Coronary artery disease: symptoms, causes and treatment

The NHS says the main symptoms of coronary heart disease are chest pain (angina), shortness of breath, pain in the neck, shoulders, jaw or arms, feeling faint and feeling sick. But not everyone has the same symptoms and some people may not have any before coronary heart disease is diagnosed.

BHF says CHD develops slowly over time, symptoms can be different for everyone and some people do not know they have it before they have a heart attack.

The NHS says to call 999 if you have chest pain that feels tight or like squeezing, pain spreading to the arms, neck or jaw, severe difficulty breathing, lips or skin that are pale, blue or grey, or if someone has passed out and is not responding normally. It says not to drive yourself to A&E; the 999 call handler will advise what to do.

While waiting for help, the NHS suggests sitting and resting in a comfortable position and taking a 300mg aspirin if you have one and are not allergic. If you have angina and have been given glyceryl trinitrate (GTN), use it. NHS advice for people already diagnosed with angina is to stop and rest, use GTN, take another dose after 5 minutes if needed, and call 999 if you still have symptoms 5 minutes after the second dose.

The NHS says to get help from NHS 111 if you have chest pain or other symptoms of angina that come and go, or if you have been diagnosed with angina and it feels worse than before, is happening more often, lasts longer or happens at rest.

The heart is a muscle that pumps blood around the body, and it gets its own blood supply from the coronary arteries on its surface. BHF explains that in coronary heart disease these arteries become narrowed by fatty material called atheroma (sometimes plaque) in their walls, a process called atherosclerosis. Eventually the arteries may become so narrow that they cannot get enough blood to the heart.

If a piece of atheroma breaks off, a blood clot can form around it and block the artery, cutting off blood and oxygen to the heart muscle. This is a heart attack. The NHS says CHD is a major cause of death in the UK and worldwide.

The NHS also notes that heart failure can happen in people with CHD, when the heart becomes too weak to pump blood around the body.

The NHS says CHD can be managed effectively with a combination of lifestyle changes, medicine and, in some cases, surgery. Treatment aims to reduce symptoms, improve how the heart works and lower the risk of further problems. The NHS says heart medicines should not be stopped suddenly without the advice of a doctor, because this may make symptoms worse.

The NHS says CHD is usually caused by a build-up of fatty deposits (atheroma) on the walls of the coronary arteries, which makes the arteries narrower. It says your risk of atherosclerosis is significantly increased if you smoke, have high blood pressure, have high cholesterol, have high levels of lipoprotein (a), do not exercise regularly or have diabetes. Other risk factors are being obese or overweight and having a family history of CHD.

BHF adds getting older, and says men have a higher risk from a younger age, while women's risk rises during and after the menopause. The NHS says diabetes can more than double your risk of developing CHD, and that smoking is a major risk factor because nicotine and carbon monoxide strain the heart and increase the risk of blood clots.

The NHS says CHD is usually diagnosed after a risk assessment and some further tests. A GP may ask about your medical and family history, check your blood pressure, do a blood test for cholesterol and ask about your lifestyle. This may be done as part of an NHS Health Check, which BHF says is free in England for people aged 40 to 74.

You may be referred for further tests to confirm CHD. The NHS lists an electrocardiogram (ECG), exercise stress tests, X-rays, an echocardiogram, blood tests, angiography, MRI and CT scans and a myocardial perfusion scan. A coronary angiogram is the test that shows where arteries are narrowed and whether you are suitable for angioplasty or bypass surgery.

The NHS says you can reduce your risk of developing CHD, or of further episodes if you have it, with lifestyle changes. It says 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.

• Eat a healthy, balanced diet: lower in saturated fat, with plenty of fruit and vegetables (5 portions a day) and whole grains, and no more than 6g of salt a day.

• Be physically active. The NHS says regular exercise lowers cholesterol, keeps blood pressure healthy and reduces the risk of a heart attack.

• Keep to a healthy weight and, if you smoke, give up. The NHS says you are 3 times more likely to quit successfully if you use NHS support together with stop-smoking medicines.

• If you drink, do not regularly drink more than 14 units a week, and avoid binge drinking.

• Keep blood pressure under control. The NHS says the target should be below 135/85mmHg, or below 140/90mmHg if you have diabetes and are under 80.

• Take prescribed medicines as directed, and have cholesterol, blood pressure and blood sugar checked regularly if you have diabetes.

The NHS says that if your blood vessels are narrow because of atheroma, or if your symptoms cannot be controlled using medicines, interventional procedures or surgery may be needed to open up or bypass blocked arteries.

Coronary angioplasty, also known as percutaneous coronary intervention (PCI), inserts a small balloon to push fatty tissue outwards, usually with a metal mesh stent to hold the artery open. Drug-eluting stents release medicines to stop the artery narrowing again. Coronary artery bypass grafting (CABG) grafts a blood vessel between the aorta and a part of the coronary artery beyond the narrowed area, so that blood can get around it. The NHS says a coronary angiogram will determine if you are suitable for either.

The NHS says that if you have had a heart attack, an angioplasty or heart surgery, advice and support are available to help you get back to as full a life as possible. BHF says its cardiac nurses on the Heart Helpline can answer questions, and describes support groups and an online community.

On the NHS, a GP assesses your risk and symptoms, arranges blood tests and an ECG and refers you to a cardiologist for specialist tests, medicines and, if needed, angioplasty or bypass surgery. Emergency treatment for a heart attack is always through 999 and a hospital.

Some people choose private cardiology for faster access to tests such as stress tests or CT coronary angiography. The tests and treatments are the same in either setting. Ask who will manage your medicines and follow-up over the long term, and make sure your GP has the results.