Coronary Heart Disease Treatment

Coronary heart disease overview

Coronary Heart Disease (CHD) is a condition that sees the narrowing of blood vessels that feed blood to your heart. Reduced blood to the heart can cause angina and heart attacks. Treatment options for CHD sufferers have developed rapidly within the past few decades as technology and research evolve, reducing patient mortality rates steadily throughout the years. Despite this, CHD remains a large threat, resulting in deadly cardiac events that are responsible for approximately one-third of deaths in people aged over 35.1 

CHD is both common and dangerous, placing massive strain on our national health service. It is important to increase our collective understanding of the treatment protocols for CHD and its complications, so that we are armed with sufficient knowledge to make important medical decisions for ourselves or loved ones should that moment arise.

Causes, symptoms and diagnosis

Causes of coronary heart disease

CHD describes the gradual narrowing of the coronary arteries. Coronary arteries are the vessels that directly supply your heart muscle walls with oxygen and nutrient-rich blood for its pumping. This narrowing is due to the build-up of fatty cholesterol-based deposits called atheromas on the artery’s inner walls. An atheroma’s presence will reduce the size of the blood vessel's hollow middle, reducing the amount of blood it can deliver to the heart. Atheromas are calcified (hardened), which makes the coronary arteries much less flexible and in turn much more susceptible to wear and tear. 

This begins a vicious cycle of increasing the risk of the type of vessel injury that will spark the formation of atheroma in the first place. Heart muscle cells depend on a constant flow of oxygen-rich blood for respiration and to fuel the muscle with enough energy for contraction. Without this, these muscle cells will tire and die, reducing the heart's capacity to pump blood to all areas of the body. Furthermore, these atheromas can rupture. In response, a blood clot will form over the rupture site and will fully block the blood vessel, suddenly cutting off the heart's blood supply and causing a heart attack. In these ways, CHD directs a massive burden on the heart, with life-threatening consequences.

The formation of these fatty plaques that contribute to CHD is caused by many different things. Atheromas are made up of cholesterol, so high amounts of cholesterol circulating in your blood due to an unhealthy diet will increase the likelihood of CHD incidence. Furthermore, atheromas and blood clots form in response to blood vessel injury, acting like a plaster over a cut. These injuries are frequently caused by the strain exerted on the heart and vessels by high blood pressure. High blood pressure can be caused by a variety of issues, from eating too many salty foods to stress.

Symptoms of coronary heart disease

The symptoms of CHD look different to everyone. Due to the disease’s slow, progressive nature, it can go under the radar in many people until a heart attack happens. However, there are some warning signs to look out for. Angina is the most common symptom of CHD.2 Caused by the reduced blood flow to the heart, angina pain can appear mainly in the chest but also can be present in the arms, neck, back, jaw, and abdomen. CHD can also present in symptoms such as breathlessness, dizziness, light-headedness, and nausea. If only a mild angina attack, these symptoms should disappear after a few minutes with proper rest and medication. However, heart attacks share these symptoms, so it is important to stay alert and cautious when you or someone you love is experiencing these symptoms. 

If the symptoms go on for longer than 5 minutes, you may be having a heart attack. Similarly, if you are experiencing these symptoms and have not been diagnosed with any heart conditions before, stop what you are doing, call an ambulance, and then sit down and rest while you wait for the paramedics. To ease the pain of your symptoms you can take aspirin (if you are not allergic and it is easy to get to). Chew on one 300 mg tablet while waiting for help. 

How is it diagnosed

We must diagnose CHD as early as possible to give patients the best possible treatment. If someone is suspected to have CHD, the need for a diagnostic test is investigated first. This is done by assessing the patient’s cardiovascular risk by doing blood tests and taking each patient's medical, lifestyle, and family history. If these result in warning signs of CHD, the physician will okay the diagnostic tests. 

Diagnosis is achieved using many different techniques, from monitoring your heart beating patterns via an ECG (especially when doing exercise during a treadmill stress test), to chest diagnostic imaging using x-ray, MRI and CT scans and coronary angiograms to assess the heart and vessel physiology.3 This method will let physicians know where the blockages are and how severe they are so that a treatment plan can be recommended.

Risk factors

CHD is a multifactorial disease, and its many risk factors include:4

  • High blood pressure
  • High cholesterol
  • Smoking
  • Physical inactivity
  • Obesity
  • Stress
  • Alcohol abuse
  • Dehydration
  • Sleep deprivation
  • Family history of circulatory diseases
  • Ageing 
  • Ethnicity5

Treatment for coronary heart disease

Before medicines and surgery are recommended, you should try to manage CHD with lifestyle changes. These will be steps to reduce the day-to-day cardiac risk factors you come across in your routine. Stopping smoking, maintaining a balanced diet, and increasing your exercise levels are some of the changes you can implement to reduce the likelihood of further heart attacks and angina episodes occurring. After diagnosis, you can speak to your GP for support in making these preventative lifestyle changes.

