By Dr. Apurba Kumar Sarma, MCh CVTS | Cardiac Surgeon, Tulip Mediworld Superspeciality Hospital, Guwahati
Quick Takeaways
- Coronary artery disease (CAD) is the leading cause of death in India – and Indians develop it nearly a decade earlier than their Western counterparts
- Heart blockage symptoms range from chest pain and shortness of breath to subtler signs like jaw pain, back pain, and unusual fatigue – especially in women
- Diabetes is a particularly dangerous risk factor in Northeast India: it can mask all symptoms entirely, making regular screening essential even when you feel fine
- Diagnosis has become far less invasive – the CT Coronary Angiogram, available at Tulip Mediworld Superspeciality Hospital, is a non-invasive scan that can detect blockages without a hospital stay
- Not every blockage needs surgery – but when it does (triple vessel disease, left main disease, diabetics with multivessel CAD), bypass surgery has decades of evidence behind it
- You do not need to travel to Delhi, Chennai, or Kolkata for advanced heart surgery – experienced cardiac surgical care is available in Guwahati
- The earlier coronary artery disease is found, the more options you have – awareness is the most powerful tool you have right now
According to the World Health Organization, cardiovascular disease is responsible for more than a quarter of all deaths in India – and coronary artery disease sits at the centre of that number. What makes it especially concerning in our part of the country is this: Indians develop coronary artery disease approximately 10 years earlier than people in Western populations, and Northeast India’s rates are rising steadily, driven by increasing rates of diabetes, hypertension, and shifting dietary patterns.
Consider this scenario. A 48-year-old man from Dibrugarh – a businessman, father of two, no prior cardiac history – begins noticing that climbing stairs leaves him more breathless than it used to. He attributes it to stress, to weight gain, to getting older. Six months pass. Then one afternoon, the chest tightens sharply during a meeting. By the time he reaches our emergency department at Tulip Mediworld, the angiogram reveals two major coronary arteries with significant blockages. He is lucky. Many patients do not get that warning.
This guide is a complete, honest resource on coronary artery disease – what it is, why it is so common in India, how it is diagnosed, what the treatment options look like, and when the right decision is to see a cardiac surgeon. Whether you are reading this because you have received a diagnosis, because your father has just been referred for a heart scan, or because you simply want to understand what your risk is – you are in the right place.
Coronary artery disease occurs when the arteries that supply blood to the heart muscle become narrowed or blocked. These vessels – the coronary arteries – are responsible for delivering the oxygen-rich blood your heart needs to pump continuously, every single day of your life. When plaque (a combination of cholesterol, fat, calcium, and other substances) builds up inside the walls of these arteries, the process is called atherosclerosis.
Think of atherosclerosis as slow rust inside a pipe. Over many years, the buildup thickens and hardens, progressively narrowing the channel through which blood flows. The heart muscle, receiving less and less blood, starts to protest – first during exertion, then even at rest. If a piece of plaque ruptures and a blood clot forms suddenly on top of it, the artery can block completely. That is a heart attack.
The Cardiological Society of India and multiple large studies have confirmed what cardiac surgeons across the country observe clinically: Indians carry a higher genetic susceptibility to coronary artery disease than most other populations. The risk factors play out differently here.
Indians tend to have lower levels of HDL (the protective “good” cholesterol), higher levels of Lipoprotein(a) – a particularly inflammatory form of blood fat – and a tendency toward central (abdominal) obesity even at lower overall body weights. The BMI thresholds used in Western populations to define overweight and obese are too high for Indians; risk begins at lower weights here.
In Northeast India specifically, we are seeing a convergence of rising diabetes rates, high-salt diets, reduced physical activity, and a growing burden of tobacco use – all of which accelerate atherosclerosis. Add to this a historical lack of access to early screening, and you have a population where CAD is frequently diagnosed late.
One of the most important things I tell patients and their families: the symptoms of coronary artery disease are not always what you expect. Television dramas have given us the image of a man clutching his chest and falling to the floor. That does happen – but far more often, coronary artery disease announces itself quietly, gradually, and sometimes not at all.
The classical symptom of CAD is angina – a pressure, tightness, squeezing, or heaviness in the chest, typically brought on by physical activity or emotional stress and relieved by rest. This is called stable angina. It occurs because during exertion, the heart needs more blood than a narrowed artery can supply.
Unstable angina is a more serious pattern – chest pain that occurs at rest, wakes you from sleep, or is increasing in frequency and severity. This requires urgent medical attention. It can be a warning sign that a blockage is becoming critical or that a heart attack is imminent.
