Coronary artery disease is a slow progressive disease that starts when you are young. It takes many years before you have the symptoms. Men have a higher prevalence for coronary artery disease compared to women and commonly occur after the age of 55 years old. For women, the incidence of coronary artery disease peaks at 65 years old due to the protection of female hormones. Bearing in mind that woman tend to live longer than men, the prevalence of coronary artery disease among elderly woman is also high.

Dr Aaron Wong, Head and Senior Consultant from the Department of Cardiology at National Heart Centre Singapore, gives detailed answers to your questions.

Question by chai

Hi, Dr Wong, Is stress one of the causes for artery disease?

Answered by Dr Aaron Wong, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

Although causes of blocked artery in the heart are not completely known, stress is unlikely to be the cause of actual narrowing of the heart. However, stress induces anxiety and increases level of adrenaline in the blood. This may lead to increase in blood pressure, heart rate and force of heart contraction and potentially may cause breakage of the narrowing in the artery, which leads to thrombus formation and heart attack.

There is a peculiar condition called stress cardiomyopathy or broken heart syndrome, where patients under immense stress (e.g. death of spouse) trigger symptoms, signs, ECG changes and blood results similar to patients who had a heart attack but with no blockage of the artery. This is thought to be due to intense nerve activation and leads to temporary abnormality of the heart muscle and the heart function typically recovers in 2 to 3 weeks.

Question by simly6

Dear Dr Wong,

Will taking health supplements also help in reducing the risk of heart disease?

Answered by Dr Aaron Wong, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

No health supplements have been proven conclusively that help in reducing risk of heart disease.

Question by rsim

Hi Dr Wong, Is breathlessness and chest tightness signs of coronary heart disease?

Answered by Dr Aaron Wong, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

Yes, chest pain or tightness is the main symptom of CAD but sometimes patients can present with breathlessness, especially in patients with diabetes or in the elderly. However, there are many other causes of chest pain or breathlessness, which may need to be investigated after CAD is ruled out.

Question by pocoyosky

Hi Dr Wong, In order to work out our heart, is it better to do strenuous exercise like long distance jogging/running or just a slow long walk for more than 20 minutes will also work out our heart?

Answered by Dr Aaron Wong, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

Depending on your age, strenuous exercise may not be good for you, especially if you are approaching 50 years old, as there is a possibility that you may have undetected CAD. You may be safe to perform strenuous exercise if you have been cleared by your doctor (e.g. a recent stress test, normal coronary angiography or CT scan). The American Heart Association recommends

At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150 minutes

OR

At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes; or a combination of the two

AND

Moderate to high intensity muscle-strengthening activity at least 2 or more days per week for additional health benefits.

Question by dsim

Hi Dr Wong,

Does family history plays a major contribution reason to coronary artery disease? Can this be overcome just by healthy diet and living?

Answered by Dr Aaron Wong, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

Family history of premature coronary artery disease is one of five important risk factors of coronary artery disease. From observational studies, patients who have male or female family member(s) who had coronary artery disease below the age of 55 and 65 years old respectively, have higher risk of developing CAD. We still know very little about the relationship of genes and CAD. So it is best to maintain a healthy lifestyle whether you have family history of premature CAD or not.

Question by mrina

Dear Dr Wong,

Is heart attack cause by coronary artery disease? What are other conditions cause by this disease?

Answered by Dr Aaron Wong, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

Yes, heart attack is caused by coronary artery disease. Most of the time, patients with coronary artery disease are in their stable state called stable angina. They have either no symptoms or only have chest pain symptoms on exertion. For some unknown reasons, breakage (plaque rupture) and clot formation (thrombosis) at the site of the narrowing in the artery occurs and this leads to death of heart muscle supplied by that particular artery, which is a heart attack.

Question by esim

Hi Dr Wong,

What are the cure options available for coronary artery disease? Is it surgery? bypass surgery?

Answered by Dr Aaron Wong, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

Coronary artery disease is a chronic condition. Once it starts, it will progress indefinitely and increases with age. Treatment options include medications to control the symptoms and risk factors such as diabetes, high blood pressure or high cholesterol and smoking.

When the blockage becomes critical and the medications failed to control the symptoms, stenting (percutaneous coronary intervention) or bypass surgery can relieve the symptoms by unblocking or bypassing the blockage respectively. However, the effect is usually temporary and renarrowing of the artery at the same area or different sites may recur with time.

The effect of bypass surgery lasts longer, usually about 8 to 10 years or more, but carry a higher risk for the initial operation. It is less invasive to perform PCI but the effect is shorter with a 10-20% risk of recurrence at the same site in 1 year, depending on complexity of the blockages and types of stent used.

Whether PCI or bypass is more appropriate depends on the number of arteries blocked and complexity of the narrowing or if the patient has diabetes.

Question by sch

Hi,

Is there any screening test to early detect coronary artery disease? Can ECG test able to screen this? How can we get to know this at early stage if we have this disease not.

Answered by Dr Aaron Wong, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

There are no symptoms or signs in the early stages of CAD and a normal resting ECG does not exclude CAD. There are many tests for the detection of coronary artery disease. Tests that look at coronary artery directly include coronary angiography, multislice CT (MSCT) and calcium score. The indirect tests include functional tests, like treadmill ECG or treadmill echocardiography.

These tests are only recommended for those who are at risk or have appropriate indications. The risk of developing CAD depends on your age, risk factors etc. If you are at high risk of developing CAD, a screening treadmill ECG may be recommended every few years. For more details, check out NHCS Conditions and Treatments page.

