Content Supplied by NHS Choices

Coronary heart disease

Coronary heart disease is the UK's biggest killer, causing around 73,000 deaths each year. About one in six men and one in ten women die from the disease.

Coronary heart disease (CHD) is the leading cause of death both in the UK and worldwide.

It's responsible for more than 73,000 deaths in the UK each year. About 1 in 6 men and 1 in 10 women die from CHD.

In the UK, there are an estimated 2.3 million people living with CHD and around 2 million people affected by angina (the most common symptom of coronary heart disease). 

CHD generally affects more men than women, although from the age of 50 the chances of developing the condition are similar for both sexes.

As well as angina (chest pain), the main symptoms of CHD are heart attacks and heart failure. However, not everyone has the same symptoms and some people may not have any before CHD is diagnosed.

CHD is sometimes called ischaemic heart disease.

Read more about the symptoms of coronary heart disease.

The heart

The heart is a muscle about the size of your fist. It pumps blood around your body and beats approximately 70 times a minute. After the blood leaves the right side of the heart, it goes to your lungs where it picks up oxygen.

The oxygen-rich blood returns to your heart and is then pumped to the body's organs through a network of arteries. The blood returns to your heart through veins before being pumped back to your lungs again. This process is called circulation.

The heart gets its own supply of blood from a network of blood vessels on the heart's surface called coronary arteries.

What causes coronary heart disease?

Coronary heart disease is the term that describes what happens when your heart's blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries.

Over time, the walls of your arteries can become furred up with fatty deposits. This process is known as atherosclerosis and the fatty deposits are called atheroma.

Atherosclerosis can be caused by lifestyle factors and other conditions, such as:

Read more about the causes of coronary heart disease.

Diagnosing coronary heart disease

If your doctor feels you're at risk of CHD, they may carry out a risk assessment. This involves asking about your medical and family history, your lifestyle and taking a blood test.

Further tests may be needed to confirm a diagnosis of CHD, including:

Read more about diagnosing coronary heart disease.

Treating coronary heart disease

Coronary heart disease can't be cured but treatment can help manage the symptoms and reduce the chances of problems such as heart attacks.

Treatment can include lifestyle changes, such as regular exercise and stopping smoking, as well as medication and surgery.

Read more about treating coronary heart disease.

Recovery

If you have problems, such as a heart attack or heart surgery, it's possible to eventually resume a normal life.

Advice and support is available to help you deal with aspects of your life that may have been affected by CHD.

Read more about recovering from the effects of coronary heart disease.

Prevention

You can reduce your risk of getting CHD by making some simple lifestyle changes. These include:

Keeping your heart healthy will also have other health benefits, such as helping reduce your risk of stroke and dementia.

Read more about preventing coronary heart disease.

Content Supplied by NHS Choices

Coronary heart disease

Although coronary heart disease (CHD) cannot be cured, treatment can help manage the symptoms and reduce the risk of further problems.

Lifestyle changes

If you have been diagnosed with CHD, you can reduce your risk of further episodes by making simple lifestyle changes.

For example, stopping smoking after a heart attack will quickly reduce your risk of having a heart attack in the future to near that of a non-smoker.

Other lifestyle changes, such as eating more healthily and doing regular exercise, will also reduce your future risk of heart disease.

Read more about preventing CHD.

Want to know more?

Medicines

Many different medicines are used to treat CHD. Usually they either aim to reduce blood pressure or widen your arteries.

Some heart medicines have side effects, so it may take a while to find one that works for you. Your GP or specialist will discuss the various options with you.

Heart medicines should not be stopped suddenly without the advice of your doctor as there is a risk this may make your symptoms worse.

Antiplatelets

Antiplatelets are a type of medicine that can help reduce the risk of a heart attack by thinning your blood and preventing it clotting.

Common antiplatelet medicines include low-dose aspirin, clopidogrel, ticagrelor and prasugrel.

Statins

If you have a high cholesterol level, a cholesterol-lowering medicine called statins may be prescribed. Examples include atorvastatin, simvastatin, rosuvastatin and pravastatin.

Statins work by blocking the formation of cholesterol and increasing the number of LDL receptors in the liver, which helps remove the LDL cholesterol from your blood. This helps slow the progression of CHD, and will make having a heart attack less likely. 

Not all statins are suitable for everyone, so you may need to try several different types until you find one that is suitable.

Beta-blockers

Beta-blockers – including atenolol, bisoprolol, metoprolol and nebivolol – are often used to prevent angina and treat high blood pressure.

They work by blocking the effects of a particular hormone in the body, which slows down your heartbeat and improves blood flow.

Nitrates

Nitrates are used to widen your blood vessels. Doctors sometimes refer to nitrates as vasodilators. They are available in a variety of forms, including tablets, sprays and skin patches such as glyceryl trinitrate and isosorbide mononitrate.

Nitrates work by relaxing your blood vessels, letting more blood pass through them. This lowers your blood pressure and relieves any heart pain you have. Nitrates can have some mild side effects, including headaches, dizziness and flushed skin.

ACE (angiotensin-converting enzyme) inhibitors

ACE inhibitors are commonly used to treat high blood pressure. Examples include ramipril and lisinopril. They block the activity of a hormone called angiotensin II, which causes the blood vessels to narrow. As well as stopping the heart working so hard, ACE inhibitors improve the flow of blood around the body. 

Your blood pressure will be monitored while you are taking ACE inhibitors, and regular blood tests will be needed to check that your kidneys are working properly. Around 1 in 10 people have kidney problems as a result of taking the drug.

