Coronary Heart Disease - Symptoms, Prevention & Treatment
Coronary heart disease (CHD) is a major cause of death here in the UK. It’s a condition where the heart's blood vessels, known as coronary arteries, become narrow or blocked due to the buildup of plaque, which restricts blood flow to the heart muscle.
This can lead to symptoms like chest pain (angina), shortness of breath and even heart attacks. CHD is caused by factors like smoking, high blood pressure, high cholesterol, obesity and diabetes.
Diagnosing coronary heart disease involves tests like ECGs, stress tests and angiograms. Treatment includes lifestyle changes (diet, exercise, quitting smoking), medications and sometimes, procedures like angioplasty or bypass surgery.
Preventing CHD involves a healthy lifestyle, managing risk factors and regular medical check-ups. Early intervention is crucial.
Symptoms
The most common coronary heart disease symptoms are chest pain (angina) and breathlessness, although some individuals may not display any symptoms at all.
Angina, often triggered by physical exertion or stress, can cause mild discomfort similar to indigestion or, in severe cases, intense pain and pressure in the chest that may radiate to the arms, neck, jaw, back or stomach.
Rest or a nitrate tablet or spray typically relieves angina symptoms. If the coronary arteries become completely blocked, it can lead to a heart attack (myocardial infarction), which can result in heart muscle damage and in some cases, can even be fatal.
Heart attack symptoms resemble angina but are typically more severe and may occur at rest. They may also include pain in various body parts, lightheadedness, sweating, nausea and breathlessness.
If you suspect a heart attack, you must call 999 immediately.
Coronary heart disease can also lead to heart failure, where the heart weakens, making it difficult to pump blood and causing fluid buildup in the lungs, leading to breathing problems. It can develop suddenly (acute heart failure) or gradually over time (chronic heart failure).
Causes
Coronary heart disease is caused by fatty deposits (atheroma) that build up in the heart's arteries, narrowing them and blocking blood flow.
This condition, called atherosclerosis, is more likely if you smoke, have high blood pressure, high cholesterol, high lipoprotein(a), don't exercise or have diabetes.
A lack of exercise allows these fatty deposits to grow. Additionally, blood clots, known as thrombosis, can cause heart attacks when they block coronary arteries. It's essential to manage these risk factors to prevent CHD and protect your heart.
Diagnosis
Coronary heart disease is typically diagnosed through a series of assessments and tests. Initially, your GP might conduct a risk evaluation to assess the likelihood of cardiovascular disease, heart attack or stroke. This assessment can be a part of the NHS Health Check and typically involves:
- Questions about your medical and family history
- Measuring your blood pressure
- Cholesterol tests (done with a blood test, usually fasting)
- A discussion about your lifestyle habits, including exercise, smoking and diet
If necessary, you may be referred for further tests to confirm coronary heart disease. Various diagnostic tests are available for heart-related issues, including:
- Electrocardiogram (ECG): Measures the heart's electrical activity
- Exercise stress tests: Assesses how your heart responds to physical activity
- X-rays: Can provide images of your heart and chest
- Echocardiogram: Uses sound waves to create images of the heart
- Blood tests: May include additional blood tests for specific markers
- Coronary angiogram: An invasive procedure to visualise coronary arteries
- Radionuclide tests: Use radioactive substances for heart imaging
- MRI scans: Provide detailed images of the heart
- CT scans: Offer cross-sectional images for assessment
These tests help healthcare professionals to accurately diagnose and evaluate the extent of CHD or any other related heart conditions.
Treatment
Treatment for coronary heart disease aims to manage symptoms and reduce the risk of further problems. This typically involves a combination of lifestyle changes, medications and, in some cases, surgical procedures.
Lifestyle changes
If you have coronary heart disease, making simple lifestyle adjustments can lower your risk of future heart issues.
For example, quitting smoking after a heart attack can rapidly reduce your risk of another one. Eating a healthier diet and engaging in regular exercise can also decrease your risk of heart disease.
Medications
Various medications are used to treat coronary heart disease, often aiming to lower blood pressure or widen narrowed arteries.
