Overview

Symptoms

The most common symptom of coronary heart disease (CHD) is chest pain (angina) and breathlessness

But some people may not have any symptoms before they are diagnosed.

Angina

If your coronary arteries become partially blocked, it can cause chest pain (angina). This can be a mild, uncomfortable feeling similar to indigestion.

However, a severe angina attack can cause a painful feeling of heaviness or tightness, usually in the centre of the chest, which may spread to the arms, neck, jaw, back or stomach.

Angina is often triggered by physical activity or stressful situations. Symptoms usually pass in less than 10 minutes, and can be relieved by resting or using a nitrate tablet or spray.

Heart attacks

If your arteries become completely blocked, it can cause a heart attack (myocardial infarction).

Heart attacks can permanently damage the heart muscle and, if not treated straight away, can be fatal.

Dial 999 for immediate medical assistance if you think you're having a heart attack.

Although symptoms can vary, the discomfort or pain of a heart attack is usually similar to that of angina. However, it's often more severe and may happen when you're resting.

During a heart attack, you may also experience the following symptoms:

• pain in other parts of the body - it can feel as if the pain is travelling from your chest to your arms, jaw, neck, back or stomach
• lightheadedness
• sweating
• nausea
• breathlessness

The symptoms of a heart attack can also be similar to indigestion. For example, they may include a feeling of heaviness in your chest, a stomach ache or heartburn.

A heart attack can occur at any time, including while you're resting. If heart pains last longer than 15 minutes, it may be the start of a heart attack.

Unlike angina, the symptoms of a heart attack aren't usually relieved using a nitrate tablet or spray.

A heart attack can occur without any symptoms. This is known as a silent myocardial infarction and is more common in elderly people and people with diabetes.

Heart failure

Heart failure can also occur in people with CHD. The heart becomes too weak to pump blood around the body. This can cause fluid to build up in the lungs, making it increasingly difficult to breathe.

Heart failure can occur suddenly (acute heart failure) or gradually over time (chronic heart failure).

What to do if someone has a heart attack

When someone has a heart attack, a bystander - often a relative with no medical expertise - is usually the first on the scene.

However, less than 1% of the population have attended an emergency life support course.

The following organisations can teach you how to help someone having a heart attack:

• British Heart Foundation: could you save a life?
• British Red Cross: first aid courses
• St John Ambulance: find first aid courses near you

Who can get it

Coronary heart disease (CHD) is usually caused by a build-up of fatty deposits (atheroma) on the walls of the arteries around the heart (coronary arteries).

The build-up of atheroma makes the arteries narrower, restricting the flow of blood to the heart muscle. This process is called atherosclerosis.

Your risk of developing atherosclerosis is significantly increased if you:

• smoke
• have high blood pressure (hypertension)
• have  high cholesterol
• have high levels of lipoprotein (a)
• do not  exercise regularly
• have diabetes

Other risk factors for developing atherosclerosis include:

• being obese or overweight
• having a family history of CHD - the risk is increased if you have a male relative under the age of 55, or a female relative under 65, with CHD 

High cholesterol

Cholesterol is a fat made by the liver from the saturated fat in your diet. It's essential for healthy cells, but too much in the blood can lead to CHD.

Read more about high cholesterol. 

High blood pressure

High blood pressure (hypertension) puts a strain on your heart and can lead to CHD.

Read more about high blood pressure.

Blood Pressure UK have also produced a useful guide explaining high, low and normal blood pressure readings.   

High lipoprotein (a)

Like cholesterol, lipoprotein (a), also known as LP (a) is a type of fat made by the liver. It's known risk factor for cardiovascular disease and atherosclerosis.

The level of LP (a) in your blood is inherited from your parents. It's not routinely measured, but screening is recommended for people with a moderate or high risk of developing cardivascular disease.

Heart UK has more information about high lipoprotein (a)

Lack of regular exercise

If you are inactive, fatty deposits can build up in your arteries.

If the arteries that supply blood to your heart become blocked, it can lead to a heart attack. If the arteries that supply blood to your brain are affected it can cause a stroke.

Smoking

Smoking is a major risk factor for coronary heart disease. Both nicotine and carbon monoxide (from the smoke) put a strain on the heart by making it work faster. They also increase your risk of blood clots.

Other chemicals in cigarette smoke can damage the lining of your coronary arteries, leading to furring of the arteries. Smoking significally increases your risk of developing heart disease.

Read about how to stop smoking and stop smoking treatments.

Diabetes

A high blood sugar level may lead to diabetes, which can more than double your risk of developing CHD.

Diabetes can lead to CHD because it may cause the lining of blood vessels to become thicker, which can restrict blood flow.

Thrombosis

A thrombosis is a blood clot in a vein or artery.

If a thrombosis occurs in a coronary artery it prevents the blood supply from reaching the heart muscle. This usually leads to a heart attack.

Diagnosis

Coronary heart disease (CHD) is usually diagnosed after a risk assessment and some further tests.

Risk assessment

If your doctor thinks you may be at risk of CHD, they may carry out a risk assessment for cardiovascular disease, heart attack or stroke. 

