What is coronary heart disease?

Coronary heart disease is a condition where blockages build up in your heart coronary arteries. These blockages are made up of fatty deposits, cholesterol and blood clots and are what is known as atherosclerosis. Other names for this disease are “coronary artery disease” or just “ischaemic heart disease”. If the blockages reach a point that blood flow in the coronary arteries becomes compromised, people are at risk of developing angina, heart attacks and weakened heart muscle.

What are the symptoms of coronary heart disease?

Coronary disease typically causes angina, which is intermittent discomfort in the chest usually on exertion. However, the symptoms of angina are very variable, and people can experience discomfort in areas other than their chest, including their jaw, neck, arms, back and even teeth. Angina can also occur after eating, at night or even at rest in some people. There may be other related symptoms such as shortness of breath, sweating and palpitations. If you have chest pain or discomfort that is new or different and could be angina, you should see a doctor right away.

Many people with coronary heart disease may have no symptoms. In other cases, the first symptom of coronary disease may be a heart attack. There may be no warning symptoms before a heart attack and that is why it is so important to know how to spot a heart attack.

Symptoms of a heart attack can include:

• pain, pressure, or discomfort in the centre of the chest
• pain, tingling, or discomfort in other parts of the upper body, including the arms, back, neck, jaw, or stomach
• shortness of breath
• nausea, vomiting, burping, or heartburn
• sweating or having cold, clammy skin
• racing or uneven heartbeat
• feeling dizzy or lightheaded

If these symptoms last more than 10 minutes or they keep coming and going, call for an ambulance right away. Do not try to get to the hospital on your own.

Is there a test for coronary heart disease?

Coronary heart disease is often suspected from a person’s description of their symptoms. Your doctor will then usually perform a number of diagnostic tests to help confirm the diagnosis. These may include:

• Electrocardiogram (ECG): This test measures the electrical activity in your heart
  Troponin blood test: This blood test measures the level of a specific protein in your blood called troponin. The levels are normally undetectable, but in cases of heart attack, the heart muscle damage that occurs results in the leaking of troponin out of the heart muscle and into the blood stream. This blood test is used to diagnose heart attacks.
• Stress test: A stress test puts your heart under additional physical stress and can help identify whether coronary disease is present. It may be detected by the onset of symptoms, the development of specific ECG changes or alterations in your heart rate and blood pressure.
• Echocardiogram: This test uses sound waves to image your heart and its components. While the echo cannot visualise the coronary arteries directly, it can identify the effects of coronary heart disease such as weakened heart muscle or signs of a previous heart attack.
• Coronary angiogram: This is an invasive procedure where a thin catheter tube is inserted into the body, advanced to the heart and is used to inject X-ray dye directly into the coronary arteries. X-ray pictures are taken and provide a very high quality picture of the coronary arteries. This is the best test available to diagnose the presence of significant obstructive coronary disease.
• Cardiac CT: In recent years, special CT scans have been developed that provide images of coronary arteries that are almost as high quality as a conventional invasive coronary angiogram. They use the same dye as coronary angiography, but are non-invasive and use much lower doses of X-rays. They are a suitable alternative to stress tests or conventional angiography under certain circumstances and have become an additional useful tool for your doctor to help diagnose and manage coronary heart disease.

How is coronary heart disease treated?

A multi-treatment approach is required for the management of coronary heart disease. The various components include:

1. Lifestyle changes

• quit smoking
• walk or do some form of physically activity on most days of the week
• eat lots of fruits and vegetables and low-fat dairy products, and avoid a lot of meat or fatty foods
• lose weight if you are overweight.

2. Medicines

The medicines that treat heart disease are very important. They are aimed at alleviating symptoms, halting the progression of coronary disease and in some cases, may actually prolong life. Medicines your doctor might prescribe include:

• medicines to prevent and treat angina. These may include nitrates, beta blockers and calcium antagonists
  aspirin, clopidogrel (Plavix) and other medicines that help prevent blood clots form in the coronary arteries

statins to lower cholesterol

• medicines to lower blood pressure
• medicines to treat diabetes

3. Procedures for treatment of coronary disease:

• coronary angioplasty and stent insertion
• bypass surgery