These can include blood-thinning medicines (e.g. aspirin), cholesterol-lowering statins, beta-blockers, nitrates to relax blood vessels, ACE inhibitors, ARBs, calcium channel blockers and diuretics.
It's essential to work with your healthcare provider to find the right medication for you.
Procedures and surgery
If medications are ineffective or your arteries are severely narrowed, interventional procedures or surgery may be necessary to open or bypass blocked arteries. This could include:
- Coronary angioplasty: Also known as angioplasty or PCI, this procedure involves inserting a balloon to widen narrowed arteries and often placing a stent to keep them open
- Coronary artery bypass graft (CABG): In cases of severely blocked arteries, bypass surgery may be performed. This involves grafting a blood vessel to reroute blood around blocked sections
- Heart transplant: In severe cases of heart damage or failure, a heart transplant may be considered, involving replacing a damaged heart with a healthy one from a donor
Recovery
Leading a normal life after heart surgery or experiencing heart-related issues, such as a heart attack, is entirely possible.
Cardiac Rehabilitation
After heart surgery, a cardiac rehabilitation team member will provide information about your condition and recovery process in the hospital. This support continues after discharge, with home visits or check-in calls during the initial weeks.
Cardiac rehab programs typically cover exercise, education and emotional support. Completing a program like this is vital, and maintaining regular exercise and a healthy lifestyle afterward is crucial for maintaining your heart health.
Support groups
Heart support groups across the UK offer opportunities to connect with others facing similar heart conditions. These groups often organise exercise sessions and social activities. Your GP or specialist can help you locate a nearby support group.
Self-care
Self-care involves taking responsibility for your health and well-being with the guidance of your healthcare team. By practising self-care, you can stay physically and mentally fit, prevent illness and effectively manage minor ailments or long-term conditions.
Relationships
Coping with a heart condition can be challenging for you and your loved ones. Communicate openly with friends and family about your feelings and needs.
Regarding your sex life, it's typically safe to resume sexual activity when you feel well enough. Maintain open communication with your partner and explore what brings you both comfort and pleasure.
Going back to work
After heart surgery, you can usually return to work, although the type of work you do might need adjustments if it involves strenuous physical activity. Your specialist can guide you on when it's safe to return to work and any necessary work-related restrictions.
Prevention
Reducing the risk of developing coronary heart disease involves several key steps.
Healthy, balanced diet
You should opt for a low-fat, high-fibre diet rich in fresh fruits, vegetables (aim for at least 5 portions daily) and whole grains.
Limit salt intake to no more than 6g (about 1 teaspoon) per day to help control blood pressure. Avoid saturated fats found in items like meat pies, sausages, butter and certain oils.
Instead, incorporate unsaturated fats from sources like oily fish, avocados and nuts. Reduce sugar consumption to prevent diabetes, a known CHD risk factor.
Exercise
Combine a balanced diet with regular exercise to maintain a healthy weight.
Physical activity improves your heart and circulatory system’s efficiency, lowers cholesterol levels and maintains blood pressure. Any aerobic exercise like walking, swimming or dancing is beneficial.
Managing your weight
Consult with a healthcare professional to determine your ideal weight based on height and build or calculate your BMI. Managing your weight is essential for preventing high blood pressure.
Quitting smoking
Quitting smoking significantly reduces your risk of developing coronary heart disease, as smoking contributes to arterial blockages (atherosclerosis) and coronary thrombosis.
NHS support, along with stop-smoking aids like patches or gum, can boost your chances of successfully quitting.
Alcohol
If you drink alcohol, adhere to recommended limits (not exceeding 14 units weekly for both men and women). Avoid binge drinking, which escalates heart attack risk.
Blood pressure
Maintain healthy blood pressure by sticking to a low-saturated fat diet, regular exercise and, when necessary, prescribed medication. Aim for a target blood pressure below 140/90mmHg.
Managing your diabetes
If you have diabetes, manage your blood sugar levels through physical activity, weight control and blood pressure management.
Take your prescribed medication
If you’ve been diagnosed with CHD or you’re at risk due to high cholesterol, high blood pressure or a family history of heart disease, always take your prescribed medications.
Taking them as directed is crucial for symptom relief and prevention of further issues. Always consult a doctor before discontinuing any medication.
