Coronary heart disease

Coronary heart disease (CHD), also referred to as coronary artery disease (CAD) or ischaemic heart disease (IHD), is the most common type of heart disease in the UK. It’s estimated that over seven million people in the UK have a diagnosis of CHD, with more men than women affected.

CHD means that there is narrowing of the arteries that supply oxygenated blood to the muscle of the heart, thereby starving it of the oxygen it needs. This may cause angina, a chest pain caused by reduced flow of blood to the heart, in the same way that any muscle can cause cramping pain if it receives insufficient oxygen. Or in more severe cases, it can cause myocardial infarction (heart attack), where the restriction of blood flow is sufficiently severe that some of the heart muscle dies.

What are the risk factors for developing CHD?

There are some risk factors that you are unable to change such as age, gender, ethnicity or a genetic predisposition. However, there are a number of ways to significantly reduce your risks of developing CHD. The main modifiable risk factors involved in developing CHD include:

What are the common symptoms of CHD?

  • Crushing, heavy pain in the centre of the chest, made worse by exertion, or a feeling of tightness, pressure or discomfort in the chest
  • Shortness of breath which may occur even when resting
  • Pain in the left arm, neck, jaw, throat or upper abdomen
  • Feeling lightheaded or dizzy
  • Extreme fatigue and weakness
  • Developing a pallor (abnormally pale or grey skin) and sweating.

If an individuals not known to have CHD develops symptoms of this kind it is a medical emergency. You must call 999 if you suspect that you or someone else is having a heart attack; don’t wait to see a GP but get immediate help.

Some patients know that they have CHD and have predictable symptoms such as stable angina, where the person develops chest pain only if they have exerted themselves to a particular extent. They may be confident in using their prescribed reliever treatment (a GTN spray or tablet that goes under the tongue) to manage their condition, as they know from experience that this will normally resolve their symptoms within a minute or two. However, these patients should seek urgent medical help if their symptoms start to behave differently. For example, if they develop symptoms without exercising, or their symptoms do not resolve quickly despite using GTN.

How is CHD diagnosed?

CHD can develop insidiously for many years before the first onset of symptoms. Typically patients will develop warning symptoms of angina prior to a heart attack, but not always. Sometimes patients with diabetes may experience less pain – when they experience angina or a heart attack – than other patients, and so they may consult their doctor with other symptoms such as breathlessness instead.

Diagnosis is made according to the clinical features (the symptoms the person reports to their doctor) and with tests such as an electrocardiogram and blood tests. These look for abnormally elevated levels of cardiac enzymes, molecules that have leached abnormally from stressed heart muscle cells into the blood stream. Coronary angiography involves injecting dye into the blood flowing through the coronary arteries and imaging the flow of the dye with X-rays. This provides a very accurate picture of the anatomy of the coronary arteries and shows exactly where the narrowed portions are.

How is CHD treated?

Treatments will depend on the kind of CHD someone has but the main types of treatment are as follows:

  • Lifestyle changes including a healthy diet, stopping smoking, cutting back on alcohol, getting enough exercise, and losing weight if you need to.
  • Medication which can include drugs to reduce blood pressure, lower cholesterol and reduce the stickiness of platelets within the blood. All of these have the effect of helping to improve arterial health.
  • Percutaneous intervention involved minimally invasive treatment to the coronary arteries, achieved by inserting a long thin wire (catheter) into the patient through the skin – normally into a blood vessel in their groin or wrist. The tip of the wire is passed through the blood vessels and into the narrowed portion of the coronary artery, where a balloon at its tip can be inflated to stretch open the blood vessel. Often a metal scaffold (stent) will be inserted, and left behind, to help hold the blood vessel open once the balloon has been deflated and the catheter removed. Some patients can have multiple stents inserted into multiple arteries.
  • Coronary artery bypass graft (CABG) surgery involves opening the patient’s chest to reveal the heart and then using the patient’s own blood vessels (often veins from their leg) to bypass the narrowed portion of the coronary artery. When two, three or four coronary arteries are bypassed in this way the operation may be called a double, triple or quadruple bypass.