Coronary Artery Disease (CAD) is a prevalent and serious health condition that affects millions globally. It is a significant concern in Singapore, particularly among mid-age to senior individuals. This article aims to provide an in-depth understanding of CAD, its symptoms, causes, diagnostic tests, treatment options, and associated costs, with a focus on CAD diagnosis and tests in Singapore. I have also included my personal recommendations that will equip you with the knowledge to manage and treat CAD effectively.

What Do You Feel When You Have CAD

The symptoms of Coronary Artery Disease (CAD) differ widely from person to person. In the early stages, CAD may be asymptomatic, which means that people do not have any visible symptoms. That is why it is important to know the different CAD diagnosis and tests in Singapore. As the condition worsens and arteries thin or obstruct, symptoms become more visible and can include:

1. Chest Pain (Angina)

Angina, or chest tightness or pain, is one of the most prevalent CAD symptoms. This pain is frequently associated with physical exertion or tension and may spread to the arms, neck, jaw, shoulder, or back.

2. Shortness of Breath

Individuals with diminished blood flow to the heart may have trouble breathing, particularly during exertion. This symptom indicates that the heart may not be receiving enough oxygen.

3. Fatigue

An overall sense of tiredness or lethargy, particularly after effort, can indicate that the heart is not receiving enough oxygenated blood. This symptom is frequently neglected but can be a key indicator of the presence of CAD.

4. Palpitations

When the heart struggles to pump blood properly, symptoms such as irregular heartbeats or palpitations may appear. These abnormalities can be worrisome, but they are vital indicators that require more research.

5. Dizziness or Lightheadedness

Reduced blood flow can cause dizziness or lightheadedness, especially after strenuous exertion. This symptom may suggest substantial obstructions in the coronary arteries.

6. Nausea

Some people may feel nausea or vomiting, particularly during angina attacks. This symptom is sometimes confused with gastrointestinal disorders, but it is critical to address in the context of heart health.

7. Sweating

Excessive sweating, particularly cold sweats, can be an indicator of CAD, especially during a heart attack. The quick beginning of sweating is a major warning sign that should not be overlooked.

Recognizing these signs early and receiving medical attention is critical to avoiding serious problems, such as heart attacks. If you encounter any of these symptoms, you should seek a CAD diagnosis and tests in Singapore to assess the severity of your problem and obtain proper treatment.

What Causes CAD

Coronary Artery Disease (CAD) is primarily caused by atherosclerosis, a condition in which plaque forms on the inner walls of the coronary arteries. This plaque is made up of cholesterol, fatty acids, cellular waste products, calcium, and fibrin. Over time, plaque hardens and narrows the arteries, limiting blood flow to the heart. There are several risk factors that lead to the development of CAD:

• Age: The risk of CAD rises with age. As people get older, their arteries naturally stiffen and become more susceptible to atherosclerosis.
• Gender: Men are generally more at risk than pre-menopausal women, while women’s risk rises after menopause. Hormonal changes after menopause considerably increase a woman’s risk for CAD.
• Family History: A family history of heart disease considerably increases the likelihood of acquiring CAD. Genetic factors can predispose people to atherosclerosis-causing circumstances.
• Smoking: Tobacco usage is a significant risk factor for CAD. Smoking harms the lining of the arteries, leaving them more vulnerable to plaque accumulation.
• High Blood Pressure: Hypertension can damage arteries over time, increasing their susceptibility to atherosclerosis. Consistently high blood pressure causes stress on the arterial walls, which contributes to plaque formation.
• High Cholesterol Levels: High levels of low-density lipoprotein (LDL) cholesterol lead to plaque development. High cholesterol levels hasten the progression of atherosclerosis, raising the risk of coronary artery disease.
• Diabetes: Diabetes raises the risk of CAD considerably. High blood sugar levels can harm blood vessels and nerves that control the heart, hence increasing the risk of atherosclerosis.
• Obesity: Excess body weight, especially around the abdomen, has been associated to an increased risk of coronary artery disease. Obesity is frequently associated with additional risk factors, such as high blood pressure, diabetes, and high cholesterol.
• Physical Inactivity: Obesity and high blood pressure are two consequences of a lack of exercise, which raises the risk of cardiovascular disease. Regular physical activity promotes a healthy weight and decreases blood pressure.
• Unhealthy Diet: Diets heavy in saturated fat, trans fat, and cholesterol can all contribute to the development of CAD. Nutritional decisions are critical in reducing CAD risk.
• Stress: Chronic stress may cause CAD by raising blood pressure and cholesterol levels. Stress management is critical for lowering the overall risk of heart disease.