Your GP will:

• ask about your medical and family history
• check your blood pressure
• do a blood test to assess your cholesterol level

Before having the cholesterol test, you may be asked not to eat for 12 hours so there is no food in your body that could affect the result.

Your GP or practice nurse can carry out the blood test. A sample will be taken either using a needle and a syringe or by pricking your finger.

Your GP will also ask about your lifestyle, how much exercise you do and whether you smoke. All these factors will be considered as part of the diagnosis.

Further tests

You may be referred for further tests to help confirm CHD. A number of different tests are used to diagnose heart-related problems, including:

• electrocardiogram (ECG)
• exercise stress tests
• X-rays
• echocardiogram
• blood tests
• coronary angiography 
• radionuclide tests
• MRI scans 
• CT scans

Further information

British Heart Foundation: tests
Blood Pressure UK: medical tests for high blood pressure

Treatment

Treatment for coronary heart disease (CHD) can help manage the symptoms and reduce the risk of further problems.

CHD can be managed effectively with a combination of lifestyle changes, medicine and, in some cases, surgery.

With the right treatment, the symptoms of CHD can be reduced and the functioning of the heart improved.

The various treatments for CHD are outlined below.

Things you can do to help with coronary heart disease (CHD)

If you've been diagnosed with coronary heart disease,making simple lifestyle changes can reduce your risk of having further episodes.

For example, stopping smoking after a heart attack quickly reduces 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.

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.

Blood-thinning medicines

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

Common blood-thinning medicines include:

• low-dose aspirin
• clopidogrel
• rivaroxaban
• ticagrelor
• prasugrel

Statins

If you have a high cholesterol level, cholesterol-lowering medicine called statins may be prescribed. Examples include:

• atorvastatin
• simvastatin
• rosuvastatin
• pravastatin

Statins work by blocking the formation of cholesterol and increasing the number of  low density lipoprotein (LDL) receptors in the liver. This helps remove LDL cholesterol from your blood, which makes 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're 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.

Angiotensin-converting enzyme (ACE) 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- 2, 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're taking ACE inhibitors, and regular blood tests will be needed to check that your kidneys are working properly. Around one in ten people have kidney problems as a result of taking the drug.

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

Angiotensin-2 receptor blockers (ARBs)

Angiotensin-2 receptor blockers (ARBs) work in a similar way to ACE inhibitors. They are used to lower your blood pressure by blocking angiotensin-2.

Mild dizziness is usually the only side effect. They're often prescribed as an alternative to ACE inhibitors, as they don't 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.

• British Heart Foundation: medicines for your heart

Procedures and surgery

If your blood vessels are narrow as the result of a build-up of atheroma (fatty deposits) or if your symptoms can't 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 (a type of x-ray used to check blood vessels) will determine if you're suitable for treatment. Coronary angioplasty is also performed as an emergency treatment during a heart attack.

During the procedure, 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, a heart bypass, or coronary artery bypass surgery.

It's carried out in people whose arteries are narrowed or blocked. A coronary angiogram will determine if you're suitable for treatment. Off-pump coronary artery bypass (OPCAB) is a type of coronary artery bypass surgery. It's 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 main artery leaving the heart (the aorta) 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

Occasionally, 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. 

Further information

• British Heart Foundation: heart surgery

Recovery

It's possible to lead a normal life after having heart surgery or problems like a heart attack.

Cardiac rehabilitation programme

If you have heart surgery, a member of the cardiac rehabilitation team may visit you in hospital to give you information about your condition and the procedure you're having.

This care will usually continue after you've left hospital. For the first few weeks after your surgery, a member of the cardiac rehabilitation team may visit you at home or call you to check on your progress.

Cardiac rehabilitation programmes can vary widely throughout the country, but most will cover the following basic areas:

• exercise
• education
• relaxation and emotional support

Once you have completed your rehabilitation programme, it's important you continue to take regular exercise and lead a healthy lifestyle. This will help protect your heart and reduce the risk of further heart-related problems.

Further information

• British Heart Foundation: cardiac rehabilitation

Self care

Self care is an integral part of daily life, and is all about you taking responsibility for your own health and wellbeing with the support of those involved in your care.

Self care includes actions you take for yourself every day so you stay fit and maintain good physical and mental health. It also helps you to prevent illness or accidents and care more effectively for minor ailments and long-term conditions.

People living with long-term conditions can benefit enormously from being supported so they can achieve self care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life, and be more active and independent.

Support groups

If you have a heart condition, or if you're caring for someone with a heart condition, you might find it useful to meet other people in your area who are in a similar situation.

There are a number of heart support groups around the UK that organise regular exercise sessions, such as walking groups, as well as other social activities. Your GP or specialist can provide you with details about your nearest group.

Further information

• British Heart Foundation: how we can help you
• British Heart Foundation: call the Heart Helpline on 0300 330 3311

Relationships and sex

Coming to terms with a long-term condition such as heart disease can put a strain on you, your family and your friends. It can be difficult to talk to people about your condition, even if they're close to you.