Medical professionals can prescribe a variety of different medicines to help you manage your CHD symptoms and improve your condition overall. High blood pressure is a large CHD risk factor as it can damage the vessels transporting your blood, triggering atheroma and blood clot formation. 

Drugs given to CHD patients to lower blood pressure include beta blockers to stop your heart from beating as fast, ACE inhibitors to relax and widen your blood vessels, and calcium channel inhibitors to widen your arteries by forcing the blood vessels’ muscular walls to relax, all of which reduce blood pressure.6,7,8 

Nitrate-based medicines like GTN spray can be prescribed to CHD patients. They act quickly to dilate blood vessels, increasing the amount of blood flow to the heart and reducing blood pressure.9 If you call an ambulance due to heart attack symptoms, one of the first things they will do is give you nitrate-based medicine to rapidly ease your symptoms. 

High cholesterol puts you at major cardiac risk. Cholesterol levels can be medically reduced with statins, which inhibit the production of cholesterol in the liver, reducing the chances of fatty plaques forming that contribute to CHD.10 

Lastly, heart attacks are a serious complication of CHD. To avoid this, CHD patients can be given blood-thinning medicines like low-dose aspirin. This reduces the likelihood of clots forming, and so indirectly prevent heart attacks.11

If your CHD is severe, surgical intervention may be the most beneficial treatment route. The two main procedures used to treat CHD patients are a coronary angioplasty and a coronary bypass graft. 

Coronary angioplasties are carried out with the intention of reopening blocked arteries to restore blood flow to the heart. The procedure entails inserting a small tube-shaped balloon into the area of the artery with the blockage of fatty atheroma along with a metal stent to keep it in place. The balloon is then inflated, forcing the artery to expand around it, widening the vessel and making it functional again.12 In contrast, coronary bypass graft surgeries are much more invasive. This type of surgery involves the complete rerouting of the coronary arterial circuit to the heart so that the blood flow can avoid the blocked area, but still reach its target. This is done by constructing a new vessel to get around the blockage, almost like a shortcut to avoid a traffic jam.13


How can we prevent coronary heart disease

Whilst the sheer amount of risk factors for CHD may be daunting, the good thing about them is that the majority are lifestyle factors that you can change. Take control of your own health and avoid CHD by taking up these lifestyle habits:14

  • Stop smoking
  • Eat a healthy balanced, low-fat diet
  • Improve exercise habits
  • Limit alcohol consumed
  • Stay hydrated
  • Get 8 hrs of sleep every night
  • Eliminate day-to-day stressors in life


If you are worried about your heart health and are experiencing any of the symptoms of CHD, seek medical advice as soon as possible. Early detection and access to treatment can save lives. There are a wide range of treatment options available to give patients the best possible treatment outcomes, and there are many lifestyle changes you can put into practice to allow for a better quality of life. 


  1. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. Annals of translational medicine. 2016 Jul;4(13).
  2. Lockyer L. Women's interpretation of their coronary heart disease symptoms. European Journal of Cardiovascular Nursing. 2005 Mar;4(1):29-35.
  4. Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, Ellis SG, Lincoff AM, Topol EJ. Prevalence of conventional risk factors in patients with coronary heart disease. Jama. 2003 Aug 20;290(7):898-904.
  5. Mochari-Greenberger H, Mosca L. Differential outcomes by race and ethnicity in patients with coronary heart disease: a contemporary review. Current cardiovascular risk reports. 2015 May;9(5):1-7.
  6. Wiysonge CS, Bradley HA, Volmink J, Mayosi BM, Opie LH. Beta‐blockers for hypertension. Cochrane database of systematic reviews. 2017(1).
  7. Bicket DP. Using ACE inhibitors appropriately. American family physician. 2002 Aug 1;66(3):461.
  8. Eisenberg MJ, Brox A, Bestawros AN. Calcium channel blockers: an update. The American journal of medicine. 2004 Jan 1;116(1):35-43.
  9. Parker JO, Vankoughnett KA, Farrell B. Nitroglycerin lingual spray: clinical efficacy and dose-response relation. The American journal of cardiology. 1986 Jan 1;57(1):1-5.
  10. Sarti C, Gallagher J. The metabolic syndrome: prevalence, CHD risk, and treatment. Journal of Diabetes and its Complications. 2006 Mar 1;20(2):121-32.
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Frankie Perrett

MSc Molecular Medicine and BSc Biological Sciences – University of East Anglia, Norwich

Frankie works in an NHS Hospital Pathology laboratory so has acquired excellent insight into many different diseases and their mechanisms of action.

Frankie’s Master’s course focused on key areas of biomedicine, centring around patient-first learning. In her degree, she specialised in Lung adenocarcinoma and its mechanisms of cell communication.

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