Coronary artery disease, a 'silent danger' that can take your life without warning

Coronary artery disease (Coronary Artery Disease : CAD) is one of the leading causes of death among Thai people. Because it often shows no symptoms in the early stages or only mild symptoms that are often overlooked, such as chest tightness, easy fatigue, or brief chest pain, this disease is considered a ‘silent threat’ to health that can occur in all genders and ages, even in seemingly healthy individuals like athletes. It can lead to ischemic heart disease, myocardial infarction, or sudden death. 

Prevention and early detection of the disease are therefore extremely important, especially for those over 40 years old or with major risk factors such as diabetes, hypertension, high blood cholesterol, smoking, abdominal obesity, or a family history of heart disease. Regular heart health check-ups are recommended to assess risk and plan appropriate health care. 

Because ‘early detection and treatment’ is the key to avoiding severity and possible complications, one of the methods to detect coronary artery stenosis is “Coronary Angiography” (Coronary Angiography) 

What is Coronary Angiography (Coronary Angiography : CAG) for diagnosing coronary artery stenosis?  

Coronary Angiography (Coronary Angiography : CAG) is a diagnostic procedure for coronary artery stenosis or blockage using moving X-ray imaging (Fluoroscopy) with a small catheter (Catheter) about 2 millimeters in diameter inserted through an artery in the wrist or groin to inject contrast dye into the coronary arteries, allowing real-time visualization of the coronary arteries with high accuracy for diagnosis. 

If abnormalities are found, doctors can immediately treat by balloon angioplasty (Balloon Angioplasty) or stent placement (Stent) without the need for general anesthesia in most cases, although it may be considered depending on the patient’s condition. 

The importance of coronary angiography (CAG) 

Coronary angiography (CAG) provides the most comprehensive and accurate information for diagnosing coronary artery stenosis and helps plan appropriate treatment for coronary artery disease as follows: 

• Reduces sudden death rate : Early detection reduces the risk of acute myocardial infarction by 30-50% and also helps prevent long-term complications.
• Differentiates diseases with similar symptoms : Chest pain may be caused by acid reflux or muscle pain. The test helps differentiate the cause and provide targeted treatment.
• Assesses severity : Provides detailed millimeter-level images of coronary arteries and real-time blood flow assessment, unlike static imaging such as CT or MRI, allowing precise identification of the location and percentage of artery stenosis, enabling appropriate treatment choices such as medication, stenting (PCI), or coronary artery bypass surgery (CABG)
• Immediate combined treatment : If severe artery stenosis is found, doctors can immediately perform balloon angioplasty (Balloon Angioplasty) or stent placement (Stent) to restore blood flow. 

Who should undergo coronary angiography (CAG)  

Doctors consider coronary angiography or CAG (Coronary Angiography) for patients who have symptoms or are at risk of coronary artery disease, including 

1. Emergency cases such as acute ischemic heart disease, acute myocardial infarction, or severe acute chest pain
    
2. Those with symptoms indicating possible coronary artery disease such as chest tightness like a heavy weight pressing, squeezing, or radiating pain to the arm, neck, jaw, or back; easy fatigue; shortness of breath; palpitations; dizziness; weakness; arrhythmia; or loss of consciousness, including cases where chest pain worsens, becomes more frequent, or occurs at rest
    
3. Elevated cardiac enzyme levels (Troponin) indicating myocardial damage
    
4. Abnormal electrocardiogram (EKG/ECG) or abnormal cardiac stress test results such as Exercise Stress Test
     
5. Those at risk of coronary artery disease such as diabetes, hypertension, high cholesterol, smoking habits, or family history of heart disease, especially when experiencing chest pain, unusual fatigue, or heart disease-like symptoms even if basic tests show no clear abnormalities 

Coronary angiography (CAG) procedure 

Coronary angiography (CAG) is a highly safe procedure when performed by specialists in accredited medical facilities. The diagnostic test usually takes about 30 minutes. However, if immediate treatment is required during the procedure, it may take longer. The steps are as follows: 

• The doctor takes a medical history, checks kidney function, allergy history to medications and contrast dye, and current medications, especially blood thinners or anticoagulants.