Many patients – and some doctors – focus so heavily on chest pain that they miss the other signals coronary artery disease can send.
Perhaps the most important thing to understand, especially if you have diabetes: coronary artery disease can be entirely silent. Nerve damage caused by long-term diabetes (diabetic neuropathy) can blunt the pain signals that would normally warn you. Many diabetic patients in our region have had significant blockages detected for the first time during a routine health check – with no prior symptoms whatsoever.
| Symptom | What It May Indicate | Urgency Level |
|---|---|---|
| Chest tightness / pressure on exertion, relieved by rest | Stable angina – coronary artery disease likely | See a cardiologist or cardiac surgeon within days |
| Chest pain at rest or waking from sleep | Unstable angina – high-risk presentation | Go to emergency immediately |
| Shortness of breath on mild exertion | Reduced cardiac output; possible CAD | Seek evaluation within days |
| Unusual fatigue, especially in women | Possible early heart dysfunction | Discuss at next medical visit; do not dismiss |
| Jaw, neck, or back pain during exertion | Possible referred cardiac pain | Seek cardiac evaluation |
| No symptoms + diabetes + risk factors | Silent CAD – common in diabetics | Annual heart screening strongly recommended |
Coronary artery disease does not happen overnight. It develops over decades, driven by a combination of factors – some you can change, and some you cannot. Understanding your risk profile is the first step toward doing something about it.
Hypertension (high blood pressure) is probably the single most common modifiable risk factor in our patients. High pressure damages the inner lining of coronary arteries, making them more susceptible to plaque buildup. In Northeast India, hypertension is significantly underdiagnosed – many patients have blood pressures well above safe limits and are unaware of it.
Diabetes does not merely increase your risk of CAD – it changes its character. Diabetics tend to have diffuse, multivessel disease (blockages across multiple arteries simultaneously) rather than focal single-artery disease. They are also the group most likely to have silent CAD and most likely to need bypass surgery rather than stenting when intervention is required.
High cholesterol (dyslipidaemia) – particularly elevated LDL and low HDL – is the fuel for atherosclerosis. Diet, genetics, and physical inactivity all contribute. Indians tend to have a particularly unfavourable cholesterol profile even at modest LDL levels, because of the role of Lipoprotein(a).
Smoking accelerates coronary artery disease dramatically. Tobacco causes direct injury to artery walls, triggers inflammation, reduces HDL, and promotes clot formation. Even passive smoking carries a meaningful risk.
Obesity and physical inactivity – both rising rapidly in urban and semi-urban Northeast India – compound every other risk factor. Central obesity (excess weight around the abdomen) is a particularly strong predictor of coronary artery disease in Indians, even when overall BMI appears moderate.
Stress – chronic psychological stress activates the same physiological pathways as physical stress: raised blood pressure, elevated cortisol, increased clotting tendency. It matters, and it is underappreciated.
| Risk Factor | How It Damages Coronary Arteries | What You Can Do |
|---|---|---|
| Hypertension | Injures artery lining; accelerates plaque formation | Regular BP monitoring; medication if needed; reduced salt intake |
| Diabetes | Promotes diffuse plaque; masks symptoms | Tight blood sugar control; regular cardiac screening |
| High LDL / low HDL | LDL deposits in artery walls; HDL removes plaque | Statin therapy; dietary change; exercise |
| Smoking | Direct artery wall toxicity; promotes inflammation and clotting | Stop smoking – the benefit begins within weeks |
| Obesity / inactivity | Drives hypertension, diabetes, dyslipidaemia | 150 minutes of moderate exercise per week; dietary adjustment |
| Family history | Genetic predisposition to early atherosclerosis | Earlier and more frequent screening; aggressive risk factor management |
A common misconception among patients is that a normal ECG means the heart is fine. It does not. The ECG is a useful tool for detecting electrical disturbances and identifying a heart attack that has already happened – but it does not reliably detect coronary artery disease until disease is advanced or a major event has occurred. Here is what the proper diagnostic pathway looks like.
An ECG records the electrical activity of the heart. It is quick, painless, and available everywhere. It is useful for identifying arrhythmias (abnormal heart rhythms), detecting evidence of a previous heart attack, and providing a baseline. It is not a reliable screening tool for coronary artery blockages on its own.
A treadmill stress test assesses how the heart responds to physical demand. As you exercise at increasing intensity, the ECG is monitored for changes that suggest the heart is not getting adequate blood supply. A positive stress test warrants further investigation. A negative result provides useful reassurance – but is not absolute, particularly in patients with diabetes or women (in whom stress tests have lower sensitivity).
