Early Warning Signs Of Coronary Heart Disease

Background 

Coronary heart disease (CHD) is a serious condition characterised by the buildup of fatty deposits, known as plaques, on the walls of the arteries that supply blood to the heart.¹ These deposits narrow the arteries, reducing blood flow to the heart and potentially leading to a range of health complications.

The manifestations of CHD can vary widely, from subtle symptoms like mild chest discomfort to more severe indicators such as intense chest pain (angina) and shortness of breath. If left untreated, CHD can also progress to life-threatening complications, including heart attacks and heart failure.

Recognising the early warning signs of CHD is crucial for seeking timely medical intervention, which can significantly improve patient outcomes and quality of life.² This article explores the various early warning signs of CHD, both common and uncommon as well as the key risk factors associated with this condition, its diagnosis and some potential prevention strategies. The aim of the article is to educate and empower readers, enabling them to recognise potential indicators of CHD and take proactive steps towards their heart health.

Risk Factors

CHD is a complex condition influenced by multiple risk factors. These factors independently increase an individual's likelihood of developing CHD as well as interacting with one another, collectively shaping a person's overall susceptibility to the condition.² Some of the more common risk factors for CHD include:³

• Age: As we age, our blood vessels naturally become less flexible and more prone to damage
• Family History: Genetic factors can predispose individuals to CHD through inherited tendencies for high blood pressure, high cholesterol, or diabetes. Some genetic variants also directly increase the risk of a person developing CHD⁴
• High Blood Pressure: Elevated pressure in arteries damages their inner lining and can make them more susceptible to fatty deposit buildup
• High Cholesterol: Excess cholesterol in the bloodstream, particularly LDL ("bad") cholesterol, can accumulate in artery walls. This forms plaques that narrow and harden arteries, contributing to CHD development
• Smoking: Nicotine, carbon monoxide and other chemicals in cigarette smoke can damage the lining of arteries
• Obesity: Excess body fat raises the risk of high blood pressure, high cholesterol and diabetes, all independent risk factors for CHD
• Diabetes: Elevated blood sugar levels can damage blood vessels and nerves controlling the heart, increasing the risk of CHD
• Chronic Stress: Contributes to CHD development and progression by increasing blood pressure, triggering inflammation, and promoting unhealthy coping behaviours like overeating, smoking, or excessive alcohol consumption

Early Warning Signs 

Recognising the common and subtle manifestations of CHD is crucial for early detection, timely intervention and improved health outcomes in patients.²

Common⁵

• Chest Pain (Angina): Can range from mild to severe. It is often described as tightness or pressure in the chest. A severe angina attack can cause a painful tightness usually in the centre of the chest, which may spread to the arms, neck, jaw, back or stomach
• Shortness of Breath: Difficulty breathing, especially during physical exercise, can be an early indicator of coronary heart disease. As the heart struggles to pump blood effectively, the body may experience a feeling of breathlessness
• Fatigue: Individuals with CHD may experience persistent fatigue or weakness, even after adequate rest
• Irregular Heartbeat: Irregular or rapid heartbeats, known as arrhythmias, can be a sign of CHD
• Dizziness: Reduced blood flow to the brain can cause feelings of dizziness or lightheadedness. This can be especially common and concerning during physical activity or when standing up quickly

Less Common⁶

• Nausea and Vomiting: In some cases, individuals with CHD may experience nausea or vomiting, particularly during periods of physical exertion or emotional stress. This is a result of the body's response to reduced blood flow to the heart
• Swelling in the Legs and Feet: When the heart receives a smaller volume of blood its pumping ability declines. This can cause fluid to accumulate in these areas and is called oedema
• Sleep disturbances: Difficulty sleeping or waking up in the night with shortness of breath can signal heart problems
• Unusual Sweating: Excessive sweating without a clear cause can indicate heart trouble

Early Diagnosis 

The diagnosis of CHD typically begins with a risk assessment conducted by a healthcare professional; this is usually a GP. They look into a person's medical and family history, lifestyle habits (smoking, exercise, diet etc.) and measure their blood pressure and cholesterol levels.¹ When a person appears to be at risk, further tests are usually carried out. 

Common diagnostic tests routinely carried out include electrocardiograms (ECG), which measure the heart's electrical activity, echocardiograms, which are ultrasounds that provide detailed images of the heart and exercise stress tests which evaluate a person's cardiac performance during physical activity.⁷ Cardiologists (doctors specialising in heart conditions) may also use more advanced imaging techniques such as cardiac magnetic resonance imaging (MRI) to detect early signs of the disease. This method is particularly helpful in visualising the arteries and detecting plaque buildup.

Sometimes, CHD can be hard to diagnose because it doesn't always have obvious symptoms. Biochemical tests can be used to help address this.⁸ These tests help detect inflammation or damage to the heart, even if a patient isn't showing any physical signs of illness. These tests primarily look at biomarkers in the blood. If these biomarkers are present, it could mean the patient has CHD, even if they seem completely healthy. These tests often go hand in hand with other diagnostic methods and allow for CHD to be detected early, sometimes even before the onset of symptoms. 

Treatment Strategies 

Preventing CHD or reducing the risk of developing it is crucial. Lifestyle changes, medications and surgical approaches are the main methods of treatment.

To prevent and manage CHD, several lifestyle changes are recommended. A diet rich in fruits and vegetables and low in saturated fats is advised. Studies show the Mediterranean and DASH diets to be particularly effective in combating the risk of developing CHD.⁹ Regular exercise, at least 150 minutes of moderate aerobic activity weekly or 75 minutes of more intensity activity are also recommended.¹⁰ Quitting smoking is also crucial, as smokers face a higher risk of developing CHD.¹ Maintaining a healthy weight is also of paramount importance in reducing the risk of diabetes, high blood pressure and high cholesterol.

Medications are also an important method of treatment. Statins are widely used to lower bad cholesterol levels, thus reducing the rate of arterial plaque buildup. Antihypertensives, which treat high blood pressure, and aspirin, which prevents dangerous clots, are also commonly prescribed to patients.¹ 

In severe cases or when other methods have failed, surgical intervention is needed. Stents, which are small mesh tubes, can be inserted into narrowed arteries to keep them open.¹ Alternatively, a healthy blood vessel can be grafted onto a blocked coronary artery in a procedure known as coronary artery bypass grafting (CABG).¹ 

Conclusion

Recognising the early warning signs of CHD is essential for its effective management. Symptoms like chest pain, shortness of breath and fatigue are commonly associated with CHD, but less obvious signs such as nausea, sleep disturbances, and unusual sweating can also indicate underlying issues. Timely diagnosis guided by risk assessments and diagnostic tests can significantly improve outcomes for sufferers of the disease. Preventive measures, including lifestyle changes, medication and surgeries are some key strategies that can be used to treat and mitigate CHD.