Key facts
- Coronary heart disease affects the arteries that supply oxygen-rich blood to the heart muscle.
- Atherosclerosis can gradually narrow these arteries and reduce blood flow to the heart.
- Chest pain or pressure during exertion can occur, but some people have few or no obvious symptoms.
- High cholesterol, high blood pressure, diabetes and smoking are important cardiovascular risk factors.
- Sudden persistent chest pain or other symptoms suggesting a heart attack require urgent medical attention.
Signs and symptoms
Coronary heart disease may cause chest pressure, tightness or discomfort, particularly during physical activity or other situations that increase the heart’s workload.
Other possible symptoms include shortness of breath, fatigue or reduced exercise tolerance. Symptoms vary, and some people may have little warning before a more serious cardiovascular event.
Risk factors
High cholesterol
High blood pressure
Type 2 diabetes
Smoking
Increasing age
Family history of early coronary heart disease
Physical inactivity
Excess body weight or other metabolic health risks
Common causes
Coronary heart disease usually develops through atherosclerosis, a process in which fatty deposits and other material build up within the walls of the coronary arteries.
Over time, these plaques can narrow the arteries and restrict blood flow to the heart muscle. Cardiovascular risk factors such as high cholesterol, high blood pressure, diabetes and smoking can contribute to this process.
How it is checked
Assessment begins with symptoms, medical history, cardiovascular risk factors and a physical examination.
An ECG may provide information about the heart’s electrical activity, while blood pressure, cholesterol and blood glucose testing help assess cardiovascular risk. Depending on the clinical situation, further tests such as exercise testing, heart imaging or coronary artery imaging may be considered.
Assessment and investigations
ECG
An ECG records the electrical activity of the heart and may show changes relevant to coronary heart disease or previous heart injury, although a normal resting ECG does not rule out coronary artery disease.
Lipid Profile
A lipid profile measures cholesterol and triglycerides and helps assess cardiovascular risk, including LDL cholesterol that contributes to atherosclerotic plaque formation.
HbA1c
HbA1c provides information about average blood glucose over time. Diabetes is an important cardiovascular risk factor and commonly needs to be considered when assessing coronary heart disease risk.
When to see a doctor
Arrange medical assessment if you develop recurring chest pressure or discomfort, unexplained breathlessness or a noticeable decline in exercise tolerance, particularly if you have cardiovascular risk factors.
Seek urgent medical attention for new or severe chest pain or pressure that does not settle, especially if it occurs with sweating, nausea, severe breathlessness, fainting or pain spreading to the arm, jaw, back or shoulder.
Frequently asked questions
Can coronary heart disease develop without symptoms?
Yes. Coronary arteries can become narrowed gradually without causing obvious symptoms. Some people only develop symptoms when the heart needs more oxygen during exertion, while others may first become aware of the disease after a cardiovascular event.
Is coronary heart disease the same as a heart attack?
No. Coronary heart disease describes disease in the arteries supplying the heart. A heart attack can occur when blood flow through one of these arteries becomes suddenly blocked, causing damage to the heart muscle.
Can a normal ECG rule out coronary heart disease?
No. A resting ECG can provide useful information about heart rhythm and previous or current heart changes, but a normal ECG does not exclude narrowed coronary arteries. Further assessment may be needed depending on symptoms and risk.
What increases the risk of coronary heart disease?
Important risk factors include high cholesterol, high blood pressure, diabetes, smoking, increasing age and a family history of early heart disease. Several risk factors often occur together, so overall cardiovascular risk is more useful than considering one factor alone.