Coronary heart disease

Your health expert: Dr Joshua Chai, Consultant Cardiologist
Content editor review by Victoria Goldman, April 2021
Next review due April 2024

Coronary heart disease is when fatty substances build up inside the arteries that deliver blood to your heart. Your arteries may get narrower, which means your heart might not get enough oxygen. This may cause chest pain and affect your breathing. It can also increase your risk of having a heart attack in the future.

Image showing a coronary artery affected by atherosclerosis

What is coronary heart disease?

Your heart pumps blood to your lungs and the rest of your body to supply it with oxygen and nutrients. Your heart gets its own supply of blood from your coronary arteries.

Coronary heart disease happens when fatty substances in your blood build up inside your coronary artery walls. These build-ups are known as plaques. The process of developing plaques is called atherosclerosis. As a plaque forms, your artery narrows and the flow of blood is reduced. This means your heart muscle doesn’t get all the oxygen it needs.

If a plaque bursts, a clot can form on top of it. This may suddenly block your artery completely, causing a heart attack. Coronary heart disease may weaken your heart, which can lead to heart failure. This is when your heart doesn’t pump blood around your body as well as it should do.

You’re more likely to have coronary heart disease as you get older. Men are more likely to get it than women, and it’s the most common cause of death in both men and women in the UK. But there are lots of things you can do to reduce your chance of getting coronary heart disease. And if you do have it, treatments can help to control your symptoms and protect against serious problems.

Causes of coronary heart disease

You’re more likely to have coronary heart disease if you:

smoke
are overweight – especially if you have excess fat around your waist
aren’t very active
have South Asian, African or Caribbean family background
have diabetes
have high blood pressure
have high cholesterol
drink too much alcohol
have a family history of heart disease
eat an unhealthy diet with a lot of foods that are high in saturated fat, cholesterol, salt and sugar
have mental health problems such as depression or get very stressed

Symptoms of coronary heart disease

You might not get any symptoms of coronary heart disease. You may only realise there’s a problem with your arteries if you have a heart attack. But you may experience:

chest pain (angina)
trouble breathing
pain throughout your body
dizziness
more noticeable heartbeats (palpitations)

These symptoms can be caused by lots of other things too, so it’s important to discuss these with your GP.

How to spot a heart attack

If you think you may be having symptoms of a heart attack, dial 999. Don’t delay.

See our infographic on how to spot a heart attack (PDF, 0.7MB) or click on the icon below.

Diagnosis of coronary heart disease

If you see your GP because you think you may have coronary heart disease, they’ll ask about your symptoms and examine you. They may ask about your lifestyle too – such as if you smoke and how active you are. For more information, see our FAQ: How can my GP work out my risk of coronary heart disease? below.

If your GP thinks you may have coronary heart disease or you have another problem with your heart, they may refer you to a cardiologist. This is a doctor who specialises in conditions that affect your heart and blood vessels.

You may need to have one or more of the following tests.

Blood tests check how much fat, cholesterol, sugar and protein is in your blood.
An electrocardiogram (ECG) checks the electrical activity of your heart and can show any damage to your heart muscle or signs of coronary heart disease. But it can be normal even if you have coronary heart disease.
An exercise ECG (also called an exercise tolerance test or an exercise stress test) means having an ECG while you’re exercising, usually on a treadmill. This looks for signs that your heart muscle can’t get enough oxygen when it’s working harder.
An echocardiogram uses ultrasound to check the structure of your heart and to see how well it’s working.
A computerised tomography (CT) scan creates images of your coronary arteries and checks how much calcium is in your arteries.
A radionuclide test – there are lots of these with different names. One type is called a myocardial perfusion scan. Your doctor gives you a small, harmless injection of radioactive material. A large camera picks up rays sent out by this material as it passes through your heart. The results show how well blood flows through your heart muscle. You may have this test while you’re exercising on a treadmill and also while you’re resting.
A magnetic resonance imaging (MRI) scan uses magnets and radio waves to create images of your heart. It can help to check the flow of blood through your arteries and look for any signs of damage.
A coronary angiogram involves an injection of a harmless dye into your coronary arteries so they show up clearly on X-rays.

Self-help for coronary heart disease

If you have coronary heart disease, there’s a lot you can do to help yourself.

Your doctor may suggest you make some healthy changes to your lifestyle to help reduce your risk of serious problems in the future. Changes may include:

stopping smoking
losing weight if you’re overweight
keeping active and exercising regularly if you can
eating a healthy diet
not drinking too much alcohol
eating fewer saturated fats to reduce high cholesterol levels
getting help if you’re feeling stressed or very down
taking any medicines that your doctor recommends
managing any other health conditions you may have such as high blood pressure or diabetes
getting a flu jab every year

Your GP may arrange for you to join a local cardiac rehabilitation programme. This usually involves some exercise that’s right for you, and advice on other lifestyle changes such as dealing with stress and eating a healthy diet. For more information, see our section on prevention of coronary heart disease below.