Be open about how you feel and let your family and friends know what they can do to help. But don't feel shy about telling them you need some time to yourself.

Your sex life

If you have coronary heart disease (CHD) or you've recently had heart surgery, you may be concerned about having sex. Usually, you can resume sexual activity as soon as you feel well enough.

Communicate with your partner and stay open-minded. Explore what you both like sexually. Simply touching, being touched and being close to someone helps a person feel loved and special.

Further information

• British Heart Foundation: sex and heart conditions

Returning to work

After recovering from heart surgery, you should be able to return to work, but it may be necessary to change the type of work you do. For example, you may not be able to do a job that involves heavy physical exertion.

Your specialist will be able to advise you about when you can return to work and what type of activities you should avoid.

Want to know more?

• British Heart Foundation: returning to work

Financial support

If you're unable to work after having heart surgery, you may be entitled to financial support, such as:

• GOV.UK: Attendance Allowance 
• GOV.UK: Disability Living Allowance 
• GOV.UK: Statutory Sick Pay 

If you're caring for someone who has heart disease, you may also be entitled to financial support.

To find out if you're entitled to financial support, you can contact your local Social Security department. To request a claim form, contact the Disability Service Centre.

Further information

• British Heart Foundation: finance and benefits
• GOV.UK: benefits and financial support

Prevention

There are several ways you can help reduce your risk of developing coronary heart disease (CHD), such as lowering your blood pressure and cholesterol levels.

Eat a healthy, balanced diet

A low-fat, high-fibre diet is recommended, which should include plenty of fresh fruit and vegetables (five portions a day) and whole grains.

You should limit the amount of salt you eat to no more than 6g (0.2oz) a day as too much salt will increase your blood pressure. 6g of salt is about one teaspoonful.

There are two types of fat: saturated and unsaturated. You should avoid food containing saturated fats, because these will increase the levels of bad cholesterol in your blood.

Foods high in saturated fat include:

• meat pies 
• sausages and fatty cuts of meat 
• butter 
• ghee – a type of butter often used in Indian cooking 
• lard 
• cream 
• hard cheese 
• cakes and biscuits 
• foods that contain coconut or palm oil

However, a balanced diet should still include unsaturated fats, which have been shown to increase levels of good cholesterol and help reduce any blockage in your arteries.

Foods high in unsaturated fat include:

• oily fish 
• avocados 
• nuts and seeds 
• sunflower, rapeseed, olive and vegetable oils

You should also try to avoid too much sugar in your diet, as this can increase your chances of developing diabetes, which is proven to dramatically increase your chances of developing CHD.

Be more physically active

Combining a healthy diet with regular exercise is the best way of maintaining a healthy weight. Having a healthy weight reduces your chances of developing high blood pressure.

Regular exercise will make your heart and blood circulatory system more efficient, lower your cholesterol level, and also keep your blood pressure at a healthy level.

Exercising regularly reduces your risk of having a heart attack. The heart s a muscle and, like any other muscle, benefits from exercise. A strong heart can pump more blood around your body with less effort.

Any aerobic exercise, such as walking, swimming and dancing makes your heart work harder and keeps it healthy.

Keep to a healthy weight

Your GP or practice nurse can tell you what your ideal weight is in relation to your height and build. Alternatively, find out what your body mass index (BMI) is by using our BMI calculator.

Give up smoking

If you smoke, giving up will reduce your risk of developing CHD.

Smoking is a major risk factor for developing atherosclerosis (furring of the arteries).

Research has shown you're up to 3 times more likely to successfully give up smoking if you use NHS support together with stop-smoking medicines, such as patches or gum.

Read more about stopping smoking.

Reduce your alcohol consumption

If you drink, do not exceed the maximum recommended limits.

• men and women are advised not to regularly drink more than 14 units a week
• spread your drinking over three days or more if you drink as much as 14 units a week
• if you want to cut down, try to have several drink-free days each week

Always avoid binge drinking, as this increases the risk of a heart attack.

Keep your blood pressure under control

You can keep your blood pressure under control by eating a healthy diet low in saturated fat, exercising regularly and, if required, taking the appropriate medication to lower your blood pressure.

Your target blood pressure should be below 135/85mmHg. If you have high blood pressure, ask your GP to check your blood pressure regularly.

Read more about high blood pressure

Keep your diabetes under control

You have a greater chance of developing CHD if you have diabetes. You can help lower your risk of heart problems by being physically active and controlling your weight.

It’s also important to have your blood pressure, cholesterol and blood sugar levels (HBA1C) checked regularly.

If you have diabetes and you are under the age of 80, your target blood pressure level should be below 140/90mmHg.

Read more about diabetes

Take any prescribed medicine

If you have CHD, you may be prescribed medicine to help relieve your symptoms and stop further problems developing.

If you don't have CHD but have high cholesterol, high blood pressure or a history of family heart disease, your doctor may prescribe medication to prevent you developing heart-related problems.

If you're prescribed medication, it's vital you take it and follow the correct dosage. Don't stop taking your medication without consulting your doctor first, as doing so is likely to make your symptoms worse and put your health at risk.