Coronary Heart Disease 
 
Coronary Heart disease (CHD) — also known as coronary artery disease (CAD) or ischaemic heart disease (IHD) — is a condition where the coronary arteries, which supply blood to the heart muscle, become narrowed or blocked due to the buildup of plaque (atherosclerosis) or thrombus. This reduces blood flow to the heart and can lead to chest pain (angina pectoris), heart attacks (myocardial infarction), or other serious complications (such as heart failure or arrhythmias). 
 
Key Points About Coronary Heart Disease 
 
1. Causes 
 
The main cause is atherosclerosis, a process where cholesterol, fats, and other substances build up in the arterial walls, forming plaques. These plaques can: 
Narrow the arteries (reducing blood flow) 
Rupture and form blood clots (thrombus), which may block the artery completely 
 
 
 
Risk factors include: 
 
High LDL (“bad”) cholesterol 
Low HDL (“good”) cholesterol 
High blood pressure 
Smoking 
Diabetes 
Obesity 
Sedentary lifestyle 
Unhealthy diet (high in saturated fats and sugars) 
Family history of heart disease 
Older age and male gender (though postmenopausal women are also at increased risk) 
 
2. Symptoms 
 
Early stages may cause no symptoms. As the disease progresses, common signs include: 
Angina pectoris (chest pain): A squeezing, pressure-like pain often triggered by exertion or stress 
Shortness of breath 
Fatigue 
Pain radiating to the arm, neck, jaw, or back 
Heart attack (myocardial infarction): if blood flow is completely blocked 
 
3. Diagnosis 
 
Electrocardiogram (ECG) 
Echocardiogram 
Stress test 
Coronary angiogram (visualizes blockages using dye and X-rays) 
CT coronary angiogram 
Blood tests (serial Troponin and cK) 
 
4. Prevention and Treatment:  
 
Lifestyle changes: 
 
Quit smoking 
Eat a heart-healthy diet (low in salt, sugar, and saturated fat) 
Exercise regularly 
Manage weight and stress 
 
Medications: 
 
(Acutely: MONA – Morphine, Oxygen, Nitrates, Aspirin – eg; ACS, MI) 

Antiplatelets: Aspirin, clopidogrel, DOAC 
Statins: To lower cholesterol 
Beta-blockers: Reduce heart workload 
ACE inhibitors/ARBs: Lower blood pressure and protect the heart 
Nitrates: Relieve chest pain (GTN) 
Ranolazine: for the management of chronic stable angina (often given in association with Beta-blockers) 
 
Procedures: 
Angioplasty and stent placement: Opens blocked arteries (early intervention provides better results (reduces lasting myocardial damage) 
Coronary artery bypass graft (CABG): Creates new pathways for blood flow