Coronary Heart Disease

Overview

Coronary heart disease (CHD) means the blood vessels that feed your heart muscle have become narrowed or blocked. These vessels are called the coronary arteries. Over many years, fatty material called plaque builds up inside their walls. This process is called atherosclerosis (say: ath-er-oh-skluh-ROH-sis). Narrow arteries carry less blood and oxygen to your heart muscle, which can cause chest pain or tightness, especially when you are active. If an artery becomes completely blocked, it can cause a heart attack.

Yes, it is very common. Coronary heart disease is one of the leading causes of death worldwide and a frequent reason people see their GP or go to hospital. It becomes more common as people get older.

Anyone can develop it, but it is more common in older adults and in men, who tend to develop it earlier than women. In women, risk rises after the menopause. It is also more common in people of South Asian heritage, and in people with diabetes, high blood pressure, high cholesterol or a strong family history of early heart disease. Smoking, an unhealthy diet and being inactive all raise the risk, whatever your background.

Symptoms

Common symptoms

• Chest pain or tightness, often felt as pressure or heaviness behind the breastbone — this is called angina. It usually comes on with exercise, cold weather, stress or after a big meal, and eases with rest.
• Pain spreading to the arm (often the left arm), neck, jaw, shoulder, back or stomach.
• Shortness of breath, especially when active or when lying flat.
• Feeling dizzy, lightheaded or unusually tired.
• A fluttering or pounding feeling in the chest (palpitations).
• Some people have no symptoms at all until they have a heart attack — this is called silent CHD.

Symptoms in children

• Coronary heart disease is very rare in children. Heart problems in children are usually heart defects present from birth, not CHD.
• A small number of children inherit very high cholesterol from a parent — this is called familial hypercholesterolaemia. It can lead to early heart disease, so finding and treating it early matters.
• If a child in your family has a parent or sibling with very high cholesterol or early heart disease, mention it to your doctor, as simple tests may be offered.

Symptoms in older adults

• Older adults may not get classic crushing chest pain. They may instead feel very tired, breathless on mild effort, dizzy, or even confused.
• Symptoms are sometimes blamed on getting older, which can delay diagnosis. Any new or worsening breathlessness or tiredness is worth mentioning to your doctor.
• Chest pain may feel milder but still needs checking, because older adults are more likely to have other conditions too.

Causes

Main causes

• The main cause is atherosclerosis — the slow build-up of fatty plaque inside the coronary arteries, which narrows and stiffens them.
• The inner lining of the arteries can become damaged by smoking, high blood pressure, high cholesterol and high blood sugar, making plaque more likely to form.
• If a plaque cracks or tears, a blood clot can form on top of it and block the artery — this is what usually causes a heart attack.
• In rare cases, the arteries can be affected by spasm or by inflammatory conditions.

Risk factors

• Smoking or using tobacco.
• High blood pressure.
• High cholesterol, especially high LDL ('bad') cholesterol.
• Type 1 or type 2 diabetes.
• Being overweight, especially around the waist.
• Not being physically active.
• A diet high in salt, saturated fat and processed foods, and low in fruit and vegetables.
• Drinking too much alcohol.
• A family history of early heart disease (for example, a parent or sibling affected before around age 60).
• Getting older, and being male or a woman past the menopause.
• South Asian heritage.
• Long-term stress, poor sleep and depression, which can affect heart health indirectly.
• Some medical conditions, such as kidney disease or inflammatory conditions like rheumatoid arthritis.

When to see a doctor

See a doctor urgently if:

• Call your local emergency number for chest pain that lasts more than a few minutes, or chest pain with sweating, sickness, breathlessness or fainting.
• Contact your doctor the same day if you have new chest pain, chest pain at rest, or a sudden change in your usual pattern of symptoms.
• Get urgent advice for a fast or irregular heartbeat that does not settle, or for new swelling in your legs and breathlessness.

