Coronary Heart Disease

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Introduction

Coronary Heart Disease

Coronary heart disease (CHD) is a major cause of death both in the UK and worldwide. CHD is sometimes called ischaemic heart disease.

Symptoms of CHD

The main symptoms of CHD are: 

However, not everyone has the same symptoms and some people may not have any before CHD is diagnosed.

Read about symptoms of coronary heart disease.

Causes of coronary heart disease

Coronary heart disease is the term that describes what happens when your heart's blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries.

Over time, the walls of your arteries can become furred up with fatty deposits. This process is known as atherosclerosis and the fatty deposits are called atheroma.

Atherosclerosis can be caused by lifestyle factors and other conditions, such as:

Read about the causes of coronary heart disease.

Diagnosing coronary heart disease

If your doctor feels you're at risk of CHD, they may carry out a risk assessment. This involves asking about your medical and family history, your lifestyle and taking a blood test.

Further tests may be needed to confirm a diagnosis of CHD, including:

Read about diagnosing coronary heart disease.

Treating coronary heart disease

Coronary heart disease can't be cured but treatment can help manage the symptoms and reduce the chances of problems such as heart attacks.

Treatment can include:

Read about treating coronary heart disease.

Recovering from the effects of CHD

If you have a heart attack or have had angioplasty or heart surgery, it's possible to eventually resume a normal life.

Advice and support is available to help you deal with aspects of your life that may have been affected by CHD.

Read about recovering from the effects of coronary heart disease.

Preventing CHD

You can reduce your risk of getting CHD by making some simple lifestyle changes. These include:

Keeping your heart healthy will also have other health benefits, such as helping reduce your risk of stroke and dementia.

Read about preventing coronary heart disease.

The heart

The heart is a muscle about the size of your fist. It pumps blood around your body and beats approximately 70 times a minute. After the blood leaves the right side of the heart, it goes to your lungs where it picks up oxygen.

The oxygen-rich blood returns to your heart and is then pumped to the body's organs through a network of arteries. The blood returns to your heart through veins before being pumped back to your lungs again. This process is called circulation.

The heart gets its own supply of blood from a network of blood vessels on the heart's surface called coronary arteries.

Symptoms

Symptoms

The most common symptom of coronary heart disease (CHD) is chest pain (angina).

You can also experience other symptoms, such as heart palpitations and unusual breathlessness. Some people may not have any symptoms before they are diagnosed.

Angina

If your coronary arteries become partially blocked, it can cause chest pain (angina).

This can be a mild, uncomfortable feeling similar to indigestion. However, a severe angina attack can cause a painful feeling of heaviness or tightness, usually in the centre of the chest, which may spread to the arms, neck, jaw, back or stomach.

Angina is often triggered by physical activity or stressful situations. Symptoms usually pass in less than 10 minutes, and can be relieved by resting or using a nitrate tablet or spray.

Read more about treating angina.

Heart attacks

If your arteries become completely blocked, it can cause a heart attack (myocardial infarction).

Heart attacks can permanently damage the heart muscle and, if not treated straight away, can be fatal.

Dial 999 for immediate medical assistance if you think you're having a heart attack.

Although symptoms can vary, the discomfort or pain of a heart attack is usually similar to that of angina. However, it's often more severe and may happen when you're resting.

During a heart attack, you may also experience the following symptoms:

  • pain in other parts of the body - it can feel as if the pain is travelling from your chest to your arms, jaw, neck, back and abdomen
  • lightheadedness
  • sweating
  • nausea
  • breathlessness

The symptoms of a heart attack can also be similar to indigestion. For example, they may include a feeling of heaviness in your chest, a stomach ache or heartburn.

A heart attack can occur at any time, including while you're resting. If heart pains last longer than 15 minutes, it may be the start of a heart attack.

Unlike angina, the symptoms of a heart attack aren't usually relieved using a nitrate tablet or spray.

In some cases, a heart attack can occur without any symptoms. This is known as a silent myocardial infarction and is more common in elderly people and people with diabetes.

