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Coronary heart disease

In the UK, more people die from coronary heart disease (CHD) than from any other cause.

In 2003, around 7.4 percent of men and 4.5 percent of women developed coronary heart disease in England. It becomes more common as you age.

About coronary heart disease

What is coronary heart disease?

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

Coronary heart disease happens when the coronary arteries become gradually narrowed and hardened. This is known as atherosclerosis.

In atherosclerosis, fat and cholesterol in your blood builds up on an artery wall, forming a plaque or atheroma. The plaque can prevent the heart muscle from getting the blood supply (and therefore oxygen) that it needs. If you have atherosclerosis, physical exertion or emotional stress can bring on chest pain called angina (see What can coronary heart disease cause).

Because of the reduced blood flow and the rough edges of the plaque, a blood clot sometimes forms. This can block the artery. Or the plaque may rupture, which also causes the blood to clot. This is called atherothrombosis.

Atherothrombosis stops an area of the heart muscle receiving blood and oxygen, leading to permanent damage. This is called a myocardial infarction (MI), or heart attack. If a lot of your heart muscle is damaged your heart may stop beating regularly, or stop beating at all. This is fatal (see What can coronary heart disease cause).

Why does it happen?

You are more likely to get heart disease if you have high levels of cholesterol in your blood stream. Your cholesterol levels are affected by your diet and by how much you exercise. They may also be influenced by your genes.

You are also more likely to develop atherosclerosis if you have high blood pressure. Eating too much salt raises your blood pressure.

Coronary heart disease is more common in elderly people and, up to the age of 65, it is more common in men than women. It's also more common among people from India and Pakistan.

Several factors increase your risk of developing heart disease. These factors include:

  • smoking
  • being overweight
  • having an inactive lifestyle
  • eating an unhealthy diet
  • having diabetes
  • having high blood pressure
  • having high blood cholesterol

What can coronary heart disease cause?

Coronary heart disease develops slowly over many years. You may not know anything is wrong until you develop angina (chest pains) or have a heart attack. In some people, breathlessness with exercise is the only symptom of heart disease. Below are some of the symptoms and illnesses that can happen with heart disease.

Angina

Angina pain typically starts when you are doing some sort of physical exercise. It may feel like a heavy weight or a feeling of tightening across your upper chest. Angina pain is more likely to occur when walking after a meal and in cold weather. Anger or stress can also bring it on.

The pain can radiate to your neck, jaw, throat, back or arms. The pain doesn't usually last for more than a few minutes. And goes away fairly quickly after resting. People often confuse angina pain with Indigestion. But angina pain is accompanied with other symptoms such as breathlessness, sweatiness and a sense of fear.

Angina can be treated with a combination of changes to your lifestyle (see Prevention) and medicines. Some people may need surgery (see Treatment). A mouth spray or tablets of glyceryl trinitrate (GTN) are often used to relieve symptoms. Glycerol trinitrate relaxes the coronary arteries allowing more blood to flow through them. It's also available as skin patches.

Angina is a symptom of coronary heart disease. If you don't make changes to your lifestyle it will become more frequent and the pain will get worse. Having angina means you have a higher risk of a heart attack.

Heart attack

Most heart attacks cause severe pain in the centre of the chest. However, sometimes there are no symptoms at all. This is called a silent myocardial infarction. Elderly people and people with diabetes are more likely to have this kind of heart attack.

The central chest pain of a heart attack is often described as heaviness, squeezing or crushing. Some people collapse and lose consciousness. The pain may spread to your arms, neck, jaw, face, back or stomach. If you are having a heart attack you may go pale and feel sweaty and breathless. You might feel or be sick. The symptoms can come on suddenly, but sometimes the pain develops more slowly. The pain can feel like severe indigestion.

Heart attack pain goes on for longer than angina - it can last for hours. A person who has had angina will find that the pain of a heart attack won't completely respond to their usual medicine (eg glyceryl trinitrate).

Heart attacks need emergency medical treatment. Call an ambulance immediately if you suspect someone of 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 the coronary artery from growing. However, don't leave the person alone for too long to get aspirin. When the paramedics arrive, tell them that they have taken aspirin.

At hospital, a type of medicine known as a thrombolytic drug is often given to break down the blood clot in the coronary artery.

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). It's important to realise that heart palpitations are common, and don't necessarily mean that you have either coronary heart disease or an arrhythmia. However, sometimes they may be a symptom of heart disease.

