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Coronary heart disease

 

Approximately 10,000 people die each year from cardiovascular disease (CVD) - including coronary heart disease (CHD), stroke and other circulatory diseases. CVD is the most common cause of death in Ireland, accounting for 36% of all deaths. The largest number of these deaths relate to CHD - mainly heart attack - at 5,000. 22% of premature deaths (under age 65) are from CVD.

About the heart

The heart is a muscle that is 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 organs of your body 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 surface of your heart, called coronary arteries.

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. If your coronary arteries become narrow due to a build-up of atheroma, the blood supply to your heart will be restricted. This can cause angina (chest pains).

If a coronary artery becomes completely blocked, it can cause a heart attack. The medical term for a heart attack is myocardial infarction.

By making some simple lifestyle changes, you can reduce your risk of getting CHD. If you already have heart disease, you can take steps to reduce your risk of developing further heart-related problems. Keeping your heart healthy will also have other health benefits, and help reduce your risk of stroke and dementia.

 


If your coronary arteries become partially blocked, it can cause chest pain (angina). If they become completely blocked, it can cause a heart attack (myocardial infarction).

Some people experience different symptoms, including palpitations and unusual breathlessness. In some cases, people may not have symptoms of coronary heart disease (CHD) at all before they are diagnosed.

Angina

Angina is a symptom of CHD. It can be a mild, uncomfortable feeling that is similar to indigestion. However, a severe angina attack can cause a 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. The symptoms usually pass in less than 10 minutes and can be relieved by resting or using a nitrate tablet or spray.

Heart attacks

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

If you think you are having a heart attack, dial 999 for immediate medical assistance.

The discomfort or pain of a heart attack is similar to that of angina but it is often more severe. During a heart attack you may also experience the following symptoms:

  • sweating
  • light-headedness
  • nausea
  • breathlessness

The symptoms of a heart attack can 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 happen at any time, including while you are 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 are not usually relieved using a nitrate tablet or spray.

Heart failure

Heart failure can occur in people with CHD. The heart becomes too weak to pump blood around the body, which can cause fluid to build up in the lungs, making it increasingly difficult to breathe. Heart failure can happen suddenly (acute heart failure) or gradually, over time (chronic heart failure).

Glossary

Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.
Acute
Acute means occuring suddenly or over a short period of time.
Palpitations
Palpitations refer to an irregular heartbeat, or the sensation of skipped or extra heartbeats.
Arteries
Arteries are blood vessels that carry blood from the heart to the rest of the body.

Do you know what to do if someone has a heart attack?

When a heart attack happens, a bystander, often a relative with no medical expertise, is likely to be the first on the scene. Yet less than 1% of the population have attended an emergency life support (ELS) course. Contact the Irish Heart Foundation to learn how you can help in these situations.

Coronary heart disease (CHD) is usually caused by a build-up of fatty deposits on the walls of the coronary arteries. The fatty deposits, called atheroma, are made up of cholesterol and other waste substances.The build-up of atheroma on the walls of the coronary arteries makes the arteries narrower and restricts the flow of blood to the heart. This process is called atherosclerosis.

Your risk of developing atherosclerosis is significantly increased if you:smoke have high blood pressure have a high blood cholesterol level do not take regular exercise 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 with CHD under 55 or a female relative under 65

 

Cholesterol

Cholesterol is a fat made by the liver from the saturated fat that we eat. Cholesterol is essential for healthy cells, but if there is too much in the blood it can lead to CHD.Cholesterol is carried in the blood stream by molecules called lipoproteins. There are several different types of lipoproteins, but two of the main ones are low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL, often referred to as bad cholesterol, takes cholesterol from the liver and delivers it to cells.

LDL cholesterol tends to build up on the walls of the coronary arteries, increasing your risk of heart disease. HDL, often referred to good cholesterol, carries cholesterol away from the cells and back to the liver, where it is broken down or passed from the body as a waste product.In the UK, the current government recommendation is that you should have a total blood cholesterol level of less than 5mmol/litre, and an LDL cholesterol level of under 3mmol/litre and this should be even lower if you have symptoms of CHD.