Heart failure

Heart failure can also occur in people with CHD when the heart becomes too weak to pump blood around the body. This can cause fluid to build up in the lungs, making it increasingly difficult to breathe.

Heart failure can occur suddenly (acute heart failure) or gradually over time (chronic heart failure).

What to do if someone has a heart attack

When someone has a heart attack, a bystander - often a relative with no medical expertise - is usually the first on the scene.

However, less than 1% of the population have attended an emergency life support course.

Heartstart (funded by the British Heart Foundation), British Red Cross and St John Ambulance can teach you how to help someone having a heart attack.

Causes

Causes

Coronary heart disease (CHD) is usually caused by a build-up of fatty deposits (atheroma) on the walls of the arteries around the heart (coronary arteries).

The build-up of atheroma makes the arteries narrower, restricting the flow of blood to the heart muscle. This process is called atherosclerosis.

Your risk of developing atherosclerosis is significantly increased if you:

Other risk factors for developing atherosclerosis include:

  • being obese or overweight
  • having a family history of CHD - the risk is increased if you have a male relative under the age of 55, or a female relative under 65, with CHD 

High cholesterol

Cholesterol is a fat made by the liver from the saturated fat in your diet.

It's essential for healthy cells, but too much in the blood can lead to CHD.

Read more about high cholesterol. 

High blood pressure

High blood pressure (hypertension) puts a strain on your heart and can lead to CHD.

Read more about high blood pressure.

Blood Pressure UK have also produced a useful guide explaining high, low and normal blood pressure readings.   

Smoking

Smoking is a major risk factor for coronary heart disease. Both nicotine and carbon monoxide (from the smoke) put a strain on the heart by making it work faster. They also increase your risk of blood clots.

Other chemicals in cigarette smoke can damage the lining of your coronary arteries, leading to furring of the arteries. If you smoke, you increase your risk of developing heart disease by 24%.

Read about how to stop smoking and stop smoking treatments.

Diabetes

A high blood sugar level may lead to diabetes, which can more than double your risk of developing CHD.

Diabetes can lead to CHD because it may cause the lining of blood vessels to become thicker, which can restrict blood flow.

Thrombosis

A thrombosis is a blood clot in a vein or artery.

If a thrombosis occurs in a coronary artery it prevents the blood supply from reaching the heart muscle. This usually leads to a heart attack.

Diagnosis

Diagnosis

Coronary heart disease (CHD) is usually diagnosed after a risk assessment and some further tests.

Risk assessment

If your doctor thinks you may be at risk of CHD, they may carry out a risk assessment for cardiovascular disease, heart attack or stroke

This may be carried out as part of an NHS Health Check.

Your doctor will:

  • ask about your medical and family history
  • check your blood pressure
  • do a blood test to assess your cholesterol level

Before having the cholesterol test, you may be asked not to eat for 12 hours so there is no food in your body that could affect the result.

Your GP or practice nurse can carry out the blood test. A sample will be taken either using a needle and a syringe or by pricking your finger.

Your GP will also ask about your lifestyle, how much exercise you do and whether you smoke. All these factors will be considered as part of the diagnosis.

Further tests

To confirm a suspected diagnosis, you may be referred for more tests. A number of different tests are used to diagnose heart-related problems, including:

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Treatment

Treatment

Lifestyle changes

If you've been diagnosed with CHD, you can reduce your risk of further episodes by making simple lifestyle changes.

For example, stopping smoking after a heart attack quickly reduces your risk of having a heart attack in the future to near that of a non-smoker.

Other lifestyle changes, such as eating more healthily and doing regular exercise, will also reduce your future risk of heart disease.

Read more about preventing CHD.

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Medicines

Many different medicines are used to treat CHD. Usually they either aim to reduce blood pressure or widen your arteries.

Some heart medicines have side effects, so it may take a while to find one that works for you. Your GP or specialist will discuss the various options with you.

Heart medicines should not be stopped suddenly without the advice of your doctor as there is a risk this may make your symptoms worse.

