CHD (coronary heart disease)

What is coronary heart disease?

Coronary heart disease is a chronic (long-lasting) disease. It affects the blood vessels that supply blood to your heart. It is also called coronary artery disease.

Coronary heart disease is the most common cause of death in Australia, and it cannot be cured. However, there are treatments that can reduce your risk of future heart problems and improve your symptoms.

What causes coronary heart disease?

Coronary heart disease occurs when the arteries that supply your heart with blood become blocked. There is no one cause of coronary heart disease, but risk factors can increase your chance of developing the condition.

Atherosclerosis

Blockages can form because cholesterol builds up in the walls of your blood vessels, forming plaque. Over time, the plaque grows. This makes the blood vessel narrower and allows less blood through. This is called atherosclerosis.

Sometimes parts of the plaque can break off and leave the blood vessel damaged. When the body tries to repair this damage, a blood clot can form. This can completely stop all or some of your blood flow.

Your symptoms will depend on the part of your body affected.

If your heart doesn’t get enough blood, you may experience:

• chest pain
• breathlessness
• heart attack

If blood flow to your brain is affected, this can cause a stroke. A stroke can cause:

• a loss of body control
• loss of speech
• death

If blood flow to your limbs is affected, this can cause complications such as:

• numbness
• pain
• gangrene (tissue death)
• loss of mobility

Atherosclerosis progresses slowly.

Risk factors

Some risk factors for coronary heart disease are modifiable. That means you can change them. These include:

• smoking
• excessive alcohol consumption
• lack of exercise
• social isolation
• being overweight or obese

These factors can all be changed to decrease your risk of developing coronary heart disease.

Other risk factors for developing coronary heart disease cannot be altered, such as:

• your age
• being male
• your ethnicity

You also can’t control if you have a family history that increases your risk of coronary heart disease. You may be at higher risk if you have a family history of:

• coronary heart disease
• high levels of sugar in the blood (diabetes)
• high blood pressure
• high cholesterol

Some diseases can also increase your risk of developing coronary heart disease. These include:

• high cholesterol
• high blood pressure
• diabetes
• depression

If you have any of these conditions, talk with your doctor. They can provide you with advice on how to management and treatment.

What are the symptoms of coronary heart disease?

Coronary heart disease develops slowly. You may not experience any symptoms in the early stages of the disease. Many people only discover that they have coronary heart disease when they experience:

• chest pain (angina)
• a heart attack

Symptoms of heart attacks can vary between different people, and especially between males and females.

Both males and females generally experience:

• chest pain
• pain in the neck or left arm
• a feeling of being cold and sweaty
• nausea
• shortness of breath
• greater tiredness than usual.

Many females suffer from less common warning signs such as:

• pain in your neck, jaw, shoulder, upper back, or abdomen (stomach)
• shortness of breath with or without chest pain
• pain in one or both arms
• nausea or vomiting
• breaking out in a cold sweat
• light-headedness or dizziness
• unusual feelings of tiredness
• heart palpitations

What are the complications of coronary heart disease?

Coronary heart disease can cause serious complications which can be life threatening. As well as heart attack and angina, coronary heart disease may cause:

• arrhythmia — abnormal heart rhythms
• heart failure — weakening of the heart muscle
• ischaemic heart disease — lack of blood to the heart

When should I see my doctor?

Many people do not know that they are suffering from coronary heart disease until they experience symptoms. These can include chest pain or having a heart attack. Don’t wait until you begin noticing symptoms before speaking with your doctor.

If you’re aged 45 years and over, you should arrange a Heart Health Check with your doctor. A Heart Health Check will monitor your risk for developing coronary heart disease.

If you’re Aboriginal and/or Torres Strait Islander you can get a Heart Health Check from the age of 30 years.

At your Heart Health Check, a doctor or nurse will consider different factors, including your:

• blood pressure
• blood sugar levels
• cholesterol levels
• family history
• lifestyle

If needed, your doctor or nurse will work with you to create a management plan. This will help you to keep your heart healthy.