Treatment of coronary heart disease

There are lots of treatments available for coronary heart disease that help to manage the condition well and improve your health. These may help to ease your symptoms and reduce your chances of getting more serious heart problems.

These treatments include:

changes to your lifestyle – for more advice on these, see our section on self-help above
medicines
surgery

You and your doctor will discuss your options and the best treatments for you.

Medicines

Your doctor may offer you one or more medicines to treat coronary heart disease. These medicines work in different ways.

Antiplatelet medicines and anticoagulant medicines make your blood less likely to form clots. They also make you less likely to have a heart attack.
Cholesterol-lowering medicines such as statins reduce how much cholesterol your liver makes. If you have high cholesterol, fatty plaques may build up in your blood vessels. These medicines also help to stop plaques bursting inside your arteries.
Beta-blockers slow your heart and reduce the amount of work your heart has to do. They can also help to control your heart rhythm.
Angiotensin-converting enzyme (ACE inhibitors) lower your blood pressure. They may be prescribed if you have heart failure or have had a heart attack.
Angiotensin II receptor blockers may be prescribed if you get side-effects from ACE inhibitors.
Calcium-channel blockers relax and widen your arteries.
Nitrates relax your coronary arteries and allow more blood to reach your heart muscle.

Your doctor will discuss which medicines may work best for you and why. This may depend on your symptoms and what’s causing your condition. It may also depend on any other health problems you may have. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or doctor.

Our handy medicines checklist helps you see what to check for before taking a medicine. Bupa's medicines checklist PDF opens in a new window (0.8MB)

Hospital treatment

If medicines don’t help you, your doctor may recommend you have one of the following procedures.

a coronary angioplasty to widen your narrowed coronary artery
coronary artery bypass graft (CABG) surgery to bypass your narrowed coronary arteries so more blood flows to your heart

Your doctor will be able to discuss the best procedure for you in your circumstances.

Prevention of coronary heart disease

Making healthy lifestyle choices may mean you’re less likely to get coronary heart disease in the future. This involves eating a healthy diet, being active and not smoking. To find out more about leading a healthy lifestyle to prevent coronary heart disease, see our section on self-help above.

If your GP thinks you’re at a high risk of getting coronary heart disease because of your lifestyle or family history, they may recommend regular medication. For more information on this, see our FAQ: How can my GP work out my risk of coronary heart disease? below.

The Driver and Vehicle Licensing Agency (DVLA) has strict rules about when you can or can’t drive with a heart condition. These rules may differ for people with angina or after a heart attack.

You may not need to tell the DVLA that you have coronary heart disease – it depends on your symptoms, your treatment and which type of driving licence you have. The rules are stricter if you drive a bus, lorry or coach.

If you’re not sure about whether or not it’s safe to drive, ask your doctor and follow their advice. Remember, you should never drive if you don’t feel well enough to do so safely.

You should also tell your motor insurer if you have coronary heart disease and about any treatment you have. If you don’t, you may not be insured.

Most people continue to have a healthy sex life if they have coronary heart disease. But remember that sex is a form of exercise, so your heart will be working harder than when you’re at rest.

If you have angina, your doctor will probably have given you a nitrate medicine to take if you get chest pain. You may find it helpful to keep this handy when having sex, just in case you need it. But it’s important not to take Viagra if you’re taking nitrates because they can cause a dangerous drop in blood pressure when taken together.

After a heart attack, it’s probably ok to have sex when you feel well enough. This may be after about two to four weeks, but see how you feel. Speak to your doctor for more advice.

You may have a lower sex drive or problems having sex after a heart attack or surgery for coronary heart disease. This may be because you’re feeling worried or down or it may be due to the medicines you’re taking. This doesn’t usually last long – but don’t be embarrassed to speak to your GP about it. They’re used to having discussions like this, and may be able to help.

If you’re over 40, your GP may offer you a health check called a cardiovascular risk assessment. They’ll ask you about your medical history, family history and lifestyle. They may weigh you too, and measure your blood pressure. They may also offer you a blood test to check your cholesterol levels and sometimes your blood glucose (sugar) levels – this is to check for diabetes.

Your GP will put all this information together and probably use an online risk calculator. This can give them an idea of how likely you are to get coronary heart disease over the next 10 years. Depending on your risk, your GP may recommend you have some more tests or offer you some medicines.

You and your GP can also discuss if making some lifestyle changes will help to reduce your risk of coronary heart disease. These changes may include stopping smoking or being more active.

It’s worth remembering that having an increased risk of getting coronary heart disease doesn’t mean you’ll definitely get it. And even if you have a low risk, you can still get heart disease, so you should still live a healthy lifestyle.

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