Antiplatelets

Antiplatelets are a type of medicine that can help reduce the risk of a heart attack by thinning your blood and preventing it clotting.

Common antiplatelet medicines include:

Statins

If you have a high cholesterol level, cholesterol-lowering medicine called statins may be prescribed. Examples include:

  • atorvastatin
  • simvastatin
  • rosuvastatin
  • pravastatin

Statins work by blocking the formation of cholesterol and increasing the number of  low density lipoprotein (LDL) receptors in the liver. This helps remove LDL cholesterol from your blood, which makes a heart attack less likely. 

Not all statins are suitable for everyone, so you may need to try several different types until you find one that is suitable.

Beta-blockers

Beta-blockers - including atenolol, bisoprolol, metoprolol and nebivolol - are often used to prevent angina and treat high blood pressure.

They work by blocking the effects of a particular hormone in the body, which slows down your heartbeat and improves blood flow.

Nitrates

Nitrates are used to widen your blood vessels. Doctors sometimes refer to nitrates as vasodilators. They're available in a variety of forms, including tablets, sprays and skin patches such as glyceryl trinitrate and isosorbide mononitrate.

Nitrates work by relaxing your blood vessels, letting more blood pass through them. This lowers your blood pressure and relieves any heart pain you have. Nitrates can have some mild side effects, including headaches, dizziness and flushed skin.

ACE (angiotensin-converting enzyme) inhibitors

ACE inhibitors are commonly used to treat high blood pressure. Examples include ramipril and lisinopril. They block the activity of a hormone called angiotensin II, which causes the blood vessels to narrow.

As well as stopping the heart working so hard, ACE inhibitors improve the flow of blood around the body. 

Your blood pressure will be monitored while you're taking ACE inhibitors, and regular blood tests will be needed to check that your kidneys are working properly. Around one in ten people have kidney problems as a result of taking the drug.

Side effects of ACE inhibitors can include a dry cough and dizziness.

Angiotensin II receptor antagonists

Angiotensin II receptor antagonists work in a similar way to ACE inhibitors. They are used to lower your blood pressure by blocking angiotensin II.

Mild dizziness is usually the only side effect. They're often prescribed as an alternative to ACE inhibitors, as they don't cause a dry cough.

Calcium channel blockers

Calcium channel blockers also work to decrease blood pressure by relaxing the muscles that make up the walls of your arteries. This causes the arteries to become wider, reducing your blood pressure.

Examples include amlodipine, verapamil and diltiazem. Side effects include headaches and facial flushing, but these are mild and usually decrease over time.

Diuretics

Sometimes known as water pills, diuretics work by flushing excess water and salt from the body through urine.

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Procedures and surgery

If your blood vessels are narrow as the result of a build-up of atheroma (fatty deposits) or if your symptoms can't be controlled using medication, interventional procedures or surgery may be needed to open up or bypass blocked arteries.

Some of the main procedures used to treat blocked arteries are outlined below.

Coronary angioplasty

Coronary angioplasty is also known as percutaneous coronary intervention (PCI), percutaneous transluminal coronary angioplasty (PTCA), or balloon angioplasty.

Angioplasty may be a planned procedure for some people with angina, or an urgent treatment if the symptoms have become unstable.

Having a coronary angiogram will determine if you're suitable for treatment. Coronary angioplasty is also performed as an emergency treatment during a heart attack.

During angioplasty, a small balloon is inserted to push the fatty tissue in the narrowed artery outwards. This allows the blood to flow more easily. A metal stent (a wire mesh tube) is usually placed in the artery to hold it open. Drug-eluting stents can also be used. These release drugs to stop the artery narrowing again.

Coronary artery bypass graft

Coronary artery bypass grafting (CABG) is also known as bypass surgery, a heart bypass, or coronary artery bypass surgery.

It's performed in patients where the arteries become narrowed or blocked. A coronary angiogram will determine if you're suitable for treatment. Off-pump coronary artery bypass (OPCAB) is a type of coronary artery bypass surgery. It's performed while the heart continues to pump blood by itself without the need for a heart-lung machine.

