Coronary heart disease
Coronary heart disease, also called ischaemic heart disease, is the state in which the heart muscle no longer gets enough blood because the arteries feeding…
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Medicines commonly prescribed for Coronary heart disease
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 40 mgActive substance: atorvastatinManufacturer: Sandoz Farmaceutica S.A.Prescription requiredDosage form: TABLET, 10 mgActive substance: atorvastatinManufacturer: Viatris Healthcare LimitedPrescription requiredDosage form: TABLET, 60 mgActive substance: atorvastatinManufacturer: Mabo Farma S.A.Prescription required
Coronary heart disease, also called ischaemic heart disease, is the state in which the heart muscle no longer gets enough blood because the arteries feeding it have narrowed. It is the leading cause of death worldwide and, at the same time, one of the conditions whose course a person can genuinely change: a large share of the risk depends on what happens to blood pressure, cholesterol, blood sugar and cigarettes over the coming years.
What happens in the heart's arteries
The heart is a muscle roughly the size of a fist. The blood it needs for itself does not come from the chambers inside it but from its own network of vessels running across the surface: the coronary arteries.
Over the years, fat is deposited in their walls and plaques build up; that process is called atherosclerosis and the deposit itself atheroma. The channel narrows, and under exertion the muscle stops receiving as much blood as it needs. That is angina. The greater danger lies elsewhere: the cap of a plaque can tear, a clot forms instantly at the tear, and the flow stops altogether. That is a heart attack.
How it feels
The classic sign is a pressing, squeezing pain or heaviness behind the breastbone that comes on climbing stairs, walking fast, in cold air or during a stressful moment, and eases after a few minutes of rest or with a nitrate under the tongue. It may spread to the left arm, the neck, the jaw, the back or the upper abdomen.
Often it looks quite different. Instead of pain there is breathlessness on ordinary exertion, unexplained weakness, nausea, sweating or a heaviness in the stomach much like indigestion. These atypical presentations are commoner in women, in older people and in people with diabetes, where nerve damage can blunt the pain or remove it altogether. A fair number of people learn they have the disease only on the day they have a heart attack.
There is a separate strand, heart failure: a weakened muscle pumps less well, and breathlessness on lying flat, swollen ankles and rapid fatigue appear.
Heart attack: do not wait and do not tough it out
Call emergency services immediately if chest pain or pressure:
- lasts longer than fifteen minutes and does not settle with rest;
- is not relieved by the nitrate you normally use;
- is stronger than your usual attack, or is happening for the first time;
- comes with cold sweat, nausea, vomiting, dizziness, sudden weakness or shortness of breath.
A heart attack can also strike at rest and during sleep. Every minute of delay is muscle lost, so "wait until morning" is not a decision to weigh up. Do not drive yourself and do not ask to be taken by car: the ambulance starts treatment on the way. While help is coming, sit or half-lie down and loosen tight clothing. The call handler may tell you to chew an aspirin; do so if you are not allergic to it, and they will tell you how much. If the person loses consciousness and is not breathing normally, start cardiopulmonary resuscitation and use an automated defibrillator if one is nearby.
What raises the risk
- smoking and vaping, and steady exposure to other people's smoke;
- raised blood pressure;
- high low-density lipoprotein cholesterol;
- high lipoprotein (a), an inherited value that is not measured routinely but worth checking once if there is early heart disease in the family;
- diabetes and prediabetes;
- excess weight, especially around the abdomen;
- an inactive lifestyle;
- chronic kidney disease, inflammatory joint and bowel conditions, sleep apnoea;
- heart attacks and strokes in parents or siblings at a young age.
One uncommon but serious cause is worth knowing about: familial hypercholesterolaemia, an inherited disorder in which cholesterol is high from birth and heart attacks run through the family in people's thirties and forties. It treats well and usually goes unnoticed, so speak plainly about any early cardiac events among close relatives.
In younger women, including during pregnancy and shortly after birth, a heart attack is occasionally caused not by atherosclerosis but by a spontaneous tear in a coronary artery. The symptoms are the same and the response must be just as fast.
