Coronary heart disease

There is no single cause for coronary heart disease, but there are risk factors that increase your chance of developing it.

There are 'modifiable' risk factors (ones that you can change), including:

• smoking – both active smoking and being exposed to second-hand smoke
• high blood cholesterol
• high blood pressure
• diabetes
• little or no physical activity
• being overweight
• depression, social isolation and a lack of social support
• familial hypercholesterolaemia.

There are also risk factors that you can't change, including:

• being male
• increasing age
• having a family history of coronary heart disease.

While some of these risk factors (such as age and gender) can't be changed, the good news is that there are many steps that you can take to reduce your risk of developing coronary heart disease.

Many people don't know they have coronary heart disease until they have angina or a heart attack.

However, if your doctor thinks you are at risk of developing coronary heart disease, he or she may arrange a number of tests (see below) to check your heart health and determine what treatments you may need.

• Electrocardiogram (ECG) and/or 'stress ECG'
  During an ECG test, electrical leads are placed on your chest, arms and legs. These leads detect small electrical signals and produce a tracing on graph paper that illustrate the electrical impulses travelling through the heart muscle. Sometimes, an additional ECG test is done while you are exercising on an exercise bike or treadmill. This is known as an exercise ECG or stress ECG (also called a stress test).
• Echocardiogram
  An echocardiogram uses ultrasound waves to produce a picture of your heart as it beats. This lets your doctor see the structure of your heart and how well it is working.
• Angiogram
  This is a special X-ray that shows whether or not your coronary arteries are narrowed or blocked. Under a local anaesthetic, a small tube (catheter) is inserted into an artery in your arm or groin and guided into the heart. Dye is injected through the catheter into the coronary arteries and X-rays are taken. The X-rays give detailed information about the condition of these arteries.

There is no cure for coronary heart disease. However, if you have coronary heart disease, there are a range of treatments your doctor might recommend to reduce your risk of future heart problems, and relieve or manage symptoms.

Medicines

There is now a wide range of medicines to treat coronary heart disease and its risk factors, such as high blood pressure and high total blood cholesterol levels. Common medicines (or classes of medicines) include:

• aspirin
• anti-anginal medications (nitrates)
• ACE inhibitors
• beta-blockers
• statins
• clopidogrel
• warfarin.

Taking these medicines as prescribed can greatly reduce your risk of further heart problems.

Remember, most medicines will need to be taken for the long term.

See the Heart Foundation (external site) or the National Prescribing Service (external site) for more information different types of medicines.

Angioplasty and stent implantation

During coronary angioplasty, a small balloon is inflated inside one or more of your coronary arteries to open up an area of your arteries that has become very narrow. This will improve blood flow to your heart.

After angioplasty is performed, a special expandable metal tube (a stent) is usually put into your artery, expanded, and left in place to keep your artery open.

Bypass surgery

Coronary artery bypass graft surgery (often shortened to CABG and pronounced cabbage) is an operation in which a blood vessel is taken from your chest, leg or forearm and grafted to your coronary artery to let blood detour past a narrowing in this artery. This improves blood flow to your heart muscle and reduces angina.

Implantable cardiac defibrillators (ICD)

An ICD is a small device that can be put into your chest and connected to your heart to monitor and correct your heartbeat.

It can either stop an arrhythmia (abnormal heart rhythm) by pacing your heart, or in more serious situations, it can give your heart a controlled electric shock to try to return it to its normal rhythm.

ICDs can also support your heartbeat like a pacemaker if it is beating very slowly, and collect and store information about your heart's electrical activity for your doctor to check.

See the Heart Foundation (external site) for more information on ICDs.

Although there is no cure for coronary heart disease, modern treatments and healthy lifestyle choices can greatly reduce your risk of further heart problems and relieve or control symptoms.

To reduce your risk and aid your recovery:

• take your medicines as prescribed
• be smoke-free
• enjoy healthy eating
• be physically active
• control your blood pressure and cholesterol
• achieve and maintain a healthy body weight
• maintain your psychological and social health.

If you have diabetes, you should generally aim to keep your blood glucose levels within the normal non-diabetic range and follow individual advice from their doctor or accredited diabetes educator.

People with certain health conditions such as heart disease are at higher risk of serious complications from flu (such as high fever and pneumonia), and are recommended to have a flu vaccine each year.

Managing heart disease for life (external site) is a short video produced by the George Institute for Global Health to highlight what Australians should know about managing heart disease.

Cardiac rehabilitation

The Heart Foundation (external site) and the World Health Organization recommend that people who have had a heart attack, heart surgery, coronary angioplasty, angina or other heart or blood vessel disease attend an appropriate cardiac rehabilitation and prevention program.

These programs help you to make practical, potentially life-saving changes to the way in which you live. They can help you and your family deal with physical, emotional, psychological, marital, sexual and work-related issues. The right rehabilitation program will help most people to reduce their risk of further heart problems.

Cardiac rehabilitation programs complement the advice that your GP and/or cardiologist gives you.