The CT Coronary Angiogram (CTCA) is a non-invasive imaging test that uses a specialised CT scanner to produce detailed, three-dimensional images of the coronary arteries and detect plaque – including soft plaque (not yet calcified) that traditional methods may miss. It is performed as an outpatient procedure: no hospitalisation, no catheter, no overnight stay.
Tulip Mediworld Superspeciality Hospital was the first hospital in Northeast India to offer the CT Coronary Angiogram. For patients in Assam and the surrounding states, this means a test that previously required a trip to Delhi or Kolkata can now be done in Guwahati – and in many cases, it can replace the need for a traditional invasive angiogram at the diagnostic stage.
The invasive coronary angiogram remains the gold standard for definitive diagnosis when intervention is being planned. A thin tube (catheter) is passed through an artery in the wrist or groin, dye is injected directly into the coronary arteries, and X-ray images reveal the location and severity of blockages in real time. This procedure is typically performed by an interventional cardiologist. At Tulip Mediworld, we have a fully equipped Cathlab for this purpose.
An echocardiogram uses ultrasound to assess the structure and function of the heart – how well it is pumping, whether the heart muscle has been damaged by a previous heart attack, and whether the valves are functioning normally. It is an essential part of the cardiac workup and guides treatment decisions.
Key blood tests in the assessment of coronary artery disease include the lipid panel (total cholesterol, LDL, HDL, triglycerides), HbA1c (for diabetes control), C-reactive protein (inflammation marker), and troponin – a highly sensitive marker that rises when heart muscle cells are damaged, used to diagnose or rule out a heart attack.
Once coronary artery disease is diagnosed, treatment decisions depend on the severity and distribution of disease, your symptoms, heart function, and other health factors. No two patients are the same – and this is why evaluation by an experienced team matters.
For mild-to-moderate coronary artery disease – single vessel disease, or disease without significant symptoms – medications are often the first line of treatment. The evidence base for medical therapy is robust when used correctly. Key medications include:
Medical therapy works best as part of a comprehensive programme that includes lifestyle change: dietary modification, regular physical activity, smoking cessation, weight management, and control of diabetes.
Percutaneous Coronary Intervention (PCI) – commonly called angioplasty or stenting – is a procedure in which a collapsed balloon is threaded to the blocked artery, inflated to widen it, and a small mesh tube (stent) is left in place to keep the artery open. This is the domain of interventional cardiologists, not cardiac surgeons.
PCI is well suited for single-vessel disease or focal blockages in suitable anatomy. It is not, however, the best option for all patients – and in some situations, trying to treat complex disease with stenting when surgery is more appropriate puts patients at a disadvantage.
Coronary Artery Bypass Grafting (CABG) involves creating new routes – grafts – for blood to flow around the blocked coronary arteries, using vessels taken from the patient’s own chest, arm, or leg. It does not remove the blockages; it bypasses them. The result, when performed well, is a significant and lasting improvement in blood supply to the heart.
The evidence for when CABG is preferred over stenting is substantial. The landmark SYNTAX trial established clearly that patients with complex three-vessel coronary artery disease or left main artery disease had significantly better outcomes – lower rates of death, heart attack, and repeat procedures – with bypass surgery compared to stenting. Diabetic patients with multivessel disease also consistently do better with CABG in long-term follow-up studies.
As a cardiac surgeon in Guwahati with over 25 years of experience and 7,000+ successful heart surgeries, I have operated on patients with triple vessel disease, left main stenosis, failed prior stenting, and complex redo procedures. The decision between stenting and surgery should never be made on the basis of which option is faster or less frightening – it should be made on the basis of what will give you the best outcome over the next 10, 15, 20 years.
For a complete guide to bypass surgery, read our detailed article on bypass surgery in Guwahati.
This is one of the most important and frequently misunderstood distinctions in cardiac care. Cardiologists and cardiac surgeons are different specialists with complementary but distinct roles.
A cardiologist diagnoses heart disease, manages it medically, and performs catheter-based procedures such as angioplasty and stenting. A cardiac surgeon performs open-heart operations – bypass surgery, valve surgery, aortic surgery, and complex reconstructive procedures on the heart.
Many patients with coronary artery disease will be managed entirely by a cardiologist, and that is entirely appropriate. But there are specific clinical situations where a referral to a cardiac surgeon should happen – and where delay in that referral can have serious consequences.
In my 25+ years as a cardiac surgeon – treating patients referred from across Assam, from Manipur, Nagaland, Meghalaya, Tripura, Arunachal Pradesh, and from Bangladesh – I have seen many patients who came to us after months of symptoms being managed without a surgical review. A timely assessment by a cardiac surgeon does not mean surgery is inevitable; it means all options are properly on the table.
