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Coronary heart disease


Expert reviewer, Tim Cripps, Consultant Cardiologist
Next review due June 2021

Coronary heart disease is a condition in which fatty substances build up inside the arteries that run to your heart. This makes them narrower, which can reduce the supply of oxygen to your heart.

You may not get any symptoms if you have coronary heart disease. But it may lead to angina (pain in your chest) or breathlessness, and there’s a risk you could have a heart attack.

There’s a lot you can do to reduce your chance of getting coronary heart disease. And if you have it, treatments can help control your symptoms and help protect against serious problems.

More about coronary heart disease

Your heart is a muscle and it pumps blood to your lungs and the rest of your body to supply it with oxygen and nutrients. But your heart also needs a supply of blood, and it gets this from your coronary arteries.

Coronary heart disease happens when fat and cholesterol from your blood build up over many years inside your artery walls. They form what are called plaques and the process of fat building up is called atherosclerosis. As a plaque forms, this narrows your artery and reduces the blood flow so the result is your heart muscle doesn’t get all the oxygen it needs. And sometimes a plaque may rupture, and a clot can form on top which suddenly blocks your artery completely (causing a heart attack).

Have a look at our video above, which begins with a description of coronary heart disease.

Coronary heart disease can damage your heart muscle and lead to a range of symptoms, which can be serious. In the UK, coronary heart disease is the most common cause of death.

Image showing a coronary artery affected by atherosclerosis

Symptoms of coronary heart disease

Coronary heart disease develops slowly over many years, and may not give you any symptoms at all. If you get symptoms, they’ll be from the narrowing of the coronary arteries. This may happen over time or may occur suddenly when a plaque ruptures.

You might not know anything is wrong until you start getting chest pain (angina) or breathlessness, or have a heart attack (myocardial infarction). Coronary heart disease may weaken your heart and lead to a condition called heart failure too. This is where your heart doesn’t pump blood around your body as well as it should.

For information about these conditions and the symptoms of each, see our information on angina, heart attack and heart failure.

Diagnosis of coronary heart disease

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.

Infographic showing how to spot a heart attack

If you see your GP with symptoms which may be due to coronary heart disease, they’ll ask about your symptoms and examine you. They may ask about your lifestyle too – for instance if you smoke and how active you are.

For information about how your GP assesses you, see our FAQ, ‘How can my GP work out my risk of coronary heart disease?’

Depending on your symptoms and the results of initial tests, your GP may refer you to see a cardiologist. This is a doctor who specialises in conditions that affect the heart and blood vessels.

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

  • Blood tests. These can check the levels of certain fats, cholesterol, sugar and proteins in your blood.
  • An electrocardiogram (ECG). This measures the electrical activity of your heart and can show any damage to your heart muscle or signs of coronary heart disease. However, an ECG can be normal even if you have coronary heart disease.
  • An exercise ECG (also called an exercise tolerance test or an exercise stress test). You have an ECG recorded 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. This uses ultrasound to check the structure of your heart and to see how well it’s working.
  • A radionuclide test. There are lots of different names for these tests – one type is called a myocardial perfusion scan. Your doctor will give you a small, harmless injection of radioactive material. A large camera picks up rays sent out by the radioactive material as it passes through your heart. This will show how well blood flows through your heart muscle. You may have this test both while exercising on a treadmill and while resting.
  • A coronary angiogram. Your doctor will inject a dye into your coronary arteries to make them show up clearly on X-rays.
  • A computerised tomography (CT) scan. This can produce images of your coronary arteries and give a measure of the amount of calcium in your arteries. This can show if you might have coronary heart disease.
  • A magnetic resonance imaging (MRI) scan. This uses magnets and radio waves to produce images of the inside of your body to examine your heart for signs of coronary heart disease.

If your doctor recommends you have a particular test, they’ll explain what this involves and why it may help in your particular circumstances. It’s OK to ask your doctor questions or share any concerns you have about the test.

Self-help for coronary heart disease

If you have coronary heart disease, there’s a lot you can do to help yourself. This includes making healthy changes to your lifestyle and taking any medicines your doctor recommends.

You’re probably already familiar with the main ways to live a healthy lifestyle. These include:


You may find it helpful to read our information on high cholesterol. We also have useful tips and hints for a healthy lifestyle with our information on giving up smoking, preventing heart disease and cutting back on your alcohol intake.

Your GP may be able to direct you to local information and support. Your doctor may offer you a special programme of exercise and support called cardiac rehabilitation. And you can get lots of information, advice and support from the British Heart Foundation (see ‘other helpful websites’ below for contact details).

Treatment options for coronary heart disease

Coronary heart disease can’t be cured, but treatment can ease your symptoms and reduce the chance of getting further problems. Treatments include changes to your lifestyle, which you can make yourself (see self-help) plus medicines and sometimes surgery. Your doctor will discuss with you what your options are and the best treatments for you.

Medicines

There are lots of different medicines used to treat coronary heart disease, which work in different ways. The medicines you need to take will depend on your symptoms and what’s causing your condition. For example, if you have high blood pressure, then you might need to take medicines to lower this.

Your doctor may offer you one, or a combination of medicines. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or doctor.

Here are some of the types of medicines your doctor may recommend if you have coronary heart disease.