• Generally, patients are instructed to fast for at least 4-6 hours before the test to prevent aspiration during the procedure and ensure patient safety.

• In the examination room, the patient will have an intravenous line (Intravenous Access) for fluids and medications, and monitoring devices attached for vital signs including electrocardiogram (ECG), blood pressure, and blood oxygen levels. Sedatives may be given to help the patient relax while remaining conscious and able to communicate with the doctor.

• The nurse will position the patient lying flat on a special X-ray table in the cardiac catheterization laboratory (Cath Lab), which is a sterile room. After cleaning the skin at the catheter insertion site, which may be the wrist or groin artery, the doctor will administer local anesthesia to numb the area.

• The doctor inserts a needle to access the blood vessel and then inserts a guiding sheath before advancing a small catheter (Catheter) through the large artery (Aorta) to the opening of the coronary arteries (Coronary Ostia) to inject contrast dye and capture images of the coronary arteries. This is guided by moving X-ray imaging (Fluoroscopy) and the patient remains conscious and able to communicate throughout the procedure.

• When the catheter tip is in the correct position, the doctor injects a small amount of contrast dye through the catheter into each coronary artery, making the arteries visible under X-ray imaging.

• The doctor records moving images of the coronary arteries from multiple angles to assess the location, severity, and anatomical characteristics of stenosis or blockage. If severe coronary artery stenosis or blockage is found, the doctor may proceed with treatment by balloon angioplasty and/or stent placement (Stent)

• After the procedure, the doctor removes the catheter and stops bleeding at the insertion site by applying pressure or using hemostatic devices.

• The patient will rest for observation, with monitoring of vital signs, ECG, and watch for complications such as bleeding or hematoma at the catheter site or chest pain.

• If the catheter was inserted via the wrist, the patient can sit up and move sooner. If inserted via the groin, the patient must lie flat with legs straight and limit movement for about 4-6 hours to prevent bleeding. 

Advantages of coronary angiography (CAG) 

Coronary angiography (CAG) is a diagnostic method for coronary artery stenosis with several advantages as follows: 

• Provides clear images of coronary arteries, allowing doctors to accurately identify the location, characteristics, and severity of stenosis or blockage caused by fat, calcification, or blood clots.

• Helps doctors plan appropriate treatment such as medication, balloon angioplasty, stent placement, or coronary artery bypass surgery (CABG)

• If necessary, treatment with balloon angioplasty and stent placement can be performed immediately without open-heart surgery, reducing treatment time and complications.

• It is a minimally invasive procedure with small wounds, allowing quick recovery and hospital stay of only 1-2 days. It is highly safe with very low complication rates (approximately 0.01-0.5%)

• Uses only local anesthesia, keeping the patient conscious throughout, reducing risks associated with general anesthesia.

• Allows assessment of overall heart health such as heart muscle function, heart valves, measurement of pressures in heart chambers and pulmonary vessels, and is used to diagnose congenital heart disease as well as monitor post-treatment outcomes. 

Coronary artery disease often shows no clear symptoms in the early stages and can lead to ischemic heart disease or sudden death. Screening is therefore important, especially for those with risk factors or early abnormal symptoms, to enable timely treatment planning and reduce the risk of complications. 

At Phyathai 2 Hospital, we have a team of heart disease specialists and advanced diagnostic technology such as accurate and safe coronary angiography (CAG) to care for you from risk assessment, diagnosis, to comprehensive treatment. 

Additionally, patients can choose services that meet their needs, including comfortable rooms, meal services, and close care from private nurses, along with various facilities under the concept of Value Healthcare which combines medical quality with cost-effectiveness. Treatment plans can be adjusted to fit budgets under international safety standards to ensure you receive the best care at every step.