 

High blood pressure

High blood pressure (hypertension) puts a strain on your heart and can lead to CHD.Blood pressure is measured at two points during the blood circulation cycle. The systolic pressure is a measure of your blood pressure as the heart contracts and pumps blood out. The diastolic pressure is a measure of your blood pressure when your heart is relaxed and filling up with blood.Blood pressure is measured in terms of millimetres of mercury (mmHg). When you have your blood pressure measured, the systolic pressure is the first, higher number to be recorded. The diastolic pressure is the second, lower number to be recorded. High blood pressure is defined as a systolic pressure of 140mmHg or more, or a diastolic pressure of 90mmHg or more.

Smoking

Smoking is a major risk factor. Carbon monoxide (from the smoke) and nicotine both put a strain on the heart by making it work faster. They also increase your risk of blood clots. Other chemicals in cigarette smoke damage the lining of your coronary arteries, leading to furring of the arteries. If you smoke, you increase your risk of developing heart disease by 24%.

 

Thrombosis

A thrombosis is a blood clot within an artery (or a vein). If a thrombosis occurs in a coronary artery (coronary thrombosis), it will cause the artery to narrow, increasing your chance of having a heart attack as the blood clot prevents the blood supply from reaching the heart muscle. Coronary thrombosis usually happens at the same place as where atherosclerosis is forming (furring of the coronary arteries).

Glossary

Arteries
Arteries are blood vessels that carry blood from the heart to the rest of the body.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Obesity
Obesity is when a person has an abnormally high amount of body fat.
Cholesterol
Cholesterol is a fatty substance made by the body that lives in blood and tissue. It is used to make bile acid, hormones and vitamin D.

Apples versus pears

Your body shape may increase your risk of CHD. The incidence of heart disease and diabetes is higher in people who are ‘apple-shaped', i.e. who store fat around their abdomens, than in those who are ‘pear-shaped', i.e. with fat mostly around the hips and thighs. .

Know your blood pressure

The normal range for blood pressure readings is 120/80 to 140/90, although many healthy people have a lower blood pressure than 120/80. If yours is consistently high, you have a greater risk of developing coronary heart disease and having a stroke. Ask your GP to check your blood pressure.

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

Your doctor will ask about your medical and family history, check your blood pressure and 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 and will take a sample 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.

To confirm a suspected diagnosis you may be referred for more tests. A number of different tests are used to diagnose heart-related problems including:

  • electrocardiogram (ECG)
  • x-rays
  • echocardiogram
  • blood tests
  • coronary angiography
  • radionuclide tests 
  • magnetic resonance imaging (MRI)

Electrocardiogram (ECG)

An ECG records the rhythm and electrical activity of your heart. A number of electrodes (small, sticky patches) are put on your arms, legs and chest. The electrodes are connected to a machine that records the electrical signals of each heartbeat.

Although an ECG can detect problems with your heart rhythm, an abnormal reading does not always mean that there is anything wrong, nor does a normal reading rule out heart problems.

In some cases you may have an exercise ECG test or 'stress test'. This is when an ECG recording is taken while you are exercising (usually on a treadmill or exercise bike). If you experience pain while exercising, the test can help to identify whether your symptoms are caused by angina, which is usually due to CHD.

X-rays

An x-ray may be used to look at the heart, lungs and chest wall. This can help to rule out any other conditions which may be causing your symptoms.

Echocardiogram (echo)

An echocardiogram is similar to the ultrasound scan used in pregnancy. It produces an image of your heart using sound waves. The test can identify the structure, thickness and movement of each heart valve and can be used to create a detailed picture of the heart.

During an echocardiogram you will be asked to remove your top and a small handheld device, called a transducer, will be passed over your chest. Lubricating gel is put onto your skin to allow the transducer to move smoothly and make sure there is continuous contact between the sensor and the skin.

Blood tests

In addition to cholesterol testing, you may need to have a number of blood tests that are used to monitor the activity of the heart. These include cardiac enzyme tests, which can show whether there is damage to the heart muscle, and thyroid function tests.

