"Many people with this disease are not aware they have it, as it develops slowly and silently over decades. It can go virtually unnoticed until it produces a heart attack," say doctors from National Heart Centre Singapore​ (NHCS), a member of the SingHealth​ group.

Coronary artery disease

Coronary artery disease (CAD) occurs when the arteries that supply blood to the heart muscle (the coronary arteries) become hardened and narrowed.

The arteries harden and narrow due to a build-up of fatty deposits called plaque on their inner walls. The build-up of plaque is known as atherosclerosis. As the plaque increases in size, the insides of the coronary arteries get narrower and less blood can flow through them.

Eventually, blood flow to the heart is reduced, which can cause chest pain (angina). A sudden, complete blockage can lead to a heart attack.

Causes and symptoms of coronary artery disease

Coronary artery disease (CAD) is caused by atherosclerosis or hardening of the arteries due to old age. In atherosclerosis, plaque build-up in the arteries is made up of fat, cholesterol, calcium, and other substances from the blood.

Plaque build-up in the arteries often begins in childhood and over time, it can:

  • Narrow the arteries, reducing the amount of blood and oxygen reaching the heart.
  • Block the arteries completely which stops the flow of blood to the heart.
  • Cause blood clots to form which can block the arteries that supply blood to the heart.

Coronary Artery Disease

The figure above shows a normal artery with nomal blood flow and an artery containing plaque build-up.

CAD varies in signs and symptoms and in severity.

  • No symptoms
    • Referred to as silent ischaemia, you do not have any symptoms although the blood supply to your heart may be restricted.
  • Chest pain (angina)
    • Usually brought about by physical or emotional stress. It feels like a heavy weight on your chest.
  • Shortness of breath
    • Occurs when the heart fails due to damage to the heart muscle.
  • Heart attack
    • Caused by a blood clot or rupture in a narrowed coronary artery. The part of the heart muscle fed by that artery dies. Pain from a heart attack is often described as crushing and may feel similar to angina, but lasts longer.

See next page for the treatment of coronary artery disease​.

Ref: V10