Coronary Artery Disease
Paolo Hospital Phaholyothin
More than 95 percent of coronary artery disease comes from the deterioration of blood vessels that have been used for more than ten years. The level of deterioration varies according to the cause, such as old age, heredity, high blood pressure, diabetes, abnormal lipid profile, smoking, obesity, and lack of exercise. If the coronary artery is constricted more than 50 percent, you will feel more tired when using energy and feel better when taking a rest. If it is constricted more than 75 percent, the symptoms may occur even while staying still. Moreover, in some cases, the plaque may split in the platelets of the arteries, which form blood clots and clog the coronary artery, and can suddenly cause constriction. Chest pain will occur or in serious cases, gasping for breath (heart failure) or cardiac arrest. This group of harmful symptoms is called ACS or Acute Coronary Syndrome, which is an urgent condition of the heart that needs immediate treatment. Other people call this a heart attack.
Who has a chance of having this disease?
In the past, this disease was often found in middle-aged males and menopausal females. However, at present, this condition can be found at younger ages because the situation these days are stressful. High competition, being in a rush, and changes in consumption behavior can accelerate the deterioration of the arteries. Therefore, it is not unusual to see more patients with acute myocardial infarction at the age of 30. Some people can have a heart attack and die while driving at only the age of 48-49. The risk factors of coronary artery disease are:
• Unsolvable factor: Males with history of a father who died of heart disease before the age of 55 or mother who died of heart disease before the age of 65.
• Solvable factor: High blood pressure, diabetes, high lipid profile, potbelly (males with waist circumference > 36 inches and females with waist circumference > 32 inches), lack of exercise, and often stressed.

Risk factor control
• Absolutely abstain from smoking (which can help to treat other diseases)
• Control the blood pressure to be less than or equivalent to 130/85 for patients with no diabetes. For diabetic patients, the pressure should be less than or equivalent to 130/80. For patients with nephrosis, the pressure should be less than or equivalent to 125/75 (should have 1 gram of albumin in the urine per day).
• Control blood sugar to < 130 mg% when fasting for 6 hours. Keep average HBA1c level < 7% for 3 months
• Control cholesterol < 200 mg%, triglyceride < 150 mg%, LTL (bad fat) < 100 mg%, HDL (good fat) > 40 mg% (male) and > 45 mg% (female)
• Control weight and Body Mass Index (BMI) < 25 or waist circumference < 36 inches (male) and < 32 inches (female)
• Aerobic exercise > 30 minutes more than 5 times/week
• Get enough rest and keep stress under control

Symptoms of coronary artery disease
Feeling pressure in the middle of the chest with pain that goes to the left shoulder and left arm. Some people might feel pain going up the neck. The symptoms becomes serious when using energy and will get better when sitting down. In case of those with ischemic heart disease, there will be a severe shortage of blood that can lead to myocardial infarction. The patient will feel severe chest pain, become restless, and cold sweating. If unable to go to the hospital in time, death may occur. If you suspect you have one of the abovementioned symptoms, see a doctor immediately. However, chest pain can come from 2 cases. It could be from a shortage of blood due to ischemic heart disease or myocardial infarction from a sudden clog of blood to the heart. If it is a shortage of blood from ischemic heart disease, the symptoms will occur when using energy or exercising. Stop the exertion of energy or the heavy exercise and see a doctor immediately. However, it is not an emergency case. In contrast, if myocardial infarction occurs from a sudden clog of blood that goes to the heart, the symptoms occur while taking a rest or staying still, which are serious symptoms, and you need to see a doctor at the nearest hospital immediately. The whole heart muscle will die within 4-6 hours. If we can correct it within these 4-6 hours, the heart muscles can function as normal. Currently, there is an injection that can dissolve the blood clot in the blood vessel with good results. In summary, these symptoms of coronary heart disease are considered to be an emergency condition in which you need to see a doctor as fast as possible. Do not leave it for more than 4-6 hours. Moreover, high lipid profile and high cholesterol can increase the chance of having coronary artery disease.
Treatment of coronary artery disease
Currently, there are many treatment methods for coronary artery disease. For example: Bypass by using blood vessels from other areas to connect with the aorta that goes to the coronary artery under the clogged spot; balloon angioplasty to expand the blood vessel; and stenting to hold the clogged blood vessel. However, for those who already have clogged blood vessels, this treatment method can only support the symptoms. Therefore, the best method is prevention. Those who have high blood pressure, high blood sugar, high lipid profile, or smoke should change their behavior by quitting smoking, controlling the blood pressure within the normal criteria, exercising regularly, and adjusting food consumption behavior by eating less food that contains fat, flour, and sugar and selecting food with more fiber.
Currently, there are 2 bypass surgery methods, which are:
1. Off-Pump CABG or “not stopping the heart”. The advantage is that it uses less blood in the surgery and it can reduce the surgery time, including the general anesthesia. Also, the rehabilitation period in the hospital is shorter than On Pump CABG.
2. On Pump CABG to “stop” all functions of the heart.

Foods that are suitable for patients with coronary artery disease
Food that is soft and easy to digest with not too strong flavor. Choose carbohydrates with high fiber and contain ingredients with low glycemic index. Select foods with low fat. The fat for consumption should contain unsaturated fatty acid. Moreover, increase the consumption of food with vegetables, fruits, grains, and fiber that can dissolve in water, which is a source of vitamins and antioxidants. Also, it can reduce the cholesterol in the blood, prevent constipation, and reduce the development of intestinal cancer. Fruits and food with strong flavor should not be consumed.

Paolo Hospital Phaholyothin Tel : 0-2271-7000