When Formula 1 returned to Sepang early this month, the excitement of speed and high performance once again took centre stage. But what happens when something is going wrong beneath the surface, even when your heartbeat appears perfectly normal?
Heart palpitations, the sensation of your heart racing (beating) more noticeably than usual, can have many causes and do not necessarily mean heart disease. Yet a normal heartbeat does not always mean that everything is healthy. Coronary artery disease (CAD), for example, can develop gradually and silently as plaque builds up inside the arteries that supply blood to the heart.
Dr Mohamed Nazrul bin Mohamed Nazeeb, Consultant Cardiologist at Subang Jaya Medical Centre (SJMC), explains how coronary artery disease can progress silently, how doctors assess and treat narrowed coronary arteries, and how newer technologies such as Drug-Coated Balloons (DCB) are expanding minimally invasive treatment options for suitable patients.
When a Racing Heart Hides a Quiet Problem
Heart palpitations can occur in response to exercise, stress, excitement and other factors. However, persistent or unusual palpitations should be medically assessed, especially when accompanied by:
- Chest discomfort
- Breathlessness
- Dizziness
- Fainting
The absence of symptoms does not necessarily mean that the heart and its blood vessels are healthy. Coronary artery disease occurs when plaque gradually accumulates within the coronary arteries. The plaque is made up primarily of cholesterol, calcium, inflammatory cells and other substances in the bloodstream. As it builds up, the arteries can become narrowed, restricting blood and oxygen flow to the heart muscle.
“Coronary artery disease can develop without obvious signs or symptoms, which is why it may remain undetected until a more serious complication occurs. Understanding your risk factors and seeking appropriate medical assessment when necessary are therefore important,” says Dr Nazrul.
Coronary Artery Disease Risk Factors
Risk factors include:
- High cholesterol
- Diabetes
- High blood pressure
- Smoking
- Obesity
- Family history of premature cardiovascular disease
According to the Department of Statistics Malaysia, ischaemic heart disease remained the leading cause of medically certified deaths in 2024, accounting for 17,421 deaths, or 13.0 per cent of all medically certified deaths.
How Do I “Service” My Heart?
The suitability of each test depends on an individual’s symptoms, risk profile, age, and overall clinical condition. A personalised approach is therefore essential to ensure accurate diagnosis and appropriate treatment.
Diagnostic tests used to detect coronary artery disease can be broadly categorised as non-invasive and invasive.
Non-Invasive Tests
- Coronary artery calcium scoring
- Coronary CT angiography (CCTA)
- Exercise stress testing
- Nuclear myocardial perfusion imaging
- Cardiac magnetic resonance imaging (MRI)
Invasive Tests
- Coronary angiography/angioplasty
A Blockage Does Not Always Mean a Stent
Finding a narrowed or blocked coronary artery does not automatically mean that a stent is required. The primary goal of treatment for coronary artery disease is simple: restore adequate blood flow to the heart muscle.
“The approach of treatment depends on the location and severity of the blockage, the size and condition of the affected artery, plaque characteristics, the number of blockages, heart function and the patient’s overall health,” shared Dr Nazrul.
Depending on the complexity of the disease, treatment may include medication and lifestyle management, coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI), commonly known as coronary angioplasty.
Could a Drug-Coated Balloon Be Another Option?
One of the technologies used in selected coronary interventions is the Drug-Coated Balloon (DCB). Unlike a conventional stent, which remains in the artery to provide structural support, a DCB is a specialised balloon coated with medication.
During angioplasty, the balloon is positioned at the narrowed section of the artery and inflated for a short period, allowing the drug to be delivered directly to the vessel wall. The balloon is then removed, leaving no permanent implant behind.
“Drug-Coated Balloons allow us to deliver medication directly to the vessel wall without leaving a permanent implant behind. The medication helps to prevent re-narrowing of the treated artery and, in selected situations, may also support favourable vessel remodelling,” explains Dr Nazrul.
However, DCB is not suitable for every patient or every type of coronary narrowing. The decision depends on the blockage’s location and characteristics, the vessel size and the patient’s overall condition.
Keep Your Heart in the Race
Even with today’s advances in cardiovascular medicine, prevention remains the most effective strategy against coronary artery disease.
Maintaining a healthy lifestyle, managing blood pressure, cholesterol and blood sugar, exercising regularly, avoiding smoking and attending appropriate medical assessments can help reduce cardiovascular risk.
Just as speed alone does not tell the whole story on the F1 track, a normal heartbeat does not necessarily tell us what is happening beneath the surface. For more information, visit Subang Jaya Medical Centre.