Some arrhythmias are harmless and don't need treatment. Others can be treated with medicines or with a pacemaker. A pacemaker is an electrical device that is implanted in your chest to keep your heart beating regularly.

Heart failure

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

Diagnosis

Doctors can diagnose coronary heart disease from a description of your symptoms. The diagnosis is confirmed with tests such as an electrocardiogram (ECG) and angiography.

Treatment

Treatment for coronary heart disease depends on how serious it is and what it has led to. There are several treatments available.

Medicines

After having a heart attack, or if you develop angina, you will usually be prescribed heart medicines to help stop your heart disease getting worse or to prevent further heart attacks. Some examples are listed below. Always read the patient information that comes with your medicine, and follow your doctor's advice.

Aspirin: Taking a small (75 mg) daily dose of aspirin makes your blood less likely to form clots in your coronary arteries and reduces your risk of having a heart attack.

Statins: These drugs help to lower your cholesterol levels and so slow down the process of atherosclerosis.

Beta-blockers: These drugs slow your heart rate and reduce the pumping power of the heart. This reduces your heart's demand for oxygen. Beta-blockers also widen blood vessels helping to lower blood pressure.

ACE inhibitors: These drugs are often used in people with heart failure or after a heart attack. They lower your blood pressure.

You may be prescribed glycerol trinitrates (See Angina), nifedipine or nicorandil. These drugs which relax the coronary arteries, allowing more blood to reach your heart.

Surgery

If you have angina or have had a heart attack, surgery or angioplasty may be the best treatment.

Angioplasty (also known as percutaneous coronary intervention or PCI). In this operation a collapsed balloon is threaded through the blood vessels until it reaches the arteries of the heart. The balloon is inflated to widen the narrowed coronary artery. A stent (flexible mesh tube) is sometimes inserted to help keep the artery open afterwards. The stent sometimes releases a drug that helps to keep the blood vessel open. You should be able to go home the day after the operation.

Coronary artery bypass graft (CABG). In this operation, the surgeon takes a piece of blood vessel from your leg or chest and uses it to bypass the narrowed coronary arteries. The bypass provides the heart with more blood. This is open-heart surgery and requires a longer stay in hospital.

Prevention

Coronary heart disease can be prevented in most people. By having a healthy lifestyle you can cut your risk of having heart disease and the accompanying problems.

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

  • not smoking
  • losing excess weight
  • taking regular exercise
  • sticking to a diet that is low in fat and high in fibre

Of all the changes you can make, stopping smoking is the most effective in reducing your risk of heart disease.

Further information

British Heart Foundation

Sources

  • Coronary heart disease. Department of health. www.dh.gov.uk, accessed 18 September 2007
  • British Heart Foundation. www.bhf.org.uk, accessed 21 September 2007
  • Prevalence of all coronary heart disease. British Heart Foundation statistics website. www.heartstats.org, accessed 18 September 2007
  • Simon, C, Everitt, H, and Kendrick, T, Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2005: 314
  • Obesity and health. Bandolier. www.jr2.ox.ac.uk/bandolier/band85/b85-4.html, accessed 12 February 2007
  • Angina. NHS Library for Health. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 20 September 2007
  • Angina. The British Cardiac Patients Association. . www.bcpa.co.uk, accessed 21 September 2007
  • What is coronary artery disease? National Heart Lung and Blood Institute. www.nhlbi.nih.gov, accessed 21 September 2007
  • Wilson, K, et al., Effect of smoking cessation on mortality after myocardial infarction: Meta-analysis of cohort studies. Arch Intern Med, 2000. 160: 939-944
  • At a glance guide to the current medical standards of fitness to drive. DVLA, 2007. www.dvla.gov.uk
  • Petrie, KJ, et al., Role of patients' view of their illness in predicting return to work and functioning after myocardial infarction: Longitudinal study BMJ, 1996. 312: 1191-1194

Related topics

  • The cardiovascular system
  • High cholesterol
  • Healthy eating
  • High blood pressure (hypertension)
  • Heart attack
  • Arrhythmia (palpitations)
  • Coronary angioplasty
  • Coronary artery bypass graft (CABG)
  • Heart conditions - diagnosing
  • Looking after your heart
  • Angina
  • Heart failure
  • Giving up smoking
  • Physical activity