Can coronary heart disease be prevented?

You can prevent coronary heart disease by reducing or eliminating your risk factors. A Heart Health Check with your doctor or nurse will help you to identify your risk factors.

These may include:

• smoking
• drinking alcohol
• high cholesterol
• diabetes
• high blood pressure
• not enough exercise
• unhealthy weight
• older age
• ethnicity
• family history of coronary heart disease

By identifying your risk factors, you can build a plan to manage them.

Your doctor may think you may already have coronary heart disease. If so, they will do some tests to confirm their diagnosis. These may include:

• an angiogram or cardiac catheterization
• an echocardiogram
• an electrocardiogram
• a stress test
• heart scan

An angiogram involves injecting dye into an artery through a catheter. This dye will show up on X-rays and can help identify blocked arteries. This procedure can help diagnose coronary heart disease.

Echocardiograms use ultrasound to examine your heart structure and heart beats. This can be done internally (trans-oesophageal) or externally.

An electrocardiogram examines your heart’s activity by use of electrodes.

A stress test is usually completed on a tread mill. It shows how your heart copes with physical activity.

If you have coronary heart disease, your doctor will help you build a personalised management plan. This plan will help improve your symptoms and help prevent you from having heart attacks.

If you have had a heart attack, it is even more important that you:

• manage your risk factors
• follow your management plan
• check in frequently with your healthcare team

Need a Heart Health Check?

If you don’t have a regular doctor, use the Healthdirect Service finder to find a health service near you.

How is coronary heart disease treated?

Coronary heart disease is treated through a combination of lifestyle changes, medicines and sometimes surgery. This will not cure your coronary heart disease. However, it will reduce your symptoms and lessen your chance of having a heart attack in the future.

Lifestyle changes

Maintaining a healthy lifestyle is very important to help you manage coronary heart disease. This will ensure your symptoms don’t get worse over time. This could include:

• becoming smoke-free
• improving your diet
• reducing your stress
• exercising regularly

Cigarette smoke damages your artery walls and reduces the amount of oxygen in your blood. Reducing your smoking habit can improve your coronary heart disease symptoms.

A good diet can help you maintain a healthy weight and reduce the amount of cholesterol in your blood.

Stress increases your blood pressure. Finding ways to relax can help your blood pressure stay at a healthy level.

Staying fit will mean your heart does not have to work as hard to pump blood around your body.

Cardiac rehabilitation can help you make practical changes in your lifestyle, especially if you:

• are at risk of having a heart attack
• have had a heart attack in the past
• are experiencing chest pain (angina)

Medicines

Coronary heart disease is also treated with medicines. These can help reduce your risk factors and treat your symptoms.

These may include treatments that:

• lower your blood pressure
• lower your cholesterol
• prevent blood clots
• ease your chest pain (angina)

Medicines that lower blood pressure can reduce the strain on your heart. These may include angiotensin-converting enzyme ACE inhibitors and angiotensin II receptor blockers (ARBs).

Medicines such as statins can help reduce the level of cholesterol in your blood.

Blood clot formation can be prevented in your heart’s blood vessels by medicines such as aspirin.

Chest pain (angina) can be treated by medicines such as nitrate mouth spray.

Beta-blockers can also be used to help your heart pump stronger and slower.

Surgical treatments

In some cases, you may need surgery to improve the blood flow to your heart. Surgical treatments include:

• angioplasty and stent implantation
• bypass surgery (coronary artery bypass graft surgery)
• implantable cardioverter defibrillator (ICD)

Angioplasty involves placing a small, inflated balloon in the blocked blood vessel. This clears the way for blood to flow through. After this, an expandable metal tube (stent) is left in place to keep the blood vessel open.

Cardiac bypass surgery can improve the blood flow to your heart and reduce chest pain (angina).

An ICD is a small device placed near your heart that detects and corrects abnormal heart rhythms.