Understanding these risk factors aids in implementing preventive strategies to lower the possibility of acquiring CAD. If you are at risk or have symptoms, it is critical to get a CAD diagnosis and tests in Singapore to assess the severity of your problem and receive suitable treatment. Comprehensive examination and early detection of CAD in Singapore can considerably improve outcomes.

CAD Diagnosis and Tests Singapore

Accurate diagnosis of CAD is critical for successful management and treatment. Singapore provides a variety of modern diagnostic techniques to identify CAD, providing timely and accurate identification. Here are some of the important tests performed in CAD diagnosis and tests in Singapore:

1. Electrocardiogram (ECG or EKG)

An ECG measures the electrical activity of the heart. It may reveal indications of prior heart attacks or continuing ischemia (decreased blood supply to the heart muscle).

2. Stress Testing

This test assesses the heart’s performance under physical stress. It usually involves walking on a treadmill or riding a stationary bike while heart rate is measured. Variants include stress echocardiography and nuclear stress tests.

3. Echocardiogram

An echocardiography creates images of the heart using ultrasonic waves, allowing clinicians to assess its anatomy and function while also detecting areas of poor blood flow.

4. Coronary Angiography

Coronary angiography is a specialist X-ray procedure that involves injecting a contrast dye into the coronary arteries via a catheter. This test generates comprehensive pictures of the arteries, identifying obstructions.

5. CT Coronary Angiogram

This test visualizes the coronary arteries using CT scanning technology, providing a non-invasive alternative to standard coronary angiography.

6. Blood Tests

Blood testing can detect cholesterol, blood sugar, and other markers that suggest a higher risk of CAD.

7. Cardiac MRI

Magnetic Resonance Imaging (MRI) of the heart provides precise images of its structure and can determine the level of damage caused by a heart attack.

8. Ankle-Brachial Index (ABI)

This easy test measures blood pressure in the ankle and arm to identify peripheral artery disease, which can be linked to CAD.

These tests can provide an early and accurate diagnosis of CAD, considerably improving management and treatment outcomes.

Natural Ways to Treat CAD

While medical treatments are necessary for controlling CAD, natural remedies can supplement traditional treatments and promote heart health. Here are some natural approaches of treating CAD:

1. Healthy Diet

Adopting a heart-healthy diet is critical. This includes:

• Fruits and vegetables: High in vitamins, minerals, and fiber.
• Whole Grains: Whole grains provide critical minerals and fiber.
• Lean Proteins: Lean proteins include fish, chicken, beans, and lentils.
• Healthy Fats: Healthy fats include omega-3 fatty acids found in fish, flaxseeds, and walnuts.
• Reduced Sodium: Limiting salt consumption can help regulate blood pressure.

2. Regular Exercise

Regular physical activity promotes cardiovascular health. Aim to complete at least 150 minutes of moderate-intensity exercise per week. Walking, cycling, swimming, and yoga are all useful.

3. Weight Management

Maintaining a healthy weight lowers the risk of CAD. Developing and maintaining a healthy weight through nutrition and exercise is critical.

4. Smoking Cessation

One of the most effective methods to lower your risk of developing CAD is to quit smoking. Seek assistance from healthcare providers or smoking cessation programs if necessary.

5. Stress Management

Stress reduction strategies such as meditation, deep breathing, and mindfulness can help decrease blood pressure and enhance cardiovascular health.

6. Adequate Sleep

Ensuring adequate and quality sleep is critical for overall health. Aim for 7-9 hours of sleep each night.

7. Limit Alcohol

Excessive alcohol drinking can cause high blood pressure and lead to heart disease. It is recommended that you consume alcohol in moderation.

Incorporating these natural strategies into your daily routine will help to manage CAD and improve overall heart health. And the way to effectively know what needs to be done is by going through the different CAD diagnosis and tests Singapore.

Medications to Treat CAD

Medications are essential for the treatment of CAD. They aid in symptom management, preventing complications, and improving overall quality of life. Here are some commonly used drugs to treat CAD:

1. Anti-platelet Agents

• Aspirin: Prevents blood clots by blocking platelet aggregation.
• Clopidogrel (Plavix): Another antiplatelet medicine used in conjunction with aspirin for some patients.

2. Cholesterol-Lowering Drugs

• Statins: Lowers LDL cholesterol levels and stabilize plaque in the arteries.
• Ezetimibe: Lowers cholesterol by limiting absorption from the gut.
• PCSK9 inhibitors: Newer medications that significantly decrease LDL cholesterol.

3. Beta-Blockers

Reduce heart rate and blood pressure, lowering the heart’s workload and oxygen consumption.