  • Antiplatelet medicines, such as aspirin or clopidogrel, and anticoagulant medicines make your blood less likely to form clots. They also reduce your risk of having a heart attack.
  • Cholesterol-lowering medicines, such as statins, reduce the amount of cholesterol your liver produces. High cholesterol is one of the causes of plaques forming (atherosclerosis). These medicines also help to prevent plaques rupturing inside your arteries.
  • Beta-blockers slow your heart rate and reduce the amount of work your heart has to do. They can also help to control your heart rhythm, and may increase the amount of blood getting to your heart muscle.
  • Angiotensin-converting enzyme (ACE inhibitors) lower your blood pressure and are used if you have heart failure or have had a heart attack.
  • Angiotensin II receptor blockers are an alternative treatment to ACE inhibitors if you get side-effects from them.
  • Calcium-channel blockers relax and widen your arteries.
  • Nitrates relax your coronary arteries and allow more blood to reach your heart muscle.

Hospital treatment

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

  • A coronary angioplasty can widen your narrowed coronary artery. To find what this procedure involves, see our information on coronary angioplasty.
  • Coronary artery bypass graft (CABG) is a type of surgery to bypass your narrowed coronary arteries to improve the flow of blood to your heart. For more, see our information on CABG.

Causes of coronary heart disease

Coronary heart disease is usually caused by a build-up of fatty substances in your artery walls. This makes your coronary arteries narrower so your heart muscle may get less oxygen than it needs.

Coronary heart disease is a very common disease and your chance of getting it increases as you get older. Men are more likely to get it than women, but it’s the most common cause of death in both men and women.

Other things that increase your risk of developing coronary heart disease include:


Prevention of coronary heart disease

From the list of causes of coronary heart disease, you can see that there are some causes you can’t do anything about. But there are many others you can change by starting to make healthy choices.

To find out more about leading a healthy lifestyle to prevent coronary heart disease, see our section on self-help.

Frequently asked questions

  • The Driver and Vehicle Licensing Agency (DVLA) have rules about when you can drive with heart conditions and whether you need to inform them. These vary depending on your symptoms, your treatment and what type of licence you have. The rules are stricter if you drive a bus, lorry or coach. For more information, contact the DVLA or check their website. You can also find out more about DVLA rules for specific situations from our information on angina, heart attack, heart failure, coronary angioplasty and coronary artery bypass graft.

    If you’re not sure about whether it’s safe to drive, ask your doctor and follow their advice. Remember, you should never drive if you feel it’s not safe.

    You should also tell your motor insurer if you have coronary heart disease, and about any treatment you have. This is because it may affect your cover.

  • Yes, most people can continue to have a healthy sex life if they have coronary heart disease. 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 medicine called GTN (a nitrate medicine) to take if you have chest pain. You may find it helpful to keep this handy when having sex, in case you need it.

    After a heart attack it’s probably OK to have sex when you feel ready. This may be after about a month to six weeks, but see how you feel.

    However, if you have symptoms which are severe, or not yet controlled by medicines, it may be best to wait. Ask your doctor what’s best in your particular circumstances.

    You might 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 anxious or depressed, or may be due to the medicines you’re taking. It’s usually temporary – but don’t be embarrassed to speak with your GP about problems with having sex. They’re used to having discussions like this, and may well be able to help.

  • Your GP can use information about your health, family medical history and lifestyle to work out your risk of coronary heart disease.

    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 medical history and lifestyle. Your GP may weigh you and measure your blood pressure. They might offer you a blood test to measure your cholesterol and sometimes your blood glucose (sugar) – this is to check for diabetes.

    Your GP will put all this information together and probably use an online risk calculator. This can give an indication of how likely you are to develop coronary heart disease over the next 10 years. Many doctors use the QRISK® calculator to work this out – you may find it interesting to look at this. There’s a link below in our section ‘other helpful websites’.

    Depending on your risk, your GP may recommend you have some more tests or offer you medicines. See our sections on diagnosis and treatment for more information about these.

    You and your GP can also discuss how making lifestyle changes may help reduce your risk of coronary heart disease. These may include stopping smoking or being more active. For more information about healthy lifestyle changes, see our section on self-help.

    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 consider making healthy changes to your lifestyle.


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Related information

    • Stable ischaemic heart disease. BMJ Best practice. bestpractice.bmj.com, last reviewed April 2018
    • Coronary artery atherosclerosis. Medscape. www.emedicine.medscape.com, updated April 2016
    • Heart anatomy. Medscape. www.emedicine.medscape.com, updated July 2015
    • Exercise tolerance testing. PatientPlus. www.patient.info/patientplus, last checked April 2015
    • Epidemiology of coronary heart disease. PatientPlus. www.patient.info/patientplus, last checked July 2014
    • Acute myocardial infarction management. PatientPlus. www.patient.info/patientplus, last checked May 2016
    • Overview of coronary artery disease. The MSD Manuals. www.msdmanuals.com, last full review/revision September 2016
    • Radionuclide imaging. The MSD Manuals. www.msdmanuals.com, last full review/revision September 2017
    • Heart failure - chronic. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised January 2017
    • CVD risk assessment and management. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised September 2014
    • Cardiovascular disease: risk assessment and reduction, including lipid modification. National Institute for Health and Care Excellence (NICE), 2014 (updated 2016). www.nice.org.uk
    • Atorvastatin. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed June 2018
    • Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the task force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013; 34(38):2949–3003. DOI: 10.1093/eurheartj/eht296
    • Radionuclide test. British Heart Foundation. www.bhf.org.uk, accessed June 2018
    • MRI scans. British Heart Foundation. www.bhf.org.uk, accessed June 2018
    • Medicines for my heart. British Heart Foundation 2017. www.bhf.org.uk
    • Sex and heart conditions. British Heart Foundation. www.bhf.org.uk, accessed June 2018
    • Medical conditions, disabilities and driving. GOV.UK. www.gov.uk, accessed June 2018
    • Sex and heart disease. American Heart Association. www.heart.org, updated March 2018
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, June 2018.
    Expert reviewer, Tim Cripps, Consultant Cardiologist
    Next review due June 2021



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