Quick answer. Coronary artery disease (CAD) is the build-up of fatty plaque inside the arteries that supply the heart, narrowing them and reducing blood flow. When the heart muscle is starved of blood, you may feel angina – chest tightness, pressure or pain, often spreading to the arm, neck or jaw. Stable angina comes on predictably with exertion and eases with rest; unstable angina is new, worsening or occurs at rest and is a medical emergency. In Singapore, CAD is diagnosed with ECG, treadmill stress tests, CT coronary angiogram or invasive angiogram. Treatment ranges from medications and risk-factor control to angioplasty with stenting (PCI) or bypass surgery (CABG). New, severe or rest chest pain – call 995.
Coronary artery disease (CAD) is one of the leading causes of death in Singapore. It develops slowly as fatty deposits (plaque) build up inside the coronary arteries that feed the heart muscle, narrowing them so less oxygen-rich blood gets through. When the heart cannot get enough blood – especially during exertion – it causes a warning symptom called angina.
This guide focuses on chronic, stable coronary artery disease and angina, and how they are diagnosed and treated in Singapore. A sudden, complete blockage causes a heart attack, which is a separate emergency covered in our heart attack warning signs guide. Knowing the difference between stable angina and unstable angina could save a life.
At a glance
| Feature | Stable angina | Unstable angina (emergency) |
|---|---|---|
| Trigger | Predictable – brought on by exertion, stress or cold | Occurs at rest, with minimal effort, or is new |
| Pattern | Familiar, similar each time | New, more frequent, more severe or longer-lasting |
| Relief | Eases within minutes with rest or GTN spray | Does not settle quickly with rest or GTN |
| What it means | Stable narrowing – manage with your doctor | Plaque may be rupturing – risk of heart attack; call 995 |
What is coronary artery disease?
The coronary arteries are the small vessels that wrap around the heart and supply it with blood. In CAD, cholesterol-rich plaque gradually builds up in the artery walls (atherosclerosis), narrowing the channel. When a narrowed artery cannot deliver enough blood during exertion, the heart muscle becomes starved of oxygen and signals this as angina. If a plaque suddenly ruptures and a clot blocks the artery completely, the result is a heart attack (myocardial infarction).
Stable angina vs unstable angina
Telling these apart matters because one is managed in clinic and the other is an emergency:
- Stable angina is predictable. It comes on with exertion, emotional stress or cold weather, feels similar each time, and eases within a few minutes with rest or a glyceryl trinitrate (GTN) spray.
- Unstable angina is new, more frequent, more severe, lasts longer, or happens at rest. It signals that a plaque may be cracking and a heart attack could follow.
Unstable angina, or chest pain lasting more than a few minutes with sweating, nausea or breathlessness, is a medical emergency – call 995.
Risk factors
Many CAD risk factors are modifiable:
- High blood pressure, high cholesterol and diabetes
- Smoking
- Physical inactivity, obesity and an unhealthy diet
- Family history of early heart disease
- Increasing age and male sex (though women’s risk rises after menopause)
South Asian and certain other Asian populations in Singapore carry a higher genetic risk, making early screening and risk-factor control particularly important.
How CAD is diagnosed
Investigations build a picture from non-invasive to invasive:
- ECG – records the heart’s electrical activity, at rest and sometimes during exercise.
- Treadmill or exercise stress test – looks for signs of reduced blood flow when the heart is working hard.
- CT coronary angiogram – a non-invasive scan that images the coronary arteries and detects narrowing.
- Echocardiogram and stress imaging – assess heart function and blood supply.
- Invasive coronary angiogram – the most precise test; dye is injected via a catheter to show exactly where and how severe the blockages are, and allows treatment in the same sitting.
Treatment options
Treatment is tailored to how severe the disease is and your symptoms:
- Medications and risk-factor control form the foundation – antiplatelets (such as aspirin), statins to lower cholesterol, and anti-anginal drugs (beta-blockers, nitrates, calcium-channel blockers), plus tight control of blood pressure, diabetes and smoking.
- Angioplasty and stenting (PCI) – a catheter is used to inflate a balloon across the narrowing and place a stent (a mesh tube) to hold the artery open.
- Coronary artery bypass grafting (CABG) – open-heart surgery that reroutes blood around blockages using grafts; results are durable and it is often preferred for multiple or complex blockages.
Your cardiologist will recommend the best option based on the pattern of disease, other conditions, and your preferences.
Prevention and living with CAD
Whether or not you have had a procedure, lifestyle remains central to keeping arteries healthy:
- Stop smoking – the single most powerful step.
- Eat a heart-healthy diet low in saturated fat, salt and sugar.
- Exercise regularly, ideally building up to about 150 minutes of moderate activity a week.
- Take prescribed medications consistently, including after a stent or bypass.
- Attend cardiac rehabilitation if offered, and keep follow-up appointments.
For eligible patients, MediSave can be used under the Chronic Disease Management Programme to help with ongoing care of conditions such as high blood pressure, diabetes and lipid disorders that drive CAD.
Related guides
- Best Cardiology Clinics in Singapore — our editorial shortlist
- cardiology clinics directory
- Heart failure
- Heart valve disease
- Heart rhythm disorders
Sources
- SingHealth – Acute Coronary Syndromes
- HealthXchange – Angioplasty: Coronary Artery Disease Treatment
- HealthXchange – Bypass Surgery: Coronary Artery Disease Treatment
- NHCS – Insights Into Coronary Interventions
- NHCS – Cardiology
Related conditions & guides
Related conditions and guides you may find useful:
- Diabetes Complications in Singapore
- Heart Attack Warning Signs in Singapore
- Heart Screening in Singapore
- High Blood Pressure (Hypertension) in Singapore
- High Cholesterol in Singapore
- Heart Palpitations & Atrial Fibrillation (AFib) in Singapore
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