Coronary angiography

Coronary angiography, also known as a catheter test, is usually performed under local anaesthetic. As well as providing information about your heart's blood pressure and how well your heart is functioning, an angiogram can also identify whether the coronary arteries are narrowed and how severe any blockages are.

In an angiogram, a catheter (flexible tube) is passed into an artery in your groin or arm and it is guided into the coronary arteries using X-rays. A dye is injected into the catheter to show up the arteries supplying your heart with blood. A number of X-ray pictures are taken, which will highlight any blockages.

A coronary angiogram is a relatively safe procedure and serious complications are rare. The risk of having a heart attack, stroke or dying during the procedure is estimated at about one or two in every 1,000. However, after having a coronary angiogram, you may experience some minor side effects including:

  • a slightly strange sensation when the dye is put down the catheter
  • a small amount of bleeding when the catheter is removed
  • a bruise in your groin or arm

Radionuclide tests

Radionuclide tests are used to diagnose CHD. They can also indicate how strongly your heart pumps and show the flow of blood to the muscular walls of your heart. Radionuclide tests provide more detailed information than the exercise ECG test.

During a radionuclide test, a small amount of a radioactive substance, called an isotope, is injected into your blood (sometimes during exercise). If you have difficulty exercising, you may be given some medication to make your heart beat faster. A camera placed close to your chest picks up the radiation transmitted by the isotope as it passes through your heart.

Magnetic resonance testing (MRI)

An MRI scan can be used to produce detailed pictures of your heart. During an MRI scan, you lie inside a tunnel-like scanner that has a magnet around the outside. The scanner uses a magnetic field and radio waves to produce detailed images.

 

Lifestyle changes

If you have been diagnosed with CHD, you can reduce your risk of further episodes by making simple lifestyle changes. Stopping smoking after a heart attack, for example, will quickly reduce your risk of a future heart attack to near that of a non-smoker. Other lifestyle changes, such as eating more healthily and being more physically active, will also reduce your future risk of heart disease.

Medicines

Many different medicines are used to treat CHD. Some heart medicines have side effects, so it may take a while to find one that works for you. Your GP or specialist will be able to discuss the various options with you.

ACE (angiotensin-converting enzyme) inhibitors

ACE inhibitors are commonly used to treat high blood pressure. Examples include captopril and enalapril. 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 one in 10 people have kidney problems as a result of taking ACE inhibitors.

If ACE inhibitors have been prescribed for you, do not stop taking them without first consulting you doctor. If you do, it is likely that your symptoms will get worse quickly.

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

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 limiting angiotensin II. Mild dizziness is usually the only side effect. Angiotensin II receptor antagonists 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 verapamil and diltiazem. Side effects include headache and facial flushing but these are mild and usually decrease over time.

Thiazide diuretics

Diruetics work by reducing the amount of water in your blood and widening your arteries, thereby reducing blood pressure. They are not recommended for pregnant women or people who have gout (a type of arthritis where crystals develop inside the joints).

Thiazide diuretics have been known to reduce the level of potassium in your blood, which can interfere with your heart and kidney functions. They can also raise the level of sugar in your blood, which could lead to diabetes. Therefore, you will probably be recommended to have blood and urine tests every six months so your potassium and blood sugar levels can be monitored.

Beta blockers

Beta blockers, including acebutolol, atenolol, bisprolol, metoprolol and propranolol, are often used to prevent angina and treat high blood pressure. They work by blocking the effects of a particular hormone in the body and this slows down your heartbeat and improves blood flow.

Statins

If you have a high blood cholesterol level, cholesterol-lowering medicine called statins may be prescribed. Examples include simvastatin, pravastatin and atorvastatin. They work by blocking the formation of cholesterol and increasing the number of LDL receptors in the liver, which help to remove the LDL cholesterol from your blood. This helps to slow the progression of CHD, and will make having a heart attack less likely. 

Low-dose aspirin

Low-dose aspirin may be prescribed for you by your doctor unless there are reasons not to, e.g. if you have a bleeding disorder. This type of medicine will help prevent your blood clotting and can help to reduce your risk of heart attack and angina.