A blood vessel is inserted (grafted) between the aorta (the main artery leaving the heart) and a part of the coronary artery beyond the narrowed or blocked area. Sometimes one of your own arteries that supplies blood to the chest wall is used and diverted to one of the heart arteries. This allows the blood to bypass (get around) the narrowed sections of coronary arteries.

Heart transplant

In a small number of cases, when the heart is severely damaged and medicine is not effective, or when the heart becomes unable to adequately pump blood around the body (heart failure), a heart transplant may be needed.

A heart transplant involves replacing a heart that is damaged or is not working properly with a healthy donor heart. 

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Recovery

Recovery

After having heart surgery or problems like a heart attack, it's possible to resume a normal life.

Cardiac rehabilitation programme

If you have heart surgery, a member of the cardiac rehabilitation team may visit you in hospital to give you information about your condition and the procedure you're having.

This care will usually continue after you've left hospital. For the first few weeks after your surgery, a member of the cardiac rehabilitation team may visit you at home or call you to check on your progress.

What happens in cardiac rehabilitation programmes can vary widely throughout the country, but most will cover the following basic areas:

  • exercise
  • education
  • relaxation and emotional support

Once you have completed your rehabilitation programme, it's important you continue to take regular exercise and lead a healthy lifestyle. This will help protect your heart and reduce the risk of further heart-related problems.

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Self care

Self care is an integral part of daily life, and is all about you taking responsibility for your own health and wellbeing with the support of those involved in your care.

Self care includes actions you take for yourself every day so you stay fit and maintain good physical and mental health. It also helps you to prevent illness or accidents and care more effectively for minor ailments and long-term conditions.

People living with long-term conditions can benefit enormously from being supported so they can achieve self care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life, and be more active and independent.

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Support groups

If you have a heart condition, or if you're caring for someone with a heart condition, you might find it useful to meet other people in your area who are in a similar situation.

There are a number of heart support groups around the UK that organise regular exercise sessions, such as walking groups, as well as other social activities. Your GP or specialist can provide you with details about your nearest group.

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Relationships and sex

Coming to terms with a long-term condition such as heart disease can put a strain on you, your family and your friends. It can be difficult to talk to people about your condition, even if they're close to you.

Be open about how you feel and let your family and friends know what they can do to help. But don't feel shy about telling them you need some time to yourself.

Your sex life

If you have coronary heart disease (CHD) or you've recently had heart surgery, you may be concerned about having sex. Usually, you can resume sexual activity as soon as you feel well enough.

Communicate with your partner and stay open-minded. Explore what you both like sexually. Simply touching, being touched and being close to someone helps a person feel loved and special.

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Returning to work

After recovering from heart surgery, you should be able to return to work, but it may be necessary to change the type of work you do. For example, you may not be able to do a job that involves heavy physical exertion.

Your specialist will be able to advise you about when you can return to work and what type of activities you should avoid.

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Financial support

If you're unable to work after having heart surgery, you may be entitled to financial support, such as:

If you're caring for someone who has heart disease, you may also be entitled to financial support.

To find out if you're entitled to financial support, you can contact your local Social Security department. To request a claim form, contact the Disability Service Centre.

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Prevention

Prevention

There are several ways you can help reduce your risk of developing coronary heart disease (CHD), such as lowering your blood pressure and cholesterol levels.

There are a number of ways you can do this, which are discussed below.

Eat a healthy, balanced diet

A low-fat, high-fibre diet is recommended, which should include plenty of fresh fruit and vegetables (five portions a day) and whole grains.

You should limit the amount of salt you eat to no more than 6g (0.2oz) a day as too much salt will increase your blood pressure. 6g of salt is about one teaspoonful.

There are two types of fat: saturated and unsaturated. You should avoid food containing saturated fats, because these will increase the levels of bad cholesterol in your blood.