Side effects of ACE inhibitors can include a dry cough and dizziness.

Angiotensin II receptor antagonists

Angiotensin II receptor antagonists work in a similar way to ACE inhibitors. They are used to lower your blood pressure by blocking angiotensin II. Mild dizziness is usually the only side effect. They are often prescribed as an alternative to ACE inhibitors, as they do not cause a dry cough.

Calcium channel blockers

Calcium channel blockers also work to decrease blood pressure by relaxing the muscles that make up the walls of your arteries. This causes the arteries to become wider, reducing your blood pressure. Examples include amlodipine, verapamil and diltiazem. Side effects include headaches and facial flushing, but these are mild and usually decrease over time.

Diuretics

Sometimes known as water pills, diuretics work by flushing excess water and salt from the body through urine.

Want to know more?

Procedures and surgery

If your blood vessels are narrow as the result of a build-up of atheroma (fatty deposits) or if your symptoms cannot be controlled using medication, interventional procedures or surgery may be needed to open up or bypass blocked arteries.

Some of the main procedures used to treat blocked arteries are outlined below.

Coronary angioplasty

Coronary angioplasty is also known as percutaneous coronary intervention (PCI), percutaneous transluminal coronary angioplasty (PTCA), or balloon angioplasty.

Angioplasty may be a planned procedure for some people with angina, or an urgent treatment if the symptoms have become unstable. Having a coronary angiogram will determine if you are suitable for treatment. Coronary angioplasty is also performed as an emergency treatment during a heart attack.

During angioplasty, a small balloon is inserted to push the fatty tissue in the narrowed artery outwards. This allows the blood to flow more easily. A metal stent (a wire mesh tube) is usually placed in the artery to hold it open. Drug-eluting stents can also be used. These release drugs to stop the artery narrowing again.

Coronary artery bypass graft

Coronary artery bypass grafting (CABG) is also known as bypass surgery, heart bypass, or coronary artery bypass surgery.

It is performed in patients where the arteries become narrowed or blocked. A coronary angiogram will determine if you are suitable for treatment. Off-pump coronary artery bypass (OPCAB) is a type of coronary artery bypass surgery. It is performed while the heart continues to pump blood by itself without the need for a heart-lung machine.

A blood vessel is inserted (grafted) between the aorta (the main artery leaving the heart) and a part of the coronary artery beyond the narrowed or blocked area. Sometimes one of your own arteries that supplies blood to the chest wall is used and diverted to one of the heart arteries. This allows the blood to bypass (get around) the narrowed sections of coronary arteries.

Heart transplant

In a small number of cases, when the heart is severely damaged and medicine is not effective, or when the heart becomes unable to adequately pump blood around the body (heart failure), a heart transplant may be needed.

A heart transplant involves replacing a heart that is damaged or is not working properly with a healthy donor heart. 

Want to know more?

Content Supplied by NHS Choices

Coronary heart disease

After a heart attack, 36-year-old Debbie Siddons was too scared to pick up her 18-month-old baby. Rehabilitation helped her move on with her life.

After a heart attack, 36-year-old Debbie Siddons was too scared to pick up her 18-month-old baby. Rehabilitation helped her move on with her life.

It was the usual rush in the Siddons household as Debbie raced around getting her four children ready for school. But as she strode into the living room to summon her eldest, she was suddenly stopped in her tracks by a sharp pain in her chest.

"My heart was racing, the pain was awful, and I had pins and needles in my lower jaw and down both arms," she says. "I sat down on the sofa hoping the pain would stop, but it didn't. I knew something was very wrong. I was on my own with the kids, so I got my eldest to bring me the phone. I called my mother-in-law and my father and told them I didn't feel very well. My dad was over in 10 minutes. He took one look at me and called an ambulance."

In the ambulance, paramedics gave Debbie an electrocardiogram (ECG) to test the electrical activity in her heart. She was then given an aspirin to chew. Once she got to the hospital, doctors gave her a drug to dissolve any clots in her blood that might have caused the heart attack.

"I knew it was serious, but I didn't guess how serious," she remembers. "When I got to the hospital, it was madness. Everyone was rushing around, hooking me up to machines. It didn't take the doctor long to tell me I'd suffered a heart attack. It didn't quite sink in until my mother-in-law got to the hospital and I had to tell her what had happened to me."

Debbie stayed in hospital for a week. On the sixth day, she began to experience pins and needles in her left arm. Doctors were concerned that she might be having another heart attack. As a precaution, she was given another ECG and sent for an angiogram, a procedure that checks the arteries for blockages. The angiogram was clear and Debbie didn't have another attack. The cause of her original attack is still unknown.

Back at home, she realised how much the experience had shaken her. "I was frightened to do anything. I was nervous about going up the stairs, and I was too scared to pick up my 18-month-old daughter in case I had another heart attack," she says.

"Then I was sent for rehabilitation, which really helped. We learned about healthy eating and exercise, but a big part of it was finding the confidence to carry on with our lives. The nurses reassured me that I could live a perfectly normal life again and they were right. By the end of the six-week course, I'd got my confidence back."

Two years on, Debbie still takes several drugs every day, including aspirin and a statin, to help prevent another attack. She sees a consultant once a year. But so far she hasn't had another heart attack. "It was a very frightening experience, but I came through it," she says. "I'd urge anyone who's had one to make the most of rehabilitation and use all the help they can get. It certainly helped me to move on."

Share this page