Coronary heart disease

Coronary heart disease is when:

• Fats and other substances circulating in your blood stick together in clumps in the walls of arteries – this is called atheroma
• Arteries become narrow overtime as atheroma builds up
• This restricts the supply of oxygen-rich blood that your heart needs to beat properly – you might get painful angina attacks

Sometimes, pieces of the atheroma break off and form a blood clot or thrombosis causing a heart attack or a stroke.

Sudden pain in your chest can be a symptom of a life-threatening condition such as a heart attack. If you notice any of the following symptoms, call 999 immediately:

• Chest pain that spreads to your arms, back, neck or jaw
• Chest pain that lasts more than 15 minutes
• Your chest feels heavy or tight
• Shortness of breath
• Sweating
• Nausea and/or vomiting

It’s vital that the cause of your chest pain is diagnosed and treated as soon as possible.

You may not notice any symptoms of coronary heart disease. However, you may notice angina symptoms of breathlessness, or pressure on your chest during physical exertion.

However, if you think you’re at risk it’s important to see your GP or doctor for a risk assessment to assess the possibility of developing angina, a heart attack, heart valve disease or a stroke.

Your GP will carry out a risk assessment and will ask you about:

• Your medical history
• Any family history of heart disease
• Your diet and lifestyle

They may carry out these tests:

• Blood pressure test
• Cholesterol test

If your doctor suspects coronary heart disease they’ll refer you for other tests. These may include:

• An echocardiogram – a scan to look at the structures of your heart
• Blood tests – to check for signs of heart problems
• Cardiac CT or MRI scan – to provide a detailed view of your heart
• Chest X-ray – to look for lung conditions
• Electrocardiogram (ECG) – to measure your heart’s rhythm and electrical activity
• Coronary angiogram – a special fluid is inserted into the heart using a long catheter inserted through an artery, which then shows the heart’s function on a series of X-rays
• Radionuclide tests – using contrast agents to see the structure of your heart more clearly

You may also be referred to a cardiologist – a doctor specialising in the heart and circulatory system.

Coronary heart disease is more likely as you get older, but it’s often manageable with lifestyle changes or treatment.

There are certain health conditions that increase your risk of developing coronary heart disease. These are:

• High blood pressure
• High blood cholesterol
• Diabetes
• Certain heart conditions, such as atrial fibrillation
• Other health conditions such as rheumatoid arthritis, kidney disease and gum infections (periodontitis)

However, lifestyle choices can increase your risk. You’re more likely to have coronary heart disease if you:

• Smoke
• Don’t exercise enough
• Drink too much alcohol
• Are obese
• Eat an unhealthy, high fat diet

Other factors that increase your risk, but you can’t control are:

• A family history of heart disease
• If you’re of Asian ethnicity
• If you’re male, although women are just as likely to get coronary heart disease over 75 years

You can reduce your risk of a heart attack or a stroke by:

• Exercising
• Losing weight
• Healthy eating
• Stopping smoking

You may be prescribed medications, such as:

• Antiplatelets to reduce clotting
• Statins to lower cholesterol
• Medicines to regulate heart rate, blood pressure and blood flow, including beta blockers, Nitrates, ACE inhibitors, Angiotensin II receptor antagonists, calcium channel blockers and diuretics

Surgery for coronary heart disease

• Coronary angioplasty – to remove the atheroma using a small wire with a balloon on the end which is fed into the artery (sometimes a mesh tube, called a stent, is placed in the artery afterwards to hold it open)
• Coronary artery bypass graft (CABG), or heart bypass – for more serious blockages, where an artery from another part of your body is used to redirect the blood flow from the blocked artery to your heart muscle
• Bariatric (weight loss) surgery – If you need to lose a lot of weight, your GP may consider whether obesity surgery, such as a gastric sleeve, might help