UMSC team effort to tackle CAD


Early warning signs of CAD can include chest pain and/or chest tightness from physical exertion, which could be any form of exercise or daily activity, such as climbing the stairs.

CORONARY artery disease (CAD) remains a leading cause of morbidity and mortality in Malaysia, and worldwide.

The disease requires a comprehensive and collaborative approach for effective management.

In this pursuit, a multidisciplinary strategy involving the expertise of cardiologists and radiologists is essential.

Together, these professionals contribute to the holistic care of individuals grappling with CAD.

CAD is essentially what its name states: diseased arteries involved in supplying blood and oxygen to the heart.

As such, the heart is deprived of oxygen and nutrients, eventually leading to a heart attack, amongst other sequelae.

Specialists of the heart

Cardiologists stand at the forefront of CAD management, employing a range of diagnostic and therapeutic interventions.

According to UM Specialist Centre (UMSC) consultant cardiologist Assoc Prof Dr Ahmad Syadi Mahmood Zuhdi, the early warning signs of CAD may include the typical symptoms of central or left sided chest pain, and/or tightness/heaviness, usually from physical exertion. This could include any form of exercise, climbing stairs, walking up a hill, etc.

Treatment for CAD will incorporate medications, lifestyle modifications, and potential interventions such as angioplasty, stent placement or bypass graft, says Assoc Prof Ahmad Syadi.Treatment for CAD will incorporate medications, lifestyle modifications, and potential interventions such as angioplasty, stent placement or bypass graft, says Assoc Prof Ahmad Syadi.

“Uncommon symptoms may include pain in the upper part of the tummy, breathing difficulties, as well as dizziness and palpitations. These are non-specific, but can still be symptoms of CAD.

“They are more common in the elderly, diabetics and women,” he says.

Assoc Prof Ahmad Syadi stresses the importance of not ignoring such symptoms.

“We need to detect early and start treatment as soon as possible.

“There are two main reasons for this. Early treatment reduces or slows down disease progression, which also reduces the chances of a heart attack occurring,” he advises.

CAD diagnosis and risk assessment utilise imaging techniques and diagnostic tests to evaluate the extent of coronary artery involvement and assess overall cardiac risk.

UMSC consultant radiologist Assoc Prof Dr Raja Rizal Azman Raja Aman shares that there are various cardiac imaging modalities to assess heart disease.

“Echocardiography evaluates the internal structures of the heart and ventricular contractility using sound waves.

“CT scans visualise plaque within the coronary arteries, determining the degree of narrowing within.

“Coronary angiography is the best way to evaluate plaque within the coronary arteries, utilising catheters and wires injecting dye into the vessels of the heart,” he says.

Cardiac imaging modalities to assess heart disease include echocardiography, CT scan and coronary angiography which evaluates plaque within coronary arteries, says Assoc Prof Raja Rizal.Cardiac imaging modalities to assess heart disease include echocardiography, CT scan and coronary angiography which evaluates plaque within coronary arteries, says Assoc Prof Raja Rizal.

Once a definitive diagnosis has been made, a treatment plan is devised. This will incorporate medications, lifestyle modifications, and potential interventions such as angioplasty, stent placement or bypass graft.

“Although the treatments can be divided into lifestyle changes, medications and surgical procedures, they are not ‘options’ where patients can choose and pick which one suits them more,” notes Assoc Prof Ahmad Syadi.

“Once diagnosed, all patients will have to make changes to their lifestyle, and also be prescribed medications to control CAD. These two are a necessity.

“Then, they may need to undergo procedural treatment in the form of coronary angioplasty or other procedures,” he says.

Treatment options

In terms of procedures, options like percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) are available.

According to UMSC consultant cardiothoracic surgeon Assoc Prof Dr Sivakumar Krishnasamy, the use of PCI or CABG in managing CAD will depend on the number of blockages, complexity of the lesion and vessels involved, and fitness of the patient.

“In PCI, a puncture is made over an artery and a wire is used to cannulate the coronary arteries, where a balloon or stent is then placed over the diseased segment. This therapy addresses the pathology from inside the vessel,” shares Assoc Prof Sivakumar.

“CABG is open heart surgery.

“There will be a cut in the midline of the sternum, and also a cut in the leg to harvest the saphenous vein which will be used as bypass conduit.

“The main conduit for the operation is the left internal mammary artery, which is harvested from below the sternum bone. The operation with cardiopulmonary bypass will need the heart to be stopped with a specialised solution called cardioplegia, whereby the conduits will then be stitched on the coronary arteries which are involved, and then the veins are connected to the aorta.

In terms of surgical procedures, options like PCI or CABG (i.e. open heart surgery) are available, says Assoc Prof Sivakumar.In terms of surgical procedures, options like PCI or CABG (i.e. open heart surgery) are available, says Assoc Prof Sivakumar.

“Once all the anastomosis are completed, the patient will be weaned from cardiopulmonary bypass and the procedure ends with the chest being closed,” he says.

Typically, PCI involves one or two days’ hospital stay if there are no issues.

In CABG, it’s usually five to six days in the hospital, depending on post-op recovery and rehabilitation.

Assoc Prof Ahmad Syadi stresses that CAD management is for the long term. Patients need to be monitored regularly, medications adjusted as needed, and ongoing support provided to optimise cardiovascular health.

Plague buildup

We must all be aware that the process of atherosclerosis in CAD begins early (during childhood and adolescence).

This results in slow build-up of atherosclerotic plaque (over many years) in the coronary artery that will eventually obstruct blood flow.

The disease only manifests itself clinically later in life once the plaque has significantly disrupted blood flow to the heart muscle.

This usually happens after the age of 30.

Hence, another important consideration is regular health check-ups to help identify potential cardiovascular issues before they escalate.

The multidisciplinary approach in quaternary care management and treatment of CAD underscores the necessity of a collaborative effort to address the diverse facets of this complex condition.

Cardiologists, cardiothoracic surgeons and radiologists contribute to form a united front against CAD.

By integrating these various fields of health science, this holistic approach not only treats the disease, but also empowers individuals to actively participate in their journey toward good cardiovascular health.

KKLIU 0961 / expiry Dec 31, 2026

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