Coronary heart disease - Treatment 

Treating heart disease 

Although coronary heart disease (CHD) cannot be cured, treatment can help manage the symptoms and reduce the risk of further problems.

Good heart disease care

Effective treatment of coronary heart disease (CHD) saves lives. Since 2000, there has been a 40% reduction in deaths from heart disease in people under 75. A national review of heart disease services set out standards that define good heart disease care:

  • tackling factors that increase the risk of heart disease, such as smoking, poor diet and little physical exercise
  • preventing CHD in high-risk patients and, where patients have CHD, avoiding complications and tackling the progression of the disease
  • rapid treatment for heart attack, including the choice of angioplasty in a specialist cardiac centre
  • rapid diagnosis of heart disease and access to diagnostic tests
  • rapid access and choice of treatment centre for specialised cardiac care

Treatment overview

CHD can be managed effectively with a combination of lifestyle changes, medicine and, in some cases, surgery. With the right treatment, the symptoms of CHD can be reduced and the functioning of the heart improved.

Lifestyle changes hide

If you have been diagnosed with CHD, you can reduce your risk of further episodes by making simple lifestyle changes.

For example, stopping smoking after a heart attack will quickly reduce your risk of having a heart attack in the future to near that of a non-smoker.

Other lifestyle changes, such as eating more healthily and doing regular exercise, will also reduce your future risk of heart disease.

Read more about preventing CHD.

Want to know more?

back to top

Medicines  show

Many different medicines are used to treat CHD. Usually they either aim to reduce 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. Your GP or specialist will discuss the various options with you.

Antiplatelets

Antiplatelets are a type of medicine that can help reduce the risk of a heart attack by thinning your blood and preventing it from clotting. Common antiplatelet medicines include low-dose aspirin, clopidogrel, ticagrelor and prasugrel.

Statins

If you have a high blood cholesterol level, cholesterol-lowering medicine called statins may be prescribed. Examples include simvastatin, pravastatin and atorvastatin. They work by blocking the formation of cholesterol and increasing the number of LDL receptors in the liver, which helps remove the LDL cholesterol from your blood. This helps slow the progression of CHD, and will make having a heart attack less likely. Not all statins are suitable for everyone, so you may need to try several different types until you find one that is suitable.

Beta-blockers

Beta-blockers including acebutolol, atenolol, bisoprolol, metoprolol and propranolol  are often used to prevent angina and treat high blood pressure. They work by blocking the effects of a particular hormone in the body, which slows down your heartbeat and improves blood flow.

Nitrates

Nitrates are used to widen your blood vessels. Doctors sometimes refer to nitrates as "vasodilators". They are available in a variety of forms, including tablets, sprays, skin patches and ointments such as glyceryl trinitrate and isosorbide mononitrate.

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 and flushed skin.

ACE (angiotensin-converting enzyme) 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, which causes the blood vessels to narrow. As well as stopping the heart working so hard, ACE inhibitors improve the flow of blood around the body. 

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

If ACE inhibitors have been prescribed for you, do not stop taking them without first consulting your doctor. If you do, it is likely your symptoms will get worse quickly.

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 are used to lower your blood pressure by blocking angiotensin II. Mild dizziness is usually the only side effect. Angiotensin II receptor antagonists are 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 by relaxing the muscles that make up the walls of your arteries. This causes the arteries to become wider, reducing your blood pressure. Examples include verapamil and diltiazem. Side effects include headaches and facial flushing, but these are mild and usually decrease over time.

Want to know more?

back to top

Procedures and surgery  show

If your blood vessels are narrow due to a build-up of atheroma (fatty deposits), or if your symptoms cannot be controlled using medication, surgery may be needed to open up or replace blocked arteries. Some of the main procedures used to treat blocked arteries are outlined below.

Coronary angioplasty

Coronary angioplasty is also known as percutaneous coronary intervention (PCI), percutaneous transluminal coronary angioplasty (PTCA), or balloon angioplasty.

Angioplasty may be a planned procedure for some people with angina, or an urgent treatment if the symptoms have become unstable. Having a coronary angiogram will determine if you are suitable for treatment. Coronary angioplasty is also performed as an emergency treatment during a heart attack.

During angioplasty, 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 short, 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, heart bypass, or coronary artery bypass surgery.

It is performed in patients where the arteries become narrowed or blocked. A coronary angiogram will determine if you are suitable for treatment. Off-pump coronary artery bypass (OPCAB) is a type of coronary artery bypass surgery performed without the need for a heart-lung machine, and keeps blood and oxygen circulating around the body.

A blood vessel is inserted (grafted) between the aorta (the main artery leaving the heart) and a part of the coronary artery beyond the narrowed or blocked area. This allows the blood to bypass (get around) the narrowed sections of coronary arteries.

Heart transplant

In a small number of cases, when the heart is severely damaged and medicine is not effective, or when the heart becomes unable to adequately pump blood around the body (heart failure), a heart transplant may be needed. A heart transplant involves replacing a heart that is damaged or is not working properly with a healthy donor heart. 

Want to know more?

back to top

Page last reviewed: 10/09/2012

Next review due: 10/09/2014

Ratings

How helpful is this page?

Average rating

Based on 175 ratings

All ratings

Add your rating

Comments

Coronary heart disease (CHD)

Coronary heart disease (CHD) causes heart attacks and is the UK’s biggest killer. But by no means all heart attacks are fatal, and there's plenty you can do to avoid having one.

Media last reviewed: 21/10/2013

Next review due: 21/10/2015

Compare your options

Take a look at a simple guide to the pros and cons of different treatments for coronary heart disease

Could you have high blood pressure?

At least 25% of adults have high blood pressure. Get tips on how to keep healthy