MyMedR

Ischemic heart disease is a leading cause of morbidity and mortality in Malaysia. Management strategies for this disease have changed dramatically. This article, based on discussions of real cases, reviews current treatment methods for various patient subsets, with acute myocardial ischemia.

Matched MeSH terms: Coronary Disease

Is there a role of routine resting ECG at the clinic in early detection of ischaemic heart disease?

Loh KY

Family Physician, 2003;12:23-23.

Matched MeSH terms: Coronary Disease

Lipids and coronary heart disease in Asia

Khoo KL, Tan H, Liew YM, Deslypere JP, Janus E

Atherosclerosis, 2003 Jul;169(1):1-10.

PMID: 12860245

In Western countries, it has been shown that coronary heart disease (CHD) is related to high serum total cholesterol (TC) levels. In less developed continents such as Asia and Africa, serum lipid levels are low and CHD incidence is much lower as compared with Western countries. With growing urbanization and industrialization in Asia, it has been shown that there is a concomitant rise in the level of serum TC and with it a rise in CHD. In all the Asian countries, serum TC levels are also higher in the urban compared with the rural population. Singapore, the only Asian country which is 100% urbanized since 1980, showed a rise of serum TC similar to that seen in the US and UK from the 1950s to the 1980s followed thereafter by a fall. This is reflected in the trend (rise followed by a fall) of CHD morbidity and mortality as well. In spite of a declining trend in serum TC level, CHD morbidity and mortality are still high in Singapore and comparable to the Western countries. The rest of the Asian countries show a different pattern from Singapore. In general, there is still a rising trend in serum TC level and in CHD mortality in most Asian countries. However, Japan is considered an exception in having a decreasing CHD mortality in spite of an increasing trend in serum TC. This may be attributed to a better control of other CHD risk factors such as hypertension and smoking. The rising trend in serum TC level remains a cause for concern, as this will emerge as a major problem for CHD morbidity and mortality in the future.

Matched MeSH terms: Coronary Disease/blood*; Coronary Disease/epidemiology*

Fulltext Coronary heart disease mortality in peninsular Malaysia

Yusof SM, Margetts BM

Med J Malaysia, 1995 Jun;50(2):194-6.

PMID: 7565197

Matched MeSH terms: Coronary Disease/ethnology; Coronary Disease/mortality*

Fulltext Acute coronary syndromes. I. Recent advances in pathogenesis

Yusoff K

Med J Malaysia, 1998 Mar;53(1):117-23; quiz 124.

PMID: 10968152

New knowledge on the pathogenesis of the acute coronary syndromes provides the clinician with a better understanding of these important, often life-threatening, events and opens up new ways of managing them. The identification of the vulnerable plaque whilst important and possible pathologically still requires elaborate and often invasive methods. The central role of inflammation and the platelets in these syndromes has already been translated into practical therapeutics. Identifying and predicting which plaque would rupture and thereby facilitating the formation of an acute obstructive thrombus continue as major challenges to the clinician, but, in the meantime, regressing and stabilising these plaques are achievable goals.

Matched MeSH terms: Coronary Disease/etiology*

Fulltext Total occlusion of left main coronary artery in a patient with chronic, stable angina

Soo CS, Choo M, Sim E, Ling LH, Tan K, Lee CN

Med J Malaysia, 1992 Mar;47(1):74-6.

PMID: 1387455

We report a case of total occlusion of the left main coronary artery (LMCA) in a patient with chronic, stable angina. Total occlusion of the LMCA is rare and survival depends on the existence of collateral circulation. In LMCA disease, there is usually also disease in other parts of the coronary arterial tree.

Matched MeSH terms: Coronary Disease/diagnosis*

Fulltext Percutaneous transluminal coronary angioplasty in the treatment of coronary artery disease--the local experience: a review of 100 cases

Ng SC, Hitam O, Sawat

Med J Malaysia, 1991 Mar;46(1):59-65.