Foods high in saturated fat include:

  • meat pies 
  • sausages and fatty cuts of meat 
  • butter 
  • ghee a type of butter often used in Indian cooking 
  • lard 
  • cream 
  • hard cheese 
  • cakes and biscuits 
  • foods that contain coconut or palm oil

However, a balanced diet should still include unsaturated fats, which have been shown to increase levels of good cholesterol and help reduce any blockage in your arteries.

Foods high in unsaturated fat include:

  • oily fish 
  • avocados 
  • nuts and seeds 
  • sunflower, rapeseed, olive and vegetable oils

You should also try to avoid too much sugar in your diet, as this can increase your chances of developing diabetes, which is proven to dramatically increase your chances of developing CHD.

Read more about:

Be more physically active

Combining a healthy diet with regular exercise is the best way of maintaining a healthy weight. Having a healthy weight reduces your chances of developing high blood pressure.

Regular exercise will make your heart and blood circulatory system more efficient, lower your cholesterol level, and also keep your blood pressure at a healthy level.

Read more about fitness and exercise.

Keep to a healthy weight

Your GP or practice nurse can tell you what your ideal weight is in relation to your height and build. Alternatively, find out what your body mass index (BMI) is by using our BMI calculator.

Read more about losing weight.

Give up smoking

If you smoke, giving up will reduce your risk of developing CHD.

Smoking is a major risk factor for developing atherosclerosis (furring of the arteries). It also causes the majority of cases of coronary thrombosis in people under the age of 50.

Research has shown you're up to four times more likely to successfully give up smoking if you use NHS support together with stop-smoking medicines, such as patches or gum.

Ask your doctor about this or visit NHS Smokefree.

Read more about stopping smoking.

Reduce your alcohol consumption

If you drink, don't exceed the maximum recommended limits.

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over three days or more if you drink as much as 14 units a week

Always avoid binge drinking, as this increases the risk of a heart attack.

Read more about drinking and alcohol.

Keep your blood pressure under control

You can keep your blood pressure under control by eating a healthy diet low in saturated fat, exercising regularly and, if required, taking the appropriate medication to lower your blood pressure.

Your target blood pressure should be below 140/85mmHg. If you have high blood pressure, ask your GP to check your blood pressure regularly.

Read more about high blood pressure.

Keep your diabetes under control

You have a greater risk of developing CHD if you are diabetic. If you have diabetes, being physically active and controlling your weight and blood pressure will help manage your blood sugar level.

If you're diabetic, your target blood pressure level should be below 130/80mmHg.

Read more about diabetes.

Take any prescribed medication

If you have CHD, you may be prescribed medication to help relieve your symptoms and stop further problems developing.

If you don't have CHD but have high cholesterol, high blood pressure or a history of family heart disease, your doctor may prescribe medication to prevent you developing heart-related problems.

If you're prescribed medication, it's vital you take it and follow the correct dosage. Don't stop taking your medication without consulting your doctor first, as doing so is likely to make your symptoms worse and put your health at risk.

'My heart was racing... the pain was awful'

'My heart was racing... the pain was awful'

After a heart attack, 36-year-old Debbie Siddons was too scared to pick up her 18-month-old baby. Rehabilitation helped her move on with her life.

It was the usual rush in the Siddons household as Debbie raced around getting her four children ready for school. But as she strode into the living room to summon her eldest, she was suddenly stopped in her tracks by a sharp pain in her chest.

"My heart was racing, the pain was awful, and I had pins and needles in my lower jaw and down both arms," she says. "I sat down on the sofa hoping the pain would stop, but it didn't. I knew something was very wrong. I was on my own with the kids, so I got my eldest to bring me the phone. I called my mother-in-law and my father and told them I didn't feel very well. My dad was over in 10 minutes. He took one look at me and called an ambulance."

In the ambulance, paramedics gave Debbie an electrocardiogram (ECG) to test the electrical activity in her heart. She was then given an aspirin to chew. Once she got to the hospital, doctors gave her a drug to dissolve any clots in her blood that might have caused the heart attack.

