Coronary Artery Disease (CAD) CAD is caused by the buildup of fatty plaques in the artery walls, narrowing the coronary arteries and restricting blood flow to the heart muscle. When the heart muscle receives insufficient blood, it can lead to acute heart failure.

Risk Factors for CAD Risk factors include both non-modifiable factors, like age and genetics, and modifiable factors, such as controlling chronic non-communicable diseases like diabetes, high blood pressure, high cholesterol, and obesity. Additionally, lifestyle changes such as quitting smoking, reducing intake of sugary, fatty, and processed foods, exercising regularly, getting enough rest, managing stress, avoiding pollution, and having regular health checkups can help reduce or manage CAD risk.
Symptoms of Coronary Artery Stenosis

-   Chest pain or tightness in the center or left side, sometimes with nausea and vomiting

-   Severe chest pain radiating to the arms, shoulders, or jaw
-   Shortness of breath or difficulty breathing

-   Fatigue, heart palpitations, excessive sweating, dizziness, and faintness If these symptoms occur, it is advisable to consult a doctor promptly to assess CAD risk and initiate timely treatment.

Coronary Artery Diagnostic Tests There are two main methods for diagnosing CAD or blockages:

-   Coronary CT Angiography (CTCA): This method uses a CT scan and contrast dye to visualize the coronary arteries, typically used for patients with low to moderate risk.
-   Coronary Angiography (CAG): This test uses contrast dye injected via a catheter inserted through either the wrist (Radial Artery) or groin (Femoral Artery), primarily for high-risk patients with clear symptoms, to locate specific areas of stenosis or blockages.

Radial Artery Coronary Angiography Procedure This minimally invasive procedure allows for accurate imaging and diagnosis, with higher patient comfort than the femoral approach:

1. The doctor cleanses the wrist area, administers a local anesthetic, and inserts a small catheter (about 2.5 mm in diameter) into the radial artery.
2. Once the catheter reaches the coronary arteries, contrast dye is injected to monitor its flow through the three main arteries.
3. X-rays capture the images, allowing doctors to determine the exact location of any blockage. If necessary, balloon angioplasty or stent placement can be done immediately to expand and reinforce the artery. This procedure typically takes 30-60 minutes and is performed without general anesthesia, reducing anesthesia risks and enabling patient communication during the procedure.
Advantages of Radial Artery Access

1. Lower risk of bleeding or complications compared to the femoral approach
2. Patients wear a wristband (TR band) for only 1-2 hours after the procedure to prevent bleeding, unlike femoral access, which requires several hours of lying flat
3. Faster recovery time, with most patients able to sit or walk immediately after and requiring only 4-8 hours of recovery

Limitations of Radial Artery Access This method may not be suitable for patients with small or compromised wrist arteries, such as elderly patients, women, or those with arm artery disease. Radial access also requires skilled medical professionals and may need to be changed to femoral access for larger instruments.

Reducing and Preventing CAD Risk of CAD can be reduced with lifestyle changes, controlling chronic health conditions, and regular heart health screenings, such as EKG, ECHO, exercise stress tests (EST), or coronary calcium scoring. At Phyathai 2 Hospital, specialized cardiologists provide comprehensive care for CAD, from consultation and diagnosis to treatment, including procedures such as CAG, balloon angioplasty, stent placement, and coronary artery bypass surgery, along with recovery care in a supportive environment.