Question by mosmos

Dear Dr Wong,

Does drinking coffee daily increases coronary artery problem? In the past, reports said that coffee is not good for the heart, but recent reports said is good for the heart. I am quite confused. Thanks.

Answered by Dr Aaron Wong, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

Coffee contains caffeine, which is a stimulant, and thus increases heart rate. In patients with coronary artery disease we usually give medications to slow down the heart rate to reduce the demand of the heart muscle, especially when the patients are still symptomatic or still have an artery that has not been opened.

I would advise these patients to avoid drinking excessive coffee. Studies on the effect of coffee on the heart are based on observational studies on questionnaires of coffee drinking habits. These studies have many flaws and are usually not very scientific. We do not take these results as conclusive evidence that coffee is good or bad for the heart.

Question by 53yokechan

Dear Dr Aaron Wong,

How do the symptoms of heart attack differ between men and women? Thanks.

Answered by Dr Aaron Wong, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

The classic presentation of heart attack is central chest pain or tightness associated with sweating, breathlessness and nausea. The pain usually lasts > 30 minutes may move to the throat, jaw or down the left arm. Although most patients present with these classic symptoms but men present with these symptoms more than women. In women, breathlessness may be the dominant feature and the location of the pain may not be at the centre of the chest, e.g. back or shoulder pain.

Question by 96117258

Dr Aaron Wong,

I am Chee Yong. I have question about. Does Minimal Luminal Irregularities in LAD. Minor CAD ( less than 50%) is a risk of heart disease or heart attack? Tnks.

Answered by Dr Aaron Wong, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

Patients with minor CAD have a lower chance of having heart attack, as there is more space to accommodate clots if there is a breakage of the narrowing in the artery, therefore less likely to block off completely. However, they could still have a heart attack especially in patients whose blood tend to clot easily, e.g. in smokers or patients with certain blood disorders. In young smokers who have a heart attack, the underlying narrowing is usually minor but because more clots are formed in the artery, the lumen of the artery is likely to block off completely, leading to a heart attack.

Question by ixoria

Dear Dr Wong,

I have experienced sudden "muscle cramp" kind of feeling on my left chest. The kind of "cramp" feeling caused pain if I were to move my upper body or my left arm. The kind of cramp does not occur often and last about 1-2 mins if occurred. It ever happened at night when I'm lying on my bed or daytime when I'm at sitting position. Frequency is about once every few months but no fixed period for a couple of years already. Wonder whether is this a sypmtom of any coronary artery disease? Thanks!

Answered by Dr Aaron Wong, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

Chest pain symptoms are due to blocked arteries if these are from the heart. However, chest pain is common and sometimes it is difficult to differentiate whether if the pain is from the heart or other more benign conditions like muscle, bone or nerve problems.

There are two types of chest pain due to blocked arteries. The first type, called stable angina, is due to a fixed blockage of an artery and only gives problem when the heart muscle demand exceeds what the artery can supply. This chestpain is usually at the centre of the chest and occurs on exertion and relieved immediately with rest.

The pain may sometimes be felt in the throat or jaw but it does not usually occur at rest. The second type of pain is due to sudden increase in the blockage of the artery to a critical level that at very low exertion or even at rest, there is insufficient blood supply to the heart muscle. The chest pain thus occurs at rest, lasting > 30 minutes, and does not relieve completely with rest and associated with sweating, breathlessness and nausea.

This usually suggests a heart attack or an imminent heart attack. From the way you describe your symptoms, it is unlikely that your chest pain is related to the heart. But if you have any doubt, please consult your usual doctor.

Reposted by administrator

Dear Sir/Mdm,

How do I know if I am going to have a heart attack. I have been on medication. Exforge 180mg divided into half per tablet each morning, since 2004 for Hypertension. I am 55 years old. Appreciate if you reply. Thank you very much. Live Great!

Adeline Fung

Answered by Dr Aaron Wong, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

Unfortunately, no one knows when one is going to have a heart attack. But it is possible to know when one is having a heart attack.

Heart attack is due to sudden complete blockage of an artery supplying the heart muscle. This could happen anytime, at rest or on exertion. The symptoms include sudden central chest pain or tightness, associated with sweating, breathlessness or nausea.

The duration of chest pain usually lasts more than 30 minutes. You are advised to call an ambulance and admit to the Emergency Department immediately. Hypertension is a risk factor for developing coronary artery disease and this should be controlled to target of < 140/90 mmHg. You should check your cholesterol and for diabetes regularly as these two factors may develop with age. You should avoid smoking as well.

Question by lshirley

Hi Doctor Wong,

can someone who underwent heart valve repair visit to high altitude places example: Jiuzhaiguo & Huanglong with altitude from 2500m to 3000m. If yes, any health caution? Thank you.

Answered by Dr Aaron Wong, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

The main concern with altitude is lower oxygen content in the air you breathe. After heart valve repair, the function of the heart valve usually returns back to normal and the patient can live a normal life. However, with time the heart valve may degenerate again and become abnormal.

The usual symptoms or signs of severe valve abnormalities are breathlessness and on examination a loud murmur can be heard. The doctor will usually do an ultrasound of the heart if there is any suspicion of valve abnormality. If you have good exercise tolerance, e.g. can walk up 3 to 4 floors or a few bus stops, or had a normal ultrasound scan of the heart recently, it is usually safe to visit high altitude places.

If you have a severely abnormal valve or blocked heart artery, the stress to the heart may lead to heart failure or chest pain. If you have any concern, it is prudent to consult your cardiologist. Also, even without heart problems, some people can get altitude sickness, which is not related to heart condition, when above an altitude of 2400m.

If you have a pre-existing unstable heart condition, it may worsen with altitude sickness.

Ref: S13