Treatment - Coronary heart disease (CHD)

Treatment for coronary heart disease (CHD) can help manage the symptoms. It can also reduce the risk of further problems.

CHD can be managed with a combination of lifestyle changes and medicine. In some cases, surgery may be needed.

With treatment, the symptoms of CHD can be reduced. Treatment can also help to improve your heart function.

Things you can do to help with coronary heart disease (CHD)

You can reduce your risk of further episodes of CHD by making some lifestyle changes.

Stopping smoking after a heart attack reduces your risk of having a heart attack in the future.

Having a healthy diet and doing regular exercise, will also reduce your risk of heart disease.

Medicines

Many different medicines are used to treat CHD. Usually, they either aim to reduce your blood pressure or widen your arteries.

Some heart medicines have side effects, so it may take a while to find one that works for you. A GP or specialist will discuss your options with you.

Heart medicines should not be stopped suddenly without the advice of your doctor. There is a risk that stopping your medicines may make your symptoms worse.

Antiplatelets

Antiplatelets are a type of medicine that can help reduce the risk of a heart attack. Antiplatelets thin your blood and prevent it from clotting.

Common antiplatelet medicines include:

• low-dose aspirin
• clopidogrel
• ticagrelor
• prasugrel

Statins

Cholesterol-lowering medicine called statins may be prescribed if you have high cholesterol.

Examples include:

• atorvastatin
• simvastatin
• rosuvastatin
• pravastatin

Statins work by blocking the formation of cholesterol. They also increase the number of low-density lipoprotein (LDL) receptors in the liver.

This helps remove LDL cholesterol from your blood, which makes a heart attack less likely. 

Not all statins are suitable for everyone. You may need to try several different types until you find one that is suitable.

Beta blockers

Beta blockers are often used to prevent angina and treat high blood pressure. They work by blocking the effects of a particular hormone in the body. Beta blockers slow down your heartbeat and improve blood flow.

Nitrates

Nitrates are used to temporarily widen your blood vessels. Doctors sometimes refer to nitrates as vasodilators. They're available in a variety of forms, including tablets, sprays and skin patches.

Nitrates work by relaxing your blood vessels, letting more blood pass through them. This lowers your blood pressure and relieves any heart pain you have.

Nitrates can have some mild side effects, including:

• headaches
• dizziness
• flushed skin

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors are commonly used to treat high blood pressure. Examples include ramipril and lisinopril. They block the activity of a hormone called angiotensin II. This hormone causes the blood vessels to narrow.

As well as stopping the heart from working so hard, ACE inhibitors improve the flow of blood around the body. 

Your blood pressure will be monitored while you're taking ACE inhibitors. Regular blood tests will be needed to check that your kidneys are working properly. Around 1 in 10 people have kidney problems as a result of taking the drug.

Side effects of ACE inhibitors can include a dry cough and dizziness.

Angiotensin II receptor antagonists

Angiotensin II receptor antagonists work in a similar way to ACE inhibitors. They're used to lower your blood pressure by blocking angiotensin II.

Mild dizziness is usually the only side effect. They're often prescribed as an alternative to ACE inhibitors, as they do not cause a dry cough.

Calcium channel blockers

Calcium channel blockers also work to decrease blood pressure. They relax the muscles that make up the walls of your arteries. This causes the arteries to become wider, reducing your blood pressure.

Examples include:

• amlodipine
• verapamil
• diltiazem
• lercanidipine

Side effects include headaches and facial flushing. But these are mild and usually decrease over time.

Diuretics

Diuretics work by flushing excess water and salt from the body through urine. Diuretics are sometimes known as water pills.

Heart procedures

A procedure may be needed to open up or bypass your narrow heart arteries if your:

• blood vessels are narrow as the result of a build-up of atheroma (fatty deposits)
• symptoms cannot be controlled using medicines

Some of the main procedures used to treat blocked arteries are:

• coronary angioplasty
• coronary artery bypass graft
• heart transplant

Coronary angioplasty

Coronary angioplasty is also known as:

• percutaneous coronary intervention (PCI)
• percutaneous transluminal coronary angioplasty (PTCA)
• balloon angioplasty

Angioplasty may be a planned procedure for some people with angina. It could also be an urgent treatment if the symptoms have become unstable.

Having a coronary angiogram will determine if you're suitable for treatment.

Coronary angioplasty is also performed as an emergency treatment during a heart attack. A small balloon is inserted to push the fatty tissue in the narrowed artery outwards. This allows the blood to flow more easily. A metal stent (a wire mesh tube) is usually placed in the artery to hold it open.

Drug-eluting stents can also be used. These release drugs to stop the artery from narrowing again.

Coronary artery bypass graft

Coronary artery bypass grafting (CABG) is also known as:

• bypass surgery
• a heart bypass
• coronary artery bypass surgery

It's performed in patients where the arteries become narrowed or blocked.

A coronary angiogram will determine if you're suitable for treatment.

A spare blood vessel from your leg, arm or chest is used to go around and bypass a blocked vessel.

Sometimes 1 of your own arteries that supply blood to the chest wall is used and diverted to one of the heart arteries. This allows the blood to bypass the narrowed sections of coronary arteries.

Heart transplant

A heart transplant replaces a damaged heart with a healthy donor heart.

A heart transplant may be needed if:

• the heart is severely damaged
• medicine is not effective
• the heart is not able to pump blood around the body