Understanding coronary artery disease: Introduction

This is the first part of the series entitled Heart of the Matter. As usual, read the disclaimer first.

Each year, thousands of apparently healthy Malaysians, many at the prime of their lives, collapse and die for no apparent reason. 90% of these sudden collapses (death within 24hrs of collapse) are due to Sudden Cardiac Death(SCD), often from electrical instability of the heart. These sudden cardiac deaths may or may not be due to a heart attack. It could just be cardiac electrical instability.

A heart attack is a sudden cardiac attack, often but not always, causing chest pains, with associated changes in the electrocardiograph and blood indices. This acute attack is caused by sudden cessation of blood flow to a region of the heart, from an acute blood clot occluding an artery supplying the muscle of the heart. This must be contrasted to angina, which is chest pain on effort, relieved by rest, which is due to partial arterial blockage, of the heart artery. Angina does not produce ECG or blood parameter changes, therefore are less catastrophic. This partial blockage is usually caused by cholesterol accumulation in the inner lining of the heart arteries.

In view of our better understanding of the heart circulation, and also our understanding of the process of cholesterol accumulation in arteries the majority of heart attacks can be prevented. We are also heavily indebted to the medical pharmaceutical industry, who have spent much on medical research to further develop drugs that will effective prevent heart attacks and strokes, of course at a price.

The next part of the series covers the risk factors which may be relevant.