI, the previous coronary artery lesion is usually only 50% narrow in diameter, but the shell of the lesion is thin and fragile, and when it ruptures, it will create a blood clot that completely covers the coronary artery, leading to acute MI that can cause sudden death, even though previously they were completely healthy and had no symptoms at all. Patients with symptoms due to coronary artery lesions with a narrowing of more than 70%, if not treated, can also lead to MI later.

5. WHEN IS CORONARY STENT PLACEMENT OR CORONARY BYPASS SURGERY NEEDED?

- When the patient has symptoms and the lesion is narrowed > 70% of the diameter of the vascular lumen.

6. WILL THE DISEASE BE CURED AFTER A STENT IS PLACED?

-The disease is still there and can recur at any time even though the blood vessel has been repaired. Recurrence can occur at the site of the stent placement or anywhere on the coronary artery. On average, 5-10% of patients will have a recurrence after stent placement.

7. WHAT TO DO AFTER STENT PLACEMENT?

- Absolutely must comply with the treatment as prescribed by a cardiologist. The two indispensable drugs after stent placement are "Aspirin and Clopidogrel". Currently, Brilinta can replace Clopidogrel, but there is no substitute for Aspirin. If one of the two is missing in the early period after stent placement, it will increase the risk of acute blockage in the stent, affecting life. In addition, there are a series of other drugs that must be taken together.

8. WHAT TO DO WHEN YOU SUSPECT A MIRACLE?

- Immediately go to a hospital with a cardiology department that can perform coronary intervention.

- Time is more precious than diamonds. If it is true that the NMCT is due to complete blockage, it must be recanalized as soon as possible from the onset of symptoms to the time the ear is cleared < 1 hour, 3 hours gives better results later. The longer the delay, the higher the risk of death and heart failure.

- The attitude of medical staff when encountering AMI due to complete coronary artery occlusion (shown on ECG ST segment elevation) is extremely urgent so that from admission to recanalization must be less than 60 minutes. Patients and their families must understand the emergency situation and actively cooperate with medical staff.
- The cost of cardiac catheterization is very expensive, if the patient has health insurance, it will help reduce the financial burden.

This afternoon, I just treated a male patient, only 28 years old: non-smoker, no high blood pressure, no diabetes, blood lipids within normal limits. But there was only one YTNC, the patient's biological father had a sudden death from NMCT at the age of 40. The patient had coronary artery occlusion due to thrombosis, using a catheter to aspirate many blood clots in the right coronary artery. After intervention, the patient was stable and no longer had chest pain.

In short, it is difficult to completely rule out the possibility of coronary artery disease, only to know whether the risk of the disease is low or high! Therefore, a general health check-up to screen for coronary artery disease risk is necessary for preventive treatment.

MSc. Dr. Nguyen Trung Quoc

Deputy Head of Interventional Cardiology Department, Heart Institute
Examination schedule: Monday, Wednesday, Friday from 5pm to 8pm