Coronary heart disease

Published by Bupa's Health Information Team, May 2010.

This factsheet is for people who have coronary heart disease, or who would like information about it.

Coronary heart disease is due to fatty deposits building up on the walls of the arteries to the heart. It causes angina, which is chest pain.

In the UK, more people die from coronary heart disease than from any other cause

How atherosclerosis develops

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About coronary heart disease

Your heart is a pump that circulates blood to your lungs and the rest of your body. The surface of your heart is covered with blood vessels called coronary arteries, which supply your heart muscle with blood.

Coronary heart disease happens when fatty deposits build up on the walls of your coronary arteries. This is known as atherosclerosis.

In atherosclerosis, fat and cholesterol in your blood builds up on your artery walls, forming a plaque or atheroma. The plaque can prevent your heart muscle from getting the blood supply it needs. Because of the reduced blood flow and the rough edges of the plaque, a blood clot sometimes forms, blocking your artery.

Sometimes the plaque may rupture, which also causes your blood to clot. This is called atherothrombosis. Atherothrombosis stops an area of your heart muscle receiving blood and oxygen, leading to a heart attack. If a lot of your heart muscle is damaged, your heart may stop beating regularly. Sometimes the damage causes your heart to stop beating altogether, which is fatal.

Symptoms of coronary heart disease

Coronary heart disease develops slowly over many years. In some people, breathlessness when exercising is the only symptom. You may not know anything is wrong until you develop angina (chest pains) or have a heart attack.

Angina

Angina is the feeling of chest pain, chest tightness, and sometimes breathlessness or choking. It happens when blood flow in the arteries that supply your heart is restricted.

Angina typically starts when you're walking or feeling upset. It can also be brought on after a meal and by cold weather. Symptoms include:

• discomfort or a tightening across your upper chest - this may be confused with indigestion
• pain radiating to your neck, jaw, throat, back or arms for a few minutes, disappearing quickly after resting
• breathlessness
• sweatiness

Angina can be treated with lifestyle changes and medicines. Left untreated, it will become more frequent and the pain will get worse. Having angina means you're at a higher risk of having a heart attack.

Heart attack

Most heart attacks cause severe pain in the centre of your chest and can feel like very bad indigestion. Symptoms can happen suddenly, but sometimes the pain develops more slowly. Symptoms include:

• a feeling of heaviness, squeezing or crushing in the centre of your chest
• pain may spread to your arms, neck, jaw, face, back or stomach, lasting for hours
• loss of consciousness
• sweatiness and breathlessness
• feeling or being sick

Sometimes there are no symptoms at all. This is called a silent myocardial infarction. Older people and people with diabetes are more likely to have this kind of heart attack.

Call an ambulance immediately if you suspect someone is having a heart attack. Give him or her 300 mg aspirin to chew or to swallow dissolved in water. This helps prevent the clot that is blocking his or her coronary artery from growing.

Arrhythmia

An arrhythmia is an irregular heart beat. Sometimes this can be felt as a heart palpitation (a sensation of a skipping or thumping heart beat). Sometimes palpitations are a symptom of coronary heart disease. However, heart palpitations are common, and don't necessarily mean that you have either coronary heart disease or an arrhythmia.

Heart failure

Over time, coronary heart disease may weaken your heart, leading to heart failure. Heart failure means that your heart isn't strong enough to pump blood around your body effectively and you get tired and out of breath easily. It can also lead to swelling in your ankles and legs.

Causes of coronary heart disease

Coronary heart disease is caused by the build up of fatty deposits on your artery walls.

Coronary heart disease is more common in older people. Up to the age of 65, it's more common in men than women. It's also more common among people from India and Pakistan. Factors that increase your risk of developing coronary heart disease include:

• smoking
• being overweight, especially if you have excess fat around your tummy
• an inactive lifestyle
• diabetes
• high blood pressure
• high cholesterol

Diagnosis of coronary heart disease

Your doctor will ask about your symptoms and examine you. You will need to have some tests, which may include the following.

• Blood tests.
• Electrocardiogram (ECG) – a test that measures the electrical activity of your heart to see how well it's working. You may have an exercise ECG, which means the test is done while you're walking on a treadmill or pedalling on an exercise bike.
• Echocardiogram – a test that uses ultrasound to produce a moving 'real-time' image of the inside of your heart.
• A coronary angiogram – a test that uses an injection of a special dye into the blood vessels of your heart to make them clearly visible on X-ray images.
• Radionuclide tests – for this test your doctor will give you a small, harmless injection of radioactive material, which passes through your heart muscle. A large camera directed at your heart picks up rays sent out by the radioactive material and creates an image of your heart.
• Chest X-ray.
• MRI scan.
• Electrophysiological tests – a catheter is put into a blood vessel in your groin and guided to your heart. The tip of the catheter stimulates your heart and records the electrical activity.

Treatment of coronary heart disease

Treatment for coronary heart disease depends on how serious it is. There are several treatments available. If you have angina or have had a heart attack, angioplasty or surgery may be the best treatment option.

Medicines

Medicines aim to stop coronary heart disease getting worse or prevent further heart attacks. Some examples are listed below.

• Anti-platelet medicines such as aspirin. Taking a small (75 mg) daily dose of aspirin makes your blood less likely to form clots, reducing your risk of having a heart attack.
• Cholesterol-lowering medicines, such as statins, which slow down the process of atherosclerosis.
• Beta-blockers reduce your blood pressure and the amount of work your heart does.
• Calcium channel blockers relax and widen your arteries.
• Anticoagulants help to stop blood clots forming.
• ACE inhibitors lower your blood pressure and are often used in people with heart failure or after a heart attack.
• Nitrates relax your coronary arteries, allowing more blood to reach your heart.
• Anti-arrhythmic medicines help to control your heart rhythm.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Non-surgical treatment

A coronary angioplasty involves your doctor passing a collapsed balloon through your blood vessels until it reaches the arteries of your heart. The balloon is inflated to widen your narrowed coronary artery. A stent (flexible mesh tube) is sometimes inserted to help keep your artery open afterwards.

Surgery

Your surgeon may recommend a coronary artery bypass graft (CABG). This means he or she will take a piece of a blood vessel from your leg or chest and use it to bypass the narrowed coronary arteries. The bypass provides your heart with more blood.

Prevention of coronary heart disease

Coronary heart disease can be prevented in most people by adopting a healthy lifestyle.

You can reduce your chance of having a heart attack by:

• not smoking
• losing excess weight
• doing regular physical activity – aim to do 150 minutes of moderate exercise each week
• eating a low fat and high fibre diet with five portions of fruit and vegetables a day and two portions of fish (one oily) a week
• not exceeding four units of alcohol a day for men or three units for women

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.