Doctor Explains Why Triple Vessel Disease Often Has No Warning Signs

Dr. Supharuk Wicharanyan, known as Doctor Oak on the DoctorSixpack page, explains why triple-vessel coronary artery disease occurs and why many people have no warning symptoms until the disease is severe.

Using a recent case to educate the public, he describes what triple-vessel disease means. The heart works 24 hours a day and requires constant blood and oxygen supply through coronary arteries. When we say "coronary artery disease," we usually mean atherosclerosis, the buildup of plaque inside artery walls. "Triple-vessel disease" refers to significant narrowing found in all three main coronary artery territories, considered a severe form requiring specialist evaluation.

Contrary to what many believe, coronary disease does not appear suddenly. It accumulates silently over decades. The arteries start smooth and open, but risk factors like high LDL cholesterol, high blood pressure, diabetes, smoking, abdominal obesity, sedentary lifestyle, advancing age, and family history accelerate atherosclerosis.

The process begins when LDL particles deposit in artery walls, triggering inflammation. White blood cells called macrophages consume the fat and become foam cells. As this cycle repeats, fat accumulates, inflammation spreads, plaques form, and calcium deposits harden the artery walls. Blood flow gradually decreases, starving the heart muscle of oxygen—this is myocardial ischemia.

More dangerously, plaques can rupture, triggering sudden blood clot formation. If a clot blocks a coronary artery completely, the heart muscle dies from oxygen deprivation. This is a heart attack, which can cause irregular heartbeats, heart failure, cardiac arrest, or sudden death.

This is why coronary artery disease should not be ignored until symptoms appear. The post addresses why some people with severe narrowing have almost no symptoms.