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, skin patches and ointments, examples include glyceryl trinitrate and isosorbide dinitrate.

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

Procedures and surgery

If your blood vessels are narrow due to a build up of atheroma (fatty deposits), or if your symptoms cannot be controlled using medication, surgery may be needed to open up or replace the blocked arteries. Some of the main procedures that can be used to treat blocked arteries are outlined below.

Coronary angioplasty

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

Angioplasty may be a planned procedure for some people with angina or as 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 short, 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 from narrowing again.

Coronary artery bypass graft

A coronary artery bypass graft is also known as bypass surgery, heart bypass, 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 performed without a heart-lung machine that keeps blood and oxygen circulating around the body.

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. 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 less efficient at pumping 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. 

The purpose of cardiac rehabilitation is to help you to recover and resume a normal life as soon as possible after having a heart transplant, a coronary angioplasty or coronary artery bypass surgery. It may also be useful if you have other heart-related conditions, such as a heart attack, angina or heart failure.

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

What happens in 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 is important that you continue to take regular exercise and lead a healthy lifestyle. This will help to protect your heart and reduce the risk of further heart-related problems.

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 support from the people involved in your care. Self-care includes the actions you take for yourself every day in order to stay fit and maintain good physical and mental health, 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 reach 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 or have had a heart condition or if you are 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 Ireland 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.

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 with people about your condition, even if they are close to you. Be open about how you feel and let your family and friends know what they can do to help. But do not feel shy about telling them that you need some time to yourself.

 

Your sex life

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

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 that 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.

There are several ways that you can help to reduce your risk of developing coronary heart disease (CHD), these include reducing your blood pressure and cholesterol levels. There are a number of ways you can do this, including:

Eat a healthy, balanced diet

A low-fat, high-fibre diet is recommended, including plenty of fresh fruit and vegetables (five portions a day) and whole grains. You should limit the amount of salt that you eat to no more than 6g (0.2oz) a day because too much salt will increase your blood pressure. Six grams 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 your cholesterol levels.

Foods high in saturated fat include:

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

However, a balanced diet should include a small amount of unsaturated fat, which will help reduce your cholesterol levels.

Foods high in unsaturated fat include:

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

Be more physically active

Combining a healthy diet with regular exercise is the best way to maintain 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, it will lower your cholesterol level, and also keep your blood pressure at a healthy level.

Keep to a healthy weight

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

 

Give up smoking

If you smoke, giving up will reduce your risk of developing CHD. Smoking is a major risk factor for developing atherosclerosis (hardening of the arteries). It also causes the majority of cases of coronary thrombosis in people under the age of 50.

Research has shown that you are up to four times more likely to successfully give up smoking if you use NHS support together with stop-smoking medicines, such as patches or gum. Ask your doctor about this or visit www.quit.ie.

Reduce your alcohol consumption

If you drink, make sure that you stick to recommended guidelines. The recommended weekly limit of alcohol consumption for men is twenty one standard drinks and for women fourteen standard drinks. Always avoid binge drinking.

Keep your blood pressure under control

You can keep your blood pressure under control by eating a healthy diet that is 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 140/85mmHg. If you have high blood pressure, ask your GP to check your blood pressure regularly.

Keep your diabetes under control

If you are diabetic, you have a greater risk of developing CHD. You can reduce your chances of developing diabetes by being physically active, controlling your weight, and keeping your blood pressure under control. If you have diabetes, these three things will also help you to keep control of your blood sugar level. If you are diabetic, your target blood pressure level is below 130/80mmHg.

Take any medication that is prescribed for you

If you have CHD, you may be prescribed medication to help relieve your symptoms and stop further problems developing. If you do not have CHD but you 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 are prescribed medication, it is vital that you take it and follow the correct dosage. Do not 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.

People who do not exercise are twice as likely to have a heart attack as those who exercise regularly

The heart is a muscle and like any other muscle it benefits from exercise. A strong heart can pump more blood around your body with less effort. Any aerobic exercise, e.g. walking, swimming, even dancing, makes your heart work harder and keeps it healthy. 


Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.