How the diagnosis is confirmed
It starts with a conversation and an assessment of overall risk: questions about symptoms, family and lifestyle, a blood pressure reading, and blood tests for the cholesterol profile and glucose. You may be asked not to eat for a few hours before the lipid test.
Further tests are then chosen to fit the case: an electrocardiogram at rest and during exercise, an echocardiogram, CT coronary angiography, invasive coronary angiography, cardiac magnetic resonance imaging or a myocardial perfusion scan. A normal resting trace does not rule the diagnosis out; in angina it often looks entirely calm.
How it is treated
Atherosclerosis cannot be cured outright, but halting its progress, removing symptoms and sharply cutting the risk of a heart attack are all achievable. Treatment has three parts: changes to daily life, medicines and, where needed, a procedure on the arteries.
The main drug groups are:
- antiplatelet drugs, which thin the blood and hinder clot formation;
- statins and other cholesterol-lowering drugs, prescribed even when the numbers look normal, to stabilise the plaque;
- beta blockers, which slow the pulse and cut the muscle's oxygen demand;
- nitrates, which widen the vessels and stop an attack;
- angiotensin-converting enzyme inhibitors and angiotensin receptor blockers;
- calcium channel blockers and diuretics.
Finding the right combination takes time, and that is normal. Heart medicines must never be stopped abruptly or on your own initiative, because the condition worsens. Tell the doctor about side effects: there is almost always an alternative. Statins are incompatible with pregnancy, and that is discussed in advance.
One warning stands on its own: nitrates must not be combined with drugs for erectile dysfunction. Together they drop blood pressure to dangerous levels.
When medicines are not enough, the artery is opened from within with a balloon and a stent is placed. This is coronary angioplasty, which is also performed as an emergency during a heart attack. Where the disease is extensive, bypass surgery is done: a vessel taken from the patient is grafted around the narrowed section. In severe heart failure, transplantation is discussed, though rarely.
Life after a heart attack or surgery
A full life after a heart attack or heart surgery is the norm rather than the exception. The main tool here is cardiac rehabilitation: a programme running over several weeks in which exercise is built up under supervision, medicines and symptoms are explained, and help is offered with anxiety. People who complete it are readmitted to hospital less often.
Stopping smoking after a heart attack lowers the risk of a second event faster and more powerfully than any drug. Returning to work is almost always possible, sometimes with a change in the physical demands; how soon you may drive again depends on the procedure and on local rules, so ask your doctor. Sexual activity resumes as soon as ordinary exertion is tolerated again. Anxiety and low mood after a heart attack are common and treatable, and worth saying out loud.
What genuinely lowers the risk
Food: more vegetables, fruit, pulses, wholegrains, nuts, fish and vegetable oil; less processed meat, sugary drinks and shop-bought pastry. Salt: no more than a level teaspoon a day, counting what is already hidden in ready-made products.
Movement: any regular aerobic activity, from brisk walking to swimming or dancing. Starting small beats not starting.
Tobacco: quitting pays off at any age and after any number of years, and a doctor can help with medication. Alcohol: no amount has been shown to be safe for the heart, and less is better.
Numbers under control: blood pressure, cholesterol and blood sugar. The usual reference for most adults is a blood pressure below 130/80 mm Hg, though the target is set by the doctor according to age and other conditions. Prescribed drugs work only when taken continuously, not in bursts depending on how you feel.
Online consultation
Coronary heart disease is a story measured in years, and most of it consists of conversations rather than procedures. In a remote appointment the doctor builds up the picture of your risk: symptoms, family history, habits, and the results of tests and traces already done. They will explain what your blood pressure and cholesterol figures mean, go through your medicine schedule and its interactions, help you deal with side effects and point out which investigations make sense next.
The period after a heart attack or a stent also runs well remotely: how you are feeling, how much exertion is reasonable, when to go back to work, how your mood is holding. What such a consultation does not replace is emergency care. With chest pain that will not go away there is no reason to wait for an appointment: call emergency services.
This material is for information only and does not replace medical advice.
Consult with a doctor about Coronary heart disease
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Coronary heart disease
Discuss your symptoms and possible next steps for Coronary heart disease with a doctor online.
