Coronary Artery Disease

The most commonly experienced symptom of coronary artery disease is angina. Angina is a condition caused by the narrowing of the arteries due to fatty buildups of plaque. Chest pain is a result of restricted blood flow to the heart and other parts of the body. It can feel dull, heavy or tight across the chest. The pain may be triggered by stress or exercise and may spread into your arm, neck, jaw or back. The pain of angina should stop after resting for a few minutes.

Other symptoms might include:

• Breathlessness
• Pain or discomfort in the arm or shoulder
• Heart attack

A heart attack can happen without any previous warning signs or symptoms. You should immediately call 999 if you develop sudden pain in your chest that:

• Feels tight, heavy or crushing
• Continues for more than 15 minutes
• Spreads into the arms, neck, jaw or through to the back
• Is associated with breathlessness, clamminess, sweating or your heart racing
• Makes you feel unwell, weak or nauseous

Prompt treatment can prevent heart damage and could save your life.

There are several risk factors that can increase your chance of developing coronary artery disease. These include:

• Smoking
• Being overweight or obese
• Your age
• Your family history
• Hypertension (high blood pressure)
• Diabetes
• High cholesterol

Although you can’t control some factors like your age or your family history, a healthy lifestyle can help lower your risk of developing coronary artery disease.

Our state-of-the-art cardiology clinic offers the latest investigative procedures to identify coronary heart disease. Depending on your symptoms, your examination and your health, investigations could include:

Electrocardiogram (ECG) - This simple, non-invasive test that records your heart’s rate, rhythm and electrical activity. It’s also called a resting ECG.

Echocardiogram - An echo for short, this test uses ultrasound waves to create a moving image of your heart

Exercise stress test - This ECG test is conducted while you exercise, such as walking on a treadmill or using an stationary bike

Cardiac MRI - this non-invasive test uses an MRI machine to create magnetic and radio waves to show detailed pictures of the inside of your heart

Carotid artery ultrasound - Scanning the carotid artery in the neck is an effective, low-radiation way of measuring the lining thickness and the size of any fatty plaques. Ambulatory blood pressure monitoring

Holter monitoring - Also called ambulatory ECG monitoring, this is a small, wearable device that is used to record your heart’s electrical activity over 24-48 hours.

CT angiography - A computed tomography (CT) scan is a non-invasive imaging test that looks at the coronary arteries for calcium buildup and plaque.

Coronary angiography - During a minimally invasive investigative procedure called cardiac catheterisation in which a thin, flexible tube is inserted into the artery via the groin, arm or neck, X-rays and contrast dye are used to take detailed pictures of the coronary arteries.

We believe that any treatment for coronary artery disease needs to start with a comprehensive look at your whole health. Coronary artery disease often goes hand-in-hand with other chronic conditions like hypertension and diabetes so it’s important to diagnose any underlying conditions and carefully treat and manage them.

Your consultant will create a customised plan designed around your needs. This could include setting up a plan of support to help you improve your lifestyle, prescribing medication and referring you for any surgical procedures to improve the blood supply to your heart.

Lifestyle changes
You can do a lot to reduce the buildup of fatty deposits in your arteries and protect your heart. Healthy lifestyle changes include:

• Quitting smoking
• Exercising regularly
• Eating a balanced diet
• Maintaining a healthy body mass index (BMI)

As part of the London Medical family, our cardiology clinic has access to various specialties - all under one roof. So whether you’re in need of a personalised weight management programme, expert nutritional advice or support with quitting smoking, we can help look after your whole health.

Medications
Your specialist may prescribe several different types of medication to control any pain, support the work of your heart and optimise your health. These could include:

• Nitrates and Ranolazine to ease chest pain
• Statins and Ezetimibe to reduce levels of ‘bad’ cholesterol in the blood
• Antiplatelet drugs (blood thinners) to thin the blood and reduce the risk of clot formation and heart attack
• Beta blockers to improve blood flow and slow the heart rate
• Calcium channel blockers to relax the muscles in the artery walls and reduce blood pressure
• Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers to improve the blood flow and reduce blood pressure
• Ranolazine for chronic angina
• Injectable cholesterol lowering drugs called PCSK9 inhibitors

You should always carefully follow the instructions of your consultant when taking your medications and be sure to speak to your doctor before you stop taking any medication.

Interventional procedures and surgery
If you need more aggressive treatment to improve blood flow and decrease plaque buildup, your specialist might suggest an invasive procedure or surgery.

Coronary angioplasty is a minimally invasive procedure to relieve blockages in the coronary arteries. It can be performed as an emergency measure to relieve a sudden blockage or can even be performed during a scheduled coronary angiogram procedure. Through a blood vessel in the groin, a device is inserted into the blocked coronary vessel. The specialist physician inflates a balloon to open up the narrowed area of the artery, then precisely places a stent in the artery to keep it open and maintain the blood flow. At London Medical, we also offer innovative new stents that slowly release medication to stop the artery from narrowing.

Coronary artery bypass graft (CABG) can help when the arteries are significantly narrowed. The specialist cardiothoracic surgeon grafts a new blood vessel to supply blood to the heart muscle, bypassing the blocked artery.