Coronary Artery Disease

You will be asked what the discomfort feels like, what brings it on, how long it lasts, what relieves it, and about risk factors and family history. Blood pressure, pulse, weight and heart sounds are usually checked. Being specific about your symptoms genuinely helps — it is worth writing them down before the appointment.

A quick, painless recording of the heart’s electrical activity. It can show signs of a heart attack, previous damage or rhythm problems. A normal ECG does not always rule out coronary artery disease, so other tests may still be needed.^{[14]NICE NG185}

In suspected heart attack, hospitals measure troponin, a protein released when heart muscle is damaged, usually more than once. Other blood tests may check cholesterol, blood glucose or HbA1c, kidney function, thyroid function and anaemia.^{[14]NICE NG185}

A CT scan with contrast dye that shows the coronary arteries. NICE recommends it as a first-line test for many people with stable chest pain that may be angina. You may be given medicine to slow the heart rate for the scan.^{[13]NICE — chest pain of recent onset}

• Echocardiogram — an ultrasound of the heart’s structure and pumping.
• Stress imaging — imaging during exercise or medicine-induced stress, to see how blood flow changes.
• Invasive coronary angiogram — a catheter and dye study that shows narrowings directly, and can sometimes be combined with treatment in the same visit.
• Heart-rhythm monitoring — a portable monitor worn for a period of time.

Waiting times and local pathways vary, so ask your team what happens next and who to contact if symptoms change while you wait.

• Stopping smoking is one of the single most effective steps, and free NHS support makes it far more likely to work.
• Regular activity within the limits your team advises, built up gradually.
• An eating pattern lower in saturated fat and salt, with more vegetables, fruit, pulses and wholegrains.
• Keeping within the UK low-risk alcohol guidelines, and getting help if cutting down is hard.
• Treating high blood pressure, cholesterol and diabetes as your team advises.
• Sleep, stress and mood matter too, and are a legitimate thing to raise with your GP.

Which medicines are right depends on your diagnosis, other conditions and what you already take. Common groups include:

• Antiplatelets such as aspirin or clopidogrel, to make clots less likely.
• Statins and other lipid-lowering treatments, to reduce cholesterol and cardiovascular risk.^{[7]NHS — statins}
• Beta blockers, which reduce how hard the heart works.
• Nitrates, including a spray or tablet used for angina attacks and before activity that usually brings symptoms on.
• ACE inhibitors or similar medicines, often used after a heart attack or with high blood pressure.
• Calcium channel blockers and other anti-anginal medicines, where suitable.

We do not publish doses or personalised instructions. Your prescriber decides these, and the leaflet in your medicine pack explains how to take it. A pharmacist can review everything you take, including anything bought over the counter, and offer a free medicines check.^{[12]NICE NG238}

Coronary angioplasty (PCI) opens a narrowed artery using a small balloon, usually leaving a stent in place to hold it open. It is often used as an emergency treatment for a heart attack, and sometimes planned for angina that is not controlled by medicines.^{[5]NHS — coronary angioplasty}

Afterwards, people are normally prescribed antiplatelet medicines for a period decided by the cardiology team. Taking them exactly as prescribed matters — stopping early can be dangerous. Ask your team before any dental work or surgery.

Bypass surgery uses a blood vessel from elsewhere in the body to route blood around a blocked section of artery. It may be recommended when several arteries are affected or when the pattern of disease suits surgery better than stenting. Recovery takes longer than angioplasty and includes a structured rehabilitation plan.^{[6]NHS — CABG}

Programmes usually combine supervised exercise, education about your condition and medicines, and emotional support, delivered in a group, at home or online. They are designed for people who have had a heart attack, stent, bypass surgery or a diagnosis of angina. Ask your team how to be referred if you have not been offered a place.^[4]NHS

When you can return depends on your treatment, your recovery and the kind of work you do. A phased return, adjusted duties or shorter hours are common. Your GP can issue a fit note with suggestions for your employer, and occupational health can help where it is available.

Rules differ depending on the event or procedure, your symptoms and the type of licence you hold, and they are stricter for bus, coach and lorry licences. Some situations require you to stop driving for a period, and some must be reported to the DVLA. Check the official GOV.UK guidance for your exact situation and follow the advice your cardiology team gives you.^{[15]GOV.UK — health conditions and driving (DVLA)}

Most people can return to sexual activity as they recover, and many find that if they can manage moderate everyday exertion comfortably they can manage sex. Worry, tiredness and changes in confidence are common for both partners, and some heart medicines can affect erections or desire.

Please ask your cardiac rehabilitation team or GP rather than guessing — this is a routine question for them. Important: some erectile dysfunction medicines must never be taken with nitrates. Always check with a doctor or pharmacist first, and never buy such medicines online without advice.

Anxiety, low mood, poor sleep and fear of another event are extremely common after a cardiac event, and they affect partners and family too. This is not weakness, and it is treatable.

• Tell your GP or rehab team if worry or low mood is affecting daily life.
• NHS talking therapies can be accessed via your GP, and in England you can usually self-refer.
• The British Heart Foundation is a charity, not an NHS service, and offers information and support — please check current contact details on its website.^[17]BHF