Book a routine appointment if:

• Make a routine appointment if you have a family history of early heart disease, high cholesterol or a heart attack in a close relative.
• Book a check if you have diabetes, high blood pressure or kidney disease, as your heart risk should be reviewed regularly.
• See your doctor if you feel more tired, breathless or less able to manage your usual activities than before.
• Ask about a heart health check if you are over 40, or sooner if you have several risk factors — in the UK, the NHS Health Check is offered to adults aged 40 to 74.
• Speak to your GP if you would like help to stop smoking, lose weight or become more active.

Diagnosis

Your doctor will start by asking about your symptoms — when they happen, what brings them on and what relieves them — and about your medical history, family history and lifestyle. They will check your blood pressure, weight and pulse, and may listen to your heart. Blood tests and a heart tracing (ECG) are usually the next step. If CHD is suspected, you may be referred to a heart specialist for further tests. Not everyone needs every test; your doctor will choose based on your symptoms and risk.

Tests that may be done

• Blood tests to check cholesterol, blood sugar and how well your kidneys, liver and thyroid are working.
• An electrocardiogram (ECG) — sticky patches on your chest record the electrical activity of your heart. It is quick and painless.
• An ambulatory ECG — a small portable monitor you wear for a day or more to catch an irregular rhythm.
• An echocardiogram — a painless ultrasound scan that shows your heart's shape and how well it pumps.
• An exercise stress test — you walk or cycle while your heart is monitored, to see how it copes with effort.
• A CT coronary angiogram — a detailed scan that shows whether the arteries are narrowed.
• A coronary angiogram — a thin tube is passed through a blood vessel, usually in the wrist or groin, and dye is used to take X-ray pictures of the arteries. This can be done as a day case or with an overnight stay.
• A heart MRI or other imaging, in some cases.

What to expect at your appointment

Being tested for heart disease can feel worrying. Most tests are quick and painless, and staff will explain each step. Some results come back the same day; others take a week or two. You are usually encouraged to bring someone with you. If a test shows narrowing, your team will talk you through what it means and what options you have — you do not have to decide anything on the spot.

Treatment

Coronary heart disease cannot be cured, but it can be managed very well. Treatment has three parts: healthy daily habits, medicines to protect your heart and relieve symptoms, and sometimes a procedure to improve blood flow. The aim is to help you feel better, stay active and lower your chance of a heart attack.

Self-care at home

• Stop smoking — this is the single biggest change you can make for your heart. Ask your GP or pharmacist for support; nicotine replacement and stop-smoking services greatly increase your chances of success.
• Take your medicines every day as prescribed, even when you feel well, and ask your pharmacist before taking any new over-the-counter remedy.
• Keep active within the limits your doctor advises — walking, swimming and cycling are good choices.
• Eat a heart-healthy diet and keep an eye on portion sizes.
• Keep alcohol within the recommended limits and avoid binge drinking.
• Aim for a healthy weight and waist size.
• Attend your review appointments, and know your blood pressure, cholesterol and blood sugar numbers.
• Learn to pace yourself and rest when chest pain comes on. If your doctor gives you a spray or tablet for chest pain, ask them to show you exactly when and how to use it.
• Get help with sleep, stress and low mood if these are affecting you.

Medical treatments

Most people with CHD are offered a combination of daily medicines. Different types do different jobs: some lower cholesterol, some lower blood pressure, some make the heart work more gently and reduce chest pain, and some make the blood less likely to form harmful clots. Your doctor will explain why each one has been chosen and will review them regularly. Never stop a heart medicine suddenly without speaking to your doctor or pharmacist first, as this can be risky. Your GP practice nurse can often help with repeat prescriptions and checks.

When is surgery considered?

Some people need a procedure to improve blood flow. The most common is angioplasty: a tiny balloon is inflated inside the narrowed artery and a small mesh tube called a stent is left in place to hold it open. Another option is a coronary artery bypass, where a blood vessel taken from the arm, leg or chest is used to route blood around a blocked section. These procedures can greatly improve symptoms, but they do not cure CHD — healthy habits and medicines still matter afterwards. Your heart team will discuss the risks and benefits with you, and the choice is yours.

