Overview
The coronary arteries lie on the surface of the heart and supply the heart muscle itself. In coronary artery disease, fatty deposits called build up inside their walls, a process known as atherosclerosis.
As the artery narrows, the heart muscle may get enough blood at rest but not during effort, and that shortage causes the chest discomfort called . If a plaque cracks and a clot forms on it, the artery can block completely and heart muscle begins to die: that is a heart attack.
Symptoms
The common symptoms are:
- Chest tightness, heaviness, pressure or burning, brought on by walking, climbing, heavy work or stress
- Discomfort spreading to the arm, jaw, neck, back or upper tummy
- Breathlessness on effort, and unusual tiredness
- Sweating, nausea or a feeling like indigestion
usually lasts a few minutes and eases with rest. Many people have no symptoms until a heart attack, and people with diabetes may feel very little pain.
When to see a doctor
See a doctor within a few days for chest tightness that comes with exertion and settles with rest, for angina happening more often, or for new breathlessness on stairs.
Causes
is made of , fat, calcium and other material in the blood. It collects where an artery lining has been injured, and high cholesterol, high , high blood sugar and tobacco smoke all injure that lining.
The build-up happens slowly over decades. A heart attack happens suddenly, when a plaque breaks and a clot forms on top of it and blocks the artery.
Risk factors
- Smoking or chewing tobacco
- High
- High
- Diabetes
- Being overweight and physically inactive
- A family history of early heart disease
- South Asian ancestry
- Older age
- Heavy alcohol use
- Long-term kidney disease
Complications
- Heart attack
- Heart failure, when damaged muscle can no longer pump well
- Irregular heart rhythms, including
- Sudden cardiac arrest
- that limits everyday activity
Prevention
- Stopping all forms of tobacco, and avoiding other people's smoke
- Keeping , blood sugar and within the doctor's targets
- Eating more vegetables, fruit, pulses and whole grains, and less fried food
- Using less salt and limiting alcohol
- Being active for at least 150 minutes a week
- Keeping to a healthy weight
- Taking prescribed medicines regularly
Diagnosis
The doctor starts with the symptoms, the risk factors and the family history, then examines the person and arranges tests. These may include:
- Blood tests for , blood sugar and markers of heart muscle damage
- An , at rest and sometimes during exercise on a treadmill
- An , an scan of the heart
- A of the coronary arteries
- A coronary angiogram, in which dye injected through a thin tube shows the narrowings
Treatment
Treatment has three parts. The first is a change in daily habits, above all stopping tobacco, becoming more active and eating better.
The second is medicines: usually something to reduce clotting, something to lower , and medicines to lower and ease the work of the heart. A spray or tablet under the tongue relieves an attack of .
The third, when a narrowing is severe, is a procedure to restore blood flow. In a balloon opens the narrowed part and a small metal tube called a holds it open. In bypass surgery a blood vessel from elsewhere carries blood past the blockage. follows.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Heart blockage is an old person's problem, so there is no need to worry in my thirties or forties.”What is true?
Fact
The fatty build-up begins quietly many years before symptoms appear, and people of South Asian origin tend to develop it earlier than people elsewhere. Smoking, diabetes, high blood pressure and high cholesterol can bring on a heart attack well before old age.
Myth“If the chest pain settles after a few minutes of rest, it was nothing serious.”What is true?
Fact
Pain that comes on with effort and settles with rest is the typical picture of angina, which means the heart is not getting enough blood. It is a warning that needs assessment, not a sign that everything is fine.
Myth“A normal ECG means the heart arteries are clear.”What is true?
Fact
A resting ECG is often normal in someone with narrowed arteries, because the shortage of blood shows up mainly during exertion. Doctors use the history along with other tests, such as a treadmill test, an echocardiogram or an angiogram, to see the real picture.
Myth“After a stent or bypass the blockage is cured and the medicines can stop.”What is true?
Fact
A stent or bypass restores blood flow past a narrowing, but it does not remove the disease from the rest of the arteries. Medicines, a change in diet, activity and stopping tobacco are what keep new blockages from forming, and stopping them without advice is risky.
Myth“Chest pain is always the first sign, so no pain means no heart disease.”What is true?
Fact
Some people, particularly those with diabetes, older people and some women, have little or no chest pain. Breathlessness, unusual tiredness, sweating or a feeling like indigestion may be the only signs, and in some the first sign is a heart attack.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
What is the difference between angina and a heart attack?
Angina is chest discomfort caused by a temporary shortage of blood to the heart muscle, usually during effort, and it settles with rest. A heart attack happens when an artery blocks completely, the pain does not settle, and heart muscle begins to die. Angina is a warning; a heart attack is an emergency.
Will a stent cure my blockage?
A stent opens one narrowed segment and can relieve symptoms quickly, but the underlying disease is still present in the rest of the arteries. Medicines, diet, exercise and staying off tobacco are what protect the heart in the long run, and they continue after the procedure.
Is it safe to exercise if I have been diagnosed with heart disease?
For most people regular activity is part of the treatment rather than a danger, but the safe amount depends on how the heart is working and on any symptoms. Ask your doctor what level suits you, and build up gradually. A cardiac rehabilitation programme is designed exactly for this.
Can walking and diet alone clear an existing blockage?
Diet and exercise lower cholesterol and blood pressure and can slow or stabilise the build-up, which is valuable. They do not dissolve an established blockage. They work best alongside prescribed medicines and, where needed, a procedure to restore blood flow.