"I knew it was serious, but I didn't guess how serious," she remembers. "When I got to the hospital, it was madness. Everyone was rushing around, hooking me up to machines. It didn't take the doctor long to tell me I'd suffered a heart attack. It didn't quite sink in until my mother-in-law got to the hospital and I had to tell her what had happened to me."

Debbie stayed in hospital for a week. On the sixth day, she began to experience pins and needles in her left arm. Doctors were concerned that she might be having another heart attack. As a precaution, she was given another ECG and sent for an angiogram, a procedure that checks the arteries for blockages. The angiogram was clear and Debbie didn't have another attack. The cause of her original attack is still unknown.

Back at home, she realised how much the experience had shaken her. "I was frightened to do anything. I was nervous about going up the stairs, and I was too scared to pick up my 18-month-old daughter in case I had another heart attack," she says.

"Then I was sent for rehabilitation, which really helped. We learned about healthy eating and exercise, but a big part of it was finding the confidence to carry on with our lives. The nurses reassured me that I could live a perfectly normal life again and they were right. By the end of the six-week course, I'd got my confidence back."

Two years on, Debbie still takes several drugs every day, including aspirin and a statin, to help prevent another attack. She sees a consultant once a year. But so far she hasn't had another heart attack. "It was a very frightening experience, but I came through it," she says. "I'd urge anyone who's had one to make the most of rehabilitation and use all the help they can get. It certainly helped me to move on."

'I try to go to the gym once or twice a week for a workout'

'I try to go to the gym once or twice a week for a workout'

Actor Rudolph Walker is a far cry from Patrick Trueman, the rum-swilling, fry-up-eating character he plays in EastEnders. In real life, he takes great care to ensure his heart stays in tip-top condition.

Rudolph's star tips for a healthy heart:

1. Eat well

"I eat lots of fish and fresh vegetables, and only occasionally have red meat. I resist the temptation of the stodgy food on the EastEnders set by bringing in my own meals, such as vegetable soup."

2. Get active

"I love playing tennis and cricket. But I don't always get the chance, so I try to go to the gym once or twice a week for a cardiovascular workout on the running machine."

3. Stop smoking

"I'm lucky - I've never smoked, even as a young man. I know it is hard for people to give up, but it is so important."

4. Go easy on the alcohol

"I hardly drink - just the odd glass of wine. Drinking is fine, but only in moderation."

5. Get checked out

"Every man over the age of 50 should have regular check-ups. I have one every six months to make sure everything is in working order, particularly my blood pressure and cholesterol levels."

 

'I felt like I'd been kicked in the chest'

'I felt like I'd been kicked in the chest'

A quick diagnosis and emergency treatment saved Lynn Connor's life. She shares her story:

"I'd just got back from holiday in Cyprus and was feeling on top of the world. I had given all the grandchildren their presents when I suddenly felt like I was being kicked in the chest by a horse. I knew I had to get to a doctor quickly.

"My GP knew immediately I was having a heart attack and called an ambulance. I was lucky that I was given lifesaving clot-busting drugs by the paramedics on the way to the hospital. That same night I was given an angioplasty, where a sort of balloon is put into your coronary artery to open it up. Five stents [which are like a stainless steel mesh] were then inserted to hold the artery open.

"Nobody knows what caused the attack, but my dad died of one when he was 66. Some people say it was because I smoked 20 cigarettes a day for 40 years. It could have been stress - my granddaughter had been diagnosed with cancer the same year. I believe it was probably a combination of things.

"After the operation, walking just 10 yards would totally wipe me out. Even eating was exhausting. But after a while I went on a cardiac rehabilitation programme. It starts off very gently. First I did warm-up exercises, then I progressed to step-ups and the cycling machine, until finally I could go on the treadmill. I couldn't have done any of this without the help of my cardiac nurse, Lou, who was brilliant and very reassuring.

"I've always eaten a pretty healthy diet, but now I exercise more than I used to. I love swimming and I try to go every day, and I've given up smoking.

"I feel incredibly happy that I'm alive. Everyone else I've known who had a heart attack has died, but now I know that there can be life after a heart attack."