If your coronary arteries become partially blocked, it can cause chest pain (angina).

This can be a mild, uncomfortable feeling similar to indigestion. However, a severe angina attack can cause a painful 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. Symptoms usually pass in less than 10 minutes, and can be relieved by resting or using a nitrate tablet or spray.

Read more about treating angina.

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Heart attacks

 

If your arteries become completely blocked, it can cause a heart attack (myocardial infarction).

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

Dial 999 for immediate medical assistance if you think you're having a heart attack.

Although symptoms can vary, the discomfort or pain of a heart attack is usually similar to that of angina. However, it's often more severe and may happen when you're resting.

During a heart attack, you may also have the following symptoms:

 

• pain in other parts of the body – it can feel as if the pain is travelling from your chest to your arms, jaw, neck, back or stomach

• lightheadedness

• sweating

• nausea

• breathlessness

The symptoms of a heart attack can also 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're 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.

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A heart attack can sometimes happen without any symptoms. This is known as a silent myocardial infarction and is more common in older people and people with diabetes.

Heart failure

Heart failure can also happen 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).

What to do if someone has a heart attack

When someone has a heart attack, a bystander – often a relative with no medical expertise – is usually the first on the scene.

However, less than 1% of the population have attended an emergency life support course.

Heartstart (funded by the British Heart Foundation), British Red Crossand St John Ambulance can teach you how to help someone having a heart attack.

Coronary heart disease (CHD) is usually caused by a build-up of fatty deposits (atheroma) on the walls of the arteries around the heart (coronary arteries).

The build-up of atheroma makes the arteries narrower, restricting the flow of blood to the heart muscle. This process is called atherosclerosis.

Your risk of developing atherosclerosis is significantly increased if you:

 

• smoke

• have high blood pressure (hypertension)

• have high cholesterol

• have high levels of lipoprotein (a)

• do not exercise regularly

• 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 under the age of 55, or a female relative under 65, with CHD

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Smoking

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Smoking is a major risk factor for coronary heart disease. Both nicotine and carbon monoxide (from the smoke) put a strain on the heart by making it work faster. They also increase your risk of blood clots.

Other chemicals in cigarette smoke can damage the lining of your coronary arteries, leading to furring of the arteries. Smoking significantly increases your risk of developing heart disease.

Read about how to stop smoking and stop smoking treatments.

High blood pressure

High blood pressure (hypertension) puts a strain on your heart and can lead to CHD.

Read more about high blood pressure.

Blood Pressure UK have also produced a useful guide explaining high, low and normal blood pressure readings.

High cholesterol

Cholesterol is a fat made by the liver from the saturated fat in your diet. It's essential for healthy cells, but too much in the blood can lead to CHD.

Read more about high cholesterol.

High lipoprotein (a)

Like cholesterol, lipoprotein (a), also known as LP(a), is a type of fat made by the liver. It’s a known risk factor for cardiovascular disease and atherosclerosis.

The level of LP(a) in your blood is inherited from your parents. It’s not routinely measured, but screening is recommended for people with a moderate or high risk of developing cardiovascular disease.

Heart UK has more information about high lipoprotein (a).

Lack of regular exercise

If you’re inactive, fatty deposits can build up in your arteries.

If the arteries that supply blood to your heart become blocked, it can lead to a heart attack. If the arteries that supply blood to your brain are affected it can cause a stroke.

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Read about the physical activity guidelines for adults aged 19 to 64.

Diabetes

A high blood sugar level may lead to diabetes, which can more than double your risk of developing CHD.

Diabetes can lead to CHD because it may cause the lining of blood vessels to become thicker, which can restrict blood flow.

Thrombosis

A thrombosis is a blood clot in a vein or artery.

If a thrombosis develops in a coronary artery it prevents the blood supply from reaching the heart muscle. This usually leads to a heart attack.

Coronary heart disease (CHD) is usually diagnosed after a risk assessment and some further tests.

Risk assessment

If a GP thinks you may be at risk of CHD, they may do a risk assessment for cardiovascular disease, heart attack or stroke. 

This may be carried out as part of an NHS Health Check.

The GP will:

 

• ask about your medical and family history

• check your blood pressure

• 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's no food in your body that could affect the result.

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The GP or practice nurse can carry out the blood test. A sample will be taken either using a needle and a syringe or by pricking your finger.

The 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.

Further tests

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You may be referred for further tests to help confirm CHD. A number of different tests are used to diagnose heart-related problems, including:

 

• electrocardiogram (ECG)

• exercise stress tests

• X-rays

•  echocardiogram

• blood tests

• coronary angiography

• radionuclide tests

• MRI scans

• CT scans

Further information

 

• British Heart Foundation: tests

• Blood Pressure UK: medical tests for high blood pressure

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Procedures and surgery

If your blood vessels are narrow as the result of a build-up of atheroma (fatty deposits) or if your symptoms cannot be controlled using medicines, interventional procedures or surgery may be needed to open up or bypass blocked arteries.

Here are some of the main procedures used to treat blocked arteries.

Coronary angioplasty

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

Angioplasty may be a planned procedure for someone with angina, or an urgent treatment if the symptoms have become unstable.

Having a coronary angiogram (a type of X-ray used to check blood vessels) will determine if you're suitable for treatment.

Coronary angioplasty is also performed as an emergency treatment during a heart attack.

During the procedure, a small balloon is inserted to push the fatty tissue in the narrowed artery outwards. This allows the blood to flow more easily.

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A metal stent (a wire mesh tube) is usually placed in the artery to hold it open. Drug- eluting stents can also be used. These release medicines to stop the artery narrowing again.

Coronary artery bypass graft

Coronary artery bypass grafting (CABG) is also known as bypass surgery, a heart bypass, or coronary artery bypass surgery.

It's carried out in people whose arteries are narrowed or blocked.

A coronary angiogram will determine if you're suitable for treatment.

Off-pump coronary artery bypass (OPCAB) is a type of coronary artery bypass surgery. It's performed while the heart continues to pump blood by itself without the need for a heart-lung machine.

A blood vessel is inserted (grafted) between the main artery leaving the heart (the aorta) and a part of the coronary artery beyond the narrowed or blocked area.

Sometimes, an artery that supplies blood to the chest wall is used and diverted to one of the heart arteries. This allows the blood to bypass (get around) the narrowed sections of coronary arteries.

Heart transplant

Occasionally, when the heart is severely damaged and medicine is not effective, or when the heart becomes unable to adequately pump blood around the body (heart failure), a heart transplant may be needed.

A heart transplant involves replacing a heart that's damaged or is not working properly with a healthy donor heart.