PMID: 1836039

This paper reviews our first 100 consecutive PTCAs done between December 1988 and May 1990. There were 31 females and 69 males and their ages ranged from 37 years to 80 years. The mean age was 57.7 years. We achieved a follow-up rate of 66%. The restenosis rate was 22% of those that we could follow-up. There were 35 simple and 65 complex PTCAs. An average of 1.39 arteries were entered per PTCA. Of the 100 PTCAs done there was a primary success rate of 83%. On closer examination most of the failures were in the total occlusion group. There were 30 total occlusions done and 17 were successfully dilated. The primary success rate for acute total occlusions was 77% and the primary success rate for chronic total occlusions was 41%. Of the 100 PTCAs there were two deaths and only one patient had to go for emergency bypass surgery. The other complications were relatively minor including hypotension, groin bleeding, chills and rigors. This paper documents our initial 100 cases of PTCAs. It shows that our figures are compatible with other centres in this region and those around the world.

Matched MeSH terms: Coronary Disease/therapy*

Some aspects of prevention of coronary artery disease

Pillay RP

Med J Malaysia, 1976 Sep;31(1):5-9.

PMID: 1023013

Matched MeSH terms: Coronary Disease/prevention & control*

Serum antibody response against periodontal bacteria and coronary heart disease: Systematic review and meta-analysis

Joshi C, Bapat R, Anderson W, Dawson D, Cherukara G, Hijazi K

J Clin Periodontol, 2021 12;48(12):1570-1586.

PMID: 34545592 DOI: 10.1111/jcpe.13550

AIM: The present systematic review and meta-analysis assessed the strength of a reported association between elevated serum anti-periodontal bacterial antibody responses and coronary heart disease (CHD).

MATERIALS AND METHODS: Twenty original studies were identified after systematically searching five databases. The majority (n = 11) compared serum anti-Porphyromonas gingivalis (Pg) and/or anti-Aggregatibacter actinomycetemcomitans (Aa) IgG antibody responses between CHD patients and control participants. The strength of the association between serum anti-Pg antibodies and CHD (n = 10) and serum anti-Aa antibodies and CHD (n = 6) was investigated using a meta-analysis approach separately.

RESULTS: Most studies (61%) reported that the serum IgG antibody responses were elevated in CHD patients than in controls. The meta-analyses showed a significant association between elevated serum IgG antibody responses (anti-Pg and anti-Aa) and CHD, with pooled odds ratios of 1.23 [95% confidence interval (CI): 1.09-1.38, p = .001] and 1.25 (95% CI: 1.04-1.47, p = .0004), respectively.

CONCLUSIONS: A modest increase of CHD events in individuals with higher serum anti-Pg and anti-Aa IgG antibody responses may support their use as potential biomarkers to detect and monitor at-risk populations. However, the observed inconsistencies with the design and interpretation of immunoassays warrant standardization of the immunoassays assessing antibody responses against periodontal bacteria.

Matched MeSH terms: Coronary Disease*

Fulltext A Theory-Based, Technology-Assisted Intervention in a Hybrid Cardiac Rehabilitation Program for Patients with Coronary Heart Disease: A Feasibility Study

Chong MS, Sit JWH, Choi KC, Suhaimi A, Chair SY

Asian Nurs Res (Korean Soc Nurs Sci), 2023 Aug;17(3):180-190.

PMID: 37355035 DOI: 10.1016/j.anr.2023.06.004

PURPOSE: To assess the feasibility of a technology-assisted intervention in a hybrid cardiac rehabilitation program among patients with coronary heart disease.

METHODS: This study was a two-arm parallel randomized controlled trial. Twenty-eight patients with coronary heart disease were randomly assigned to either the intervention group, receiving a 12-week technology-assisted intervention (n = 14), or the control group (n = 14), receiving usual care. Guided by the Health Belief Model, the intervention group received three center-based, supervised exercise training sessions, a fitness watch that served as a cue to action, six educational videos, and a weekly video call. The Self-efficacy for Exercise, exercise capacity, and Health Promoting Lifestyle Profile II were assessed at baseline and immediately post-intervention (12-weeks).