Living with this condition

Life with CHD usually settles into a routine. Many people take a few tablets a day, go for regular check-ups and learn to recognise what their body is telling them. It helps to know your own pattern — what brings on chest pain, what eases it, and when to seek help. Keep a list of your medicines and bring it to appointments. Tell family or friends what to do if you ever feel unwell, and keep your emergency number handy.

Lifestyle tips

• Stay smoke-free. Ask for help rather than going it alone.
• Build activity into your day — a brisk walk, gardening, or a class you enjoy. Aim for something most days if you can.
• Eat more vegetables, fruit, wholegrains, beans, nuts and oily fish, and cut back on salt, processed meat and fried food.
• Limit alcohol and avoid heavy drinking sessions.
• Keep to a healthy weight and try to reduce belly fat.
• Look after your sleep and find ways to manage stress, such as breathing exercises, hobbies, or talking to someone.
• Have your blood pressure and cholesterol checked as often as your team advises.
• Attend a cardiac rehabilitation programme if one is offered — it combines supervised exercise, education and support, and people who go tend to feel better and stay well longer.

Diet and exercise

A heart-healthy way of eating is simply a balanced one: plenty of vegetables and fruit, wholegrain bread and cereals, beans and lentils, nuts, and oily fish such as salmon or mackerel once or twice a week. Choose olive or rapeseed oil, and cut down on salt, sugary drinks and processed foods. Small swaps add up. For activity, aim for about 150 minutes of moderate exercise a week — enough to make you slightly warm and breathless but still able to talk. If you have chest pain on effort, tell your doctor before starting something new, and build up gradually. Warm up, cool down, and stop if you get chest pain, severe breathlessness or dizziness.

Mental health and emotional wellbeing

It is very normal to feel anxious or low after a heart diagnosis. Some people worry about every twinge, feel angry, or lose confidence. These feelings are common and treatable, and talking about them is a sign of strength, not weakness. Tell your GP, cardiac team or nurse how you are feeling — talking therapies, support groups and sometimes medicines can help a great deal. If you ever feel you cannot cope, or have thoughts of harming yourself, contact your local emergency number or a crisis support service in your country straight away.

Prevention

Largely, yes. Coronary heart disease is not caused by bad luck alone — a big share of the risk comes from things you can change. Stopping smoking, eating well, staying active, keeping to a healthy weight, limiting alcohol and taking medicines for high blood pressure or cholesterol when they are prescribed can greatly reduce your risk. Even if you already have CHD, these same steps slow it down and lower your chance of a heart attack.

Vaccines

People with heart conditions are usually advised to have a flu vaccine each year, because infections like flu can put extra strain on the heart. Ask your GP or pharmacist whether you are eligible for a flu vaccine or any other recommended vaccines where you live.

Screening programmes

There is no single screening test for coronary heart disease, but your risk can be estimated with a heart health check. In the UK, the NHS Health Check is offered every five years to adults aged 40 to 74 and includes blood pressure, cholesterol and a risk score. Wherever you live, ask your doctor about a heart risk assessment if you are over 40, have a family history of early heart disease, or have diabetes, high blood pressure or kidney disease. High cholesterol that runs in families can be found with a simple blood test, so relatives of someone affected should ask about it.

Complications

If left untreated

• Heart attack — when a coronary artery becomes completely blocked and part of the heart muscle is damaged. This is a medical emergency.
• Heart failure — the heart becomes too weak or stiff to pump blood efficiently, causing breathlessness and swelling.
• Irregular heart rhythms, which can cause palpitations, dizziness or fainting.
• Cardiac arrest — the heart suddenly stops beating. This is life-threatening and needs immediate cardiopulmonary resuscitation (CPR) and emergency help.
• Worsening angina, which can limit everyday activities and independence.
• Anxiety and low mood, which are common alongside heart disease and deserve their own care.

Long-term outlook

The outlook for people with coronary heart disease today is much better than it used to be. With treatment and healthy habits, many people live for decades and continue to work, travel and enjoy their families. It is a serious condition and it does need looking after, but a diagnosis is not the end of an active life — it is often the start of getting the right care and support. Your doctor can help you understand what your own outlook looks like and what steps will help most.

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