Looking after your Coronary Heart Disease (CHD)
Also known as Ischaemic Heart Disease, it is basically furring up and blocking of the arteries feeding the heart muscle; atherosclerosis. This reduces the oxygen supply and causes painful cramping of the heart – Angina and Heart Attacks (Myocardial Infarct) when a portion of the heart muscle becomes completely starved of oxygen and can also cause reduction in heart pumping performance leading to Heart Failure.
This process of blocking of the arteries happens elsewhere in the body and so CHD is associated with other conditions where damage to ‘end organs’ occurs due to oxygen starvation, such as stroke, vascular dementia, chronic kidney disease, peripheral arterial disease. All of these together are known as Cardiovascular Disease.
Diagnosing CHD
You may have a symptoms such as Angina; pressure or pain across the chest that comes on when exercising and eases at rest or the first time you may be aware of it is with a Heart Attack (usually much worse chest pain or pressure radiating to either arm, jaw, neck, tummy or back, often with sweating, shortness of breath, nausea, lightheadedness). Heart Failure often causes shortness of breath on exercise or lying in bed and can be accompanied by swelling of the ankles, fatigue and palpitations (fast or irregular heart rhythm). Arrhythmia (abnormal heart rhythm) can also be a sign.
Often CHD is diagnosed through screening for high risk, maybe during an NHS Health Check which you can have over the age of 40y (we’ll invite you if you are eligible and do not have a pre-existing condition). Meanwhile you can check your Heart Age Test.
To look for risk factors, we’ll check some Lifestyle questions, your Family History, Body Mass Index (BMI), Blood Pressure (BP), Pulse, blood test for Cholesterol, Kidney disease and Diabetes. Ethnicity and your Post Code also play a part in risk. At the end we can calculate a risk score for CHD and give advice or treatment to reduce this risk. (You can complete a comprehensive QRisk score online too).
If you have symptoms you may have an ECG and if abnormal may need an excercise stress test, Echocardiogram and if a blockage is suspected a Coronary Angiogram or other types of imaging tests to see how much oxygen gets tothe heart muscle. For more detail on the tests used see the BHF
Preventing CHD
You can’t change your Family History, Age, Gender or Ethnicity – these are all risk factors for CHD but there are other modifiable risks which make a real difference (using the QRisk calculator you can see you much your risk varies by changing the data).
The most important modifiable risks for CHD are:
- Smoking (stopping is the most important change you can make)
- Blood Pressure
- High Cholesterol
- Overweight
- Physical Inactivity
- Diabetes
Living a Healthy Lifestyle makes a major improvement to your risks of developing CHD. Read more specific details here .
Treating CHD
All the preventative measure mentioned above are important to start now: once diagnosed with CHD these reduce your chances of further damage – ‘Secondary Prevention’
You are likely to be advised to start medication – which has been shown to significantly reduce your chances of further damage and developing the conditions caused by CHD.
Statins such as atorvastatin. These reduce your cholesterol level, especially the LDL (bad) cholesterol that lead to buildups of fatty deposits in the arteries.
Aspirin, Clopidogrel , Ticagrelor etc are ‘anti platelet drugs’ – they reduce the stickiness of the platelets in the blood , responsible for initiation the clotting process which can lead to a heart attack or stoke.
ACE inhibitors (eg Ramipril,, Perindopril) and ARBs (eg Losartan, Irbesartan). These can lower blood pressure and help treat heart failure and improve blood flow through the heart and kidneys
Beta-blockers such as Bisoprolol, Atenolol, lower blood pressure and protect against heart attacks and heart failure. They can be used for treating other conditions too.
Calcium Channel Blockers such as Amlodipine, Felodipine, reduce blood pressure, angina and some arrhythmia. They relax the walls of the blood vessels and give more oxygen to the heart muscle.
Nitrates such as GTN or Isosorbide treat angina by relaxing and widening the blood vessels in the heart and other organs.
Diuretics such as Furosemide and Bendroflumethazide can reduce fluid in the cardiovascular system to unload the heart so are used in heart failure and other conditions of fluid overload.
Anti-arrythmics such as Digoxin, Calcium Channel Blockers, Beta-Blockers can stabilise a heart with an abnormal rhythm.
Other common treatments include improving the blood supply to the heart by opening up the blocked coronary arteries – Angioplasty and Stenting or carrying out a Coronary Artery Bypass Graft surgery .