For most of the last two decades, a patient in Guwahati – let alone Imphal, Shillong, Kohima, or Agartala – facing complex heart surgery had a painful choice: travel thousands of kilometres to Delhi, Chennai, or Kolkata, or go without.
That has changed.
Tulip Mediworld Superspeciality Hospital, founded by me on GS Road, Guwahati, was built specifically to close this gap. It is not a satellite hospital or a branch of a chain. It is a hospital founded by a cardiac surgeon with a specific regional mission: to ensure that patients in Northeast India have access to the same standard of cardiac care available in any major Indian city.
Patients from across Northeast India – from the hill states, from Brahmaputra valley districts, and yes, from Bangladesh – are now routinely treated here for procedures that once required a week-long journey and the associated financial and emotional burden on families.
In my surgical career, I have had the privilege of holding the hands of more than 7,000 families through the most frightening experience of their lives. “We’ve done this 7,000 times” is not a boast – it is the most reassuring thing I know how to say to a patient sitting in front of me for the first time.
This is one of the questions I hear most often – and it deserves an honest answer rather than false hope or false despair.
Coronary artery disease cannot be fully reversed in the sense of returning arteries to their original, plaque-free state. However, there is very strong evidence – including studies on intensive lifestyle intervention – that progression can be halted and, in some cases, partially reversed. Plaque can stabilise and shrink. Symptoms can dramatically improve. The risk of a heart attack can be meaningfully reduced.
The Mayo Clinic’s guidance on CAD emphasises that lifestyle changes – combined with appropriate medication – are the foundation of treatment for all stages of coronary artery disease. They are not an alternative to medical care; they are an essential part of it.
No – but they are closely related. Coronary artery disease is the underlying condition: the progressive narrowing of coronary arteries by plaque. A heart attack (myocardial infarction) is an event that occurs when a coronary artery becomes completely or near-completely blocked – usually because a piece of unstable plaque ruptures and a blood clot forms on top of it. The result is that a portion of the heart muscle is deprived of blood and begins to die.
You can live with coronary artery disease for years before a heart attack – or have a heart attack as your very first symptom. This is why detection and management before an event occurs is so important.
The rate of progression varies considerably depending on risk factor burden, genetics, and treatment. In patients with poorly controlled diabetes, hypertension, and ongoing smoking, disease can progress rapidly – from mild narrowing to severe blockage over a few years. In patients on optimal medical therapy with good lifestyle control, progression can be very slow.
This variability is why follow-up imaging (repeat CT Coronary Angiogram, stress testing, or repeat invasive angiogram if clinically indicated) is an important part of managing diagnosed CAD, not just a one-time event.
Given the Indian-specific risk profile – earlier onset, genetic susceptibility, high diabetes and hypertension rates – I recommend the following as a general guide, always subject to individual circumstances:
A CT Coronary Angiogram at Tulip Mediworld can provide a definitive baseline picture of your coronary artery health as an outpatient procedure – no admission, no recovery time. For many of our patients, it has been the step that caught disease early enough to change the outcome.
Coronary artery disease is common, serious, and deeply underdiagnosed in Northeast India. But it is also, in most cases, detectable early, manageable well, and – when surgery is needed – treatable with procedures that today carry a far smaller burden than patients fear.
The journey from awareness to diagnosis to treatment does not have to be frightening or uncertain. It starts with understanding your risk factors, taking symptoms seriously rather than explaining them away, and getting evaluated by the right team – early.
If you have read this page because something is worrying you, or because someone you love has just received a diagnosis, please do not wait. An experienced team in Guwahati is ready to see you.
Book a consultation at drapurbasarma.in or call Tulip Mediworld Superspeciality Hospital on 1800 890 4655 (toll-free). We are on GS Road, Rukmini Gaon, Guwahati – here, and ready, for Northeast India.
About the Author
Dr. Apurba Kumar Sarma, MBBS, MS (General Surgery), MCh (CVTS) is a cardiovascular and thoracic surgeon with over 25 years of experience and 7,000+ successful heart surgeries. He is the Founder, Chairman and Managing Director of Tulip Mediworld Superspeciality Hospital, GS Road, Rukmini Gaon, Guwahati, Assam — 781022. He is a Fellow of the Indian Association of Cardiovascular-Thoracic Surgeons and a Life Member of the Indian Medical Association.
This article is for informational purposes only and does not constitute medical advice. Please consult a qualified cardiac surgeon for evaluation and treatment specific to your condition.