RESULTS: Among the 28 patients who participated in this study, 85.7% completed the program, with a relatively low attrition rate (14.3%). The number of exercise training sessions accomplished by the participants in the intervention group was 51.27 ± 19.41 out of 60 sessions (85.5%) compared to 36.46 ± 23.05 (60.8%) in the control group. No cardiac adverse events or hospitalizations were reported throughout the study. Participants in the intervention group showed greater improvement in health-promoting behaviors when compared with the control group at 12 weeks. Within-group effects demonstrated improvement in exercise self-efficacy and exercise capacity among participants in the intervention group. A participant satisfaction survey conducted immediately post-intervention revealed that participants were "very satisfied" (23.1%) and "satisfied" (76.9%) with the technology-assisted intervention.

CONCLUSIONS: The findings demonstrated that technology-assisted intervention in a hybrid cardiac rehabilitation program was feasible and suggested to be beneficial in improving exercise self-efficacy, exercise capacity, and health promoting behavior among patients with coronary heart disease. A full-scale study is needed to determine its effectiveness in the long term.

TRIAL AND PROTOCOL REGISTRATION: ClinicalTrials.gov NCT04862351. https://clinicaltrials.gov/ct2/show/NCT04862351.

Matched MeSH terms: Coronary Disease*

Barriers to cardiac rehabilitation and patient perceptions on the usage of technologies in cardiac rehabilitation: A cross-sectional study

Chong MS, Sit JWH, Choi KC, Suhaimi A, Chair SY

J Clin Nurs, 2024 Mar;33(3):1084-1093.

PMID: 37909483 DOI: 10.1111/jocn.16919

AIMS AND OBJECTIVES: The study aimed to identify factors associated with participation in Phase II cardiac rehabilitation and to assess patient perceptions towards the usage of technologies in cardiac rehabilitation.

BACKGROUND: Despite efforts to promote utilisation of cardiac rehabilitation (CR), participation among patients remains unsatisfactory. Little is known of patient decision to participate Phase II CR in a multi-ethnic country.

DESIGN: A cross-sectional study design.

METHODS: A consecutive sampling of 240 patients with coronary heart disease completed Coronary Artery Disease Education Questionnaire (CADE-Q) II, Hospital Anxiety and Depression Scale (HADS), Multidimensional Scale of Perceived Social Support (MSPSS) and Cardiac Rehabilitation Barriers Scale (CRBS).

RESULTS: Seventy per cent of patients (mean age 60.5 [SD = 10.6] years, 80.8% male) participated in phase II cardiac rehabilitation. Self-driving to cardiac rehabilitation centres, higher barriers in perceived need/health care and logistical factors were significantly associated with decreased odds of participation. Patients with more barriers from comorbidities/functional status, higher perceived social support from friends, and anxiety were more likely to participate. Chinese and Indians were less likely to participate when compared with Malays. More than 80% of patients used both home and mobile broadband internet, and 72.9% of them would accept the usage of technologies, especially educational videos, instant messenger, and video calls to partially replace the face-to-face, centre-based cardiac rehabilitation approach.

CONCLUSION: Several barriers were associated with non-participation in phase II cardiac rehabilitation. With the high perceived acceptance of technology usage in cardiac rehabilitation, home-based and hybrid cardiac rehabilitation may represent potential solutions to improve participation.

RELEVANCE TO CLINICAL PRACTICE: By addressing the barriers to cardiac rehabilitation, patients are more likely to be ready to adopt health behaviour changes and adhere to the cardiac rehabilitation programme. The high perceived acceptance of using technologies in cardiac rehabilitation may provide insights into new delivery models that can improve and overcome barriers to participation.

Matched MeSH terms: Coronary Disease*

Fulltext Reduced fibrinogen, fibrinolytic biomarkers, and physical parameters after a weight-loss program in obese subjects

Aziz CB, Omar N, Abdullah WZ, Jalil RA, Nik WS, Zakaria R

N Am J Med Sci, 2014 Aug;6(8):377-82.

PMID: 25210670 DOI: 10.4103/1947-2714.139286

Obese subjects are at risk of multiple comorbidities including stroke and coronary heart disease (CHD), which is partly due to disturbances in the hemostatic system.

Matched MeSH terms: Coronary Disease

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