Coronary heart disease

Also called CHD, Ischaemic heart disease, Coronary artery disease

The disease behind angina and most heart attacks. Largely preventable, and the treatment that works best is the least glamorous.

What it is

Furring and narrowing of the arteries supplying the heart muscle, by fatty deposits called plaques. It is the underlying disease; angina is its symptom and a heart attack is what happens when a plaque ruptures and a clot blocks the artery completely.

It remains one of the leading causes of death in the UK, and the risk factors are well known and mostly modifiable: smoking, high blood pressure, high cholesterol, type 2 diabetes, inactivity, obesity and family history.

The same process in other arteries produces stroke and peripheral arterial disease, which is why someone diagnosed with one should be assessed for all three.

Two things about treatment surprise people. Stents relieve angina but, in stable disease, do not usually prevent heart attacks or extend life; tablets and lifestyle do that. And cardiac rehabilitation, a structured exercise and education programme, reduces death and readmission substantially, is free, and is taken up by less than half of those offered it.

Women's symptoms differ more often than men's, they are diagnosed later, and they are less likely to be offered rehabilitation. That gap is well documented and worth naming.

Signs you might notice

Chest tightness, heaviness or pressure on exertion, easing with rest. See angina.

Breathlessness on exertion, sometimes without any chest pain at all.

Pain spreading to the arm, neck, jaw, back or stomach.

Unusual tiredness, nausea, sweating, or a sense of dread. These are more often the presenting symptoms in women, in older people and in people with diabetes, whose nerve damage can mute the pain.

999 immediately: chest pain lasting more than 15 minutes, pain not relieved by GTN spray, or chest discomfort with sweating, breathlessness, nausea or collapse.

Often there are no symptoms until the first event, which is why risk assessment matters.

How it can affect day-to-day life

The fear after a diagnosis is usually larger than the restriction. People stop walking, stop lifting, stop having sex, and nobody has told them they do not need to.

Cardiac rehabilitation is where that gets fixed, and it is under-used partly because it is offered once, in hospital, when the person is too shocked to take it in. Asking again a fortnight later changes the answer.

Depression after a cardiac event is common, is associated with worse outcomes, and is rarely asked about.

Medication is for life and stopping it is the commonest avoidable cause of a second event. Side effects are a reason to change the drug, not to stop taking one.

Supporting someone well

Go to cardiac rehabilitation. It is the single most under-used effective treatment in this entry.

Take the statin, the blood pressure treatment and the antiplatelet, and raise side effects rather than quietly stopping.

Stop smoking. Within a year the excess risk falls by around half.

Move: brisk walking most days does more than most people believe, and the programme will set a safe level.

Ask what to do when symptoms occur: how to use GTN, how long to wait, and when to call 999. Write it down.

Ask directly about mood, and about sex, which almost nobody raises and almost everybody wonders about.

Have the family learn CPR and where the nearest defibrillator is.

Where to get help

A GP practice for risk assessment and management; the cardiology team after an event.

999 for chest pain lasting more than 15 minutes or with sweating, breathlessness or collapse.

British Heart Foundation helpline: 0808 802 1234, and their cardiac rehabilitation information.