Coronary Artery Disease (CAD): What you need to know

Keeping the heart healthy, which pumps blood throughout our body, is essential for survival. Since the heart is also a muscle, the heart muscle also needs a constant supply of blood with oxygen and nutrients to function.

However, we should all be well aware of Coronary Artery Disease (CAD), which is the leading cause of heart attacks, which is currently common throughout the world and in Sri Lanka.

Mr. Jayasekara, 52, who works in an office job, has minimal physical activity, high blood pressure and slightly high cholesterol levels. He recently came to see Dr. Priya because of a feeling of heaviness and squeezing in the middle of his chest when walking quickly or climbing stairs. Through their discussion, let us scientifically understand how heart attacks occur and how to avoid them.

Doctor-patient dialogue: "Why do I feel a heaviness in my chest, Doctor?"

Mr. Jayasekara (frightened): "Dr. Priya, recently, whenever I walk a little faster or climb a flight of stairs, I feel a heaviness or squeezing in the middle of my chest. But when I sit down and rest for about five minutes, it goes away. Am I having a heart attack, doctor?"

Dr. Priya (listening attentively): "Mr. Jayasekara, the symptoms you are describing are medically known as angina (chest pain) . This is the primary symptom of Coronary Artery Disease (CAD) .

Coronary arteries are the blood vessels that supply blood to our heart muscle. These arteries become narrowed by the buildup of cholesterol, fat, and calcium. This is called atherosclerosis . This causes the blood flow to the heart to be obstructed, leading to chest pain during exertion.

! Coronary Arteries

Mr. Jayasekara: "Doctor, then how does a heart attack occur?"

Dr. Priya: "Good question. If this fatty layer (plaque) inside the artery suddenly bursts, a blood clot is immediately formed at that location. This completely blocks the artery and completely stops the blood supply to the heart muscle. That is what is called a heart attack / myocardial infarction."

There are two main types of CAD:
1. Stable Ischemic Heart Disease: A controllable condition in which the arteries gradually become narrowed over time.
2. Acute Coronary Syndrome: A fatal heart attack that occurs suddenly when a plaque ruptures and a blood clot forms.

🚨 Red Flags that require immediate medical attention

The first few hours (Golden Hour) are crucial to saving a life in a heart attack. Emergency medical care should be sought without delay if the following symptoms appear:

1. Severe chest pain: A feeling of pressure, squeezing, or heaviness in the center or left side of the chest that lasts more than 5 minutes.
2. Spreading pain: Pain that spreads down the left arm, into the neck, jaw, back, or upper abdomen.
3. Shortness of breath: Wheezing and difficulty breathing with or without chest pain.
4. Cold sweats: Excessive cold sweats even when the room temperature is normal.
5. Fainting: Dizziness, nausea, vomiting, or loss of consciousness.

🛠️ Action Steps to Protect Yourself from Heart Disease

• First step (in case of emergency): If you experience symptoms of a heart attack, immediately call the 1990 Suwaseriya Ambulance Service and go to the nearest major hospital. If a doctor has recommended it, chew an aspirin tablet.
• Step Two: See a cardiologist regularly and have tests (ECG, Echocardiogram, Exercise Stress Test, or Angiogram) performed.
• Step 3: Take your prescribed medications (statins to lower cholesterol, aspirin or clopidogrel to thin the blood, and medications to control blood pressure) every day at the prescribed dose. Use nitroglycerin tablets or spray for chest pain.
• Step Four: Change your lifestyle. Quit smoking completely. Get some exercise, such as brisk walking for 30 minutes at least 5 days a week.
• Step Five: Follow a heart-healthy Mediterranean diet, which is rich in vegetables, fruits, whole grains, fish, and olive oil, while limiting red meat, sugar, and salt.

📊 Do's & Don'ts

❓ Frequently Asked Questions (FAQ)

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#### Can coronary artery disease (CAD) be completely cured?

No. It is not possible to completely remove the fatty deposits (plaque) that have accumulated in the arteries and restore the veins to their previous condition. However, with the right medication, lifestyle changes, and necessary surgery, you can prevent further progression of the disease and live a normal, healthy life.

#### What is Angioplasty and Stenting?

Angioplasty involves inserting a small balloon-tipped tube into a blocked artery, inflating the balloon to open the artery, and then placing a stent, a metal mesh, in place to prevent the artery from closing again.

#### When is Bypass Surgery (CABG) performed?

Bypass surgery is performed when there is severe blockage in several coronary arteries or when the blockage is in a location that is difficult to place a stent. This involves taking a vein from another part of the body (such as the leg or chest) and creating a new, alternative route for blood to flow around the blocked area.

#### What is Cardiac Rehabilitation?

A special medical program that helps patients who have suffered a heart attack or heart surgery return to a healthy lifestyle. This includes supervised exercise, nutritional advice, and stress management counseling.

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📖 Sources and Scientific References

• NHS (UK) Guidance on Coronary Heart Disease: NHS Coronary Heart Disease Overview (Accessed 2026)
• PubMed Central (PMC) Clinical Review: Updates in the Management of Coronary Artery Disease: A Review Article (PMC10725890)