4. Ace Inhibitors and ARBs

• Angiotensin-Converting Enzyme (ACE) Inhibitors: Lower blood pressure and relieve stress on the heart.
• Angiotensin II Receptor Blockers (ARBs): An alternative to ACE inhibitors.

5. Calcium Channel Blockers

Relaxing blood arteries improves blood flow, which reduces chest pain and helps lower high blood pressure.

6. Nitrates

Nitroglycerin treats angina by relaxing and expanding blood arteries.

7. Ranolazine (Randexa)

Used to alleviate persistent angina by increasing blood flow to the heart.

8. Diuretics

Help to control high blood pressure and reduce fluid retention.

These drugs are frequently used in combination to provide the best results for controlling CAD.

Non-Invasive and Surgical Treatments for CAD

When lifestyle changes and drugs are ineffective, non-invasive and surgical therapies may be required. Singapore provides advanced alternatives for treating CAD, including:

Non-Invasive Treatments

• Enhanced External Counterpulsation (EECP): EECP is a non-invasive treatment that increases blood flow to the heart by inflating leg cuffs in time with the heartbeat. It is used for people with persistent angina who are not suitable for invasive procedures.
• Lifestyle Intervention Programs: Diet, exercise, and stress management are all part of comprehensive programs for improving heart health.

Surgical Treatments

• Angioplasty and Stenting: Angioplasty is the process of employing a balloon to open restricted or obstructed arteries, followed by the placement of a stent to maintain them open. It is a minimally invasive technique carried out under local anesthetic.
• Coronary Artery Bypass Grafting (CABG): CABG is a surgical treatment that uses a blood conduit from another region of the body to bypass a blocked artery, thereby restoring blood flow to the heart. It is usually suggested for patients with significant blockages or many damaged arteries.
• Transmyocardial Revascularization (TMR): TMR is a surgical treatment for treating severe angina. It entails utilizing a laser to generate small channels in the heart muscle, which stimulates the formation of new blood vessels.
• Valve Replacement or Repair: Patients with CAD with valve disease may require valve replacement or repair procedures to maintain adequate cardiac function.

These innovative therapy approaches provide hope to individuals with CAD, improving results and quality of life.

How Much Does CAD Treatments Cost in Singapore

The cost of CAD therapies in Singapore varies greatly depending on the type of treatment, the healthcare facility, and the patient’s specific demands. Here’s a rough breakdown of the costs involved with various CAD treatments:

Diagnostic Tests

• ECG: SGD 50 – 200
• Stress Test: SGD 200 – 500
• Echocardiogram: SGD 300 – 700
• Coronary Angiography: SGD 3,000 – 5,000
• CT Coronary Angiogram: SGD 1,000 – 2,000
• Blood Tests: SGD 50 – 300

Medications

• Antiplatelet Agents: SGD 10 – 50 per month
• Statins: SGD 20 – 100 per month
• Beta-Blockers: SGD 10 – 50 per month
• ACE Inhibitors: SGD 10 – 50 per month
• Nitrates: SGD 10 – 50 per month

Non-Invasive Treatments

• EECP: SGD 5,000 – 10,000 for a full course of treatment

Surgical Treatments

• Angioplasty and Stenting: SGD 10,000 – 20,000
• CABG: SGD 30,000 – 50,000
• TMR: SGD 20,000 – 40,000

Hospitalization

The cost of hospitalization, including room charges, doctor fees, and other associated costs, can range between SGD 1,000 and 10,000 per day, depending on the facility and the quality of treatment needed.

It is crucial to note that these expenses are estimates and may change. Patients should communicate with their healthcare providers and insurance companies to obtain precise and tailored cost estimates.

Conclusion

Coronary Artery Disease is a severe illness that demands prompt and efficient treatment. Understanding the symptoms, causes, and treatment choices is critical for people who are at risk or have been diagnosed with CAD. Singapore provides a variety of innovative diagnostic tests and treatment choices, ensuring that patients receive the best possible care. There are numerous methods for efficiently managing and treating CAD, including lifestyle changes and drugs, as well as non-invasive and surgical procedures.

If you or a loved one is suffering signs of CAD, seek medical attention right once. Early diagnosis and treatment can greatly improve results and quality of life. Individuals with CAD can have healthy and fulfilling lives if they receive the appropriate care and management.

If you have signs of heart disease or simply wish to check your heart health, don’t delay. Contact the Harley Street Heart and Vascular Centre for a thorough evaluation. Call us at +65 6235 5300 to make an appointment with one of our renowned cardiac doctors. Prioritize your heart health today—your well-being is our number one priority!

Written by: Dr Michael MacDonald MB ChB, BSc (Hons), MRCP (UK), MD (Research), FESC (Europe).  Dr MacDonald was trained in the UK and is a senior Consultant Cardiologist.