In coronary heart disease (CHD), the coronary arteries are narrowed by deposits in the vessel walls (atherosclerosis, plaques). As a result, the heart muscle gets too little oxygen on exertion — or, in severe cases, even at rest.¹
CHD is one of the most common causes of death in Germany and worldwide. The disease usually develops over decades and is promoted by the classic cardiovascular risk factors: elevated cholesterol, high blood pressure, diabetes, smoking.¹,²
Very treatable — prognosis can be considerably improved
CHD is very treatable. Modern medications, lifestyle changes and, where needed, interventional procedures (stent, bypass) can considerably improve the prognosis and prevent heart attacks.
2. Symptoms
Angina pectoris (chest tightness)
A feeling of pressure, tightness or pain in the chest — the key symptom
Typically occurs with physical exertion, stress or cold and improves at rest
Radiation possible: left arm, jaw, back, upper abdomen
Shortness of breath on exertion
Atypical symptoms
Especially in women, older people and with diabetes, CHD can present atypically:
Heart attack warning — call 112 immediately (in the US: 911)
Sudden, severe chest pain lasting longer than five minutes, with radiation, cold sweats, shortness of breath, a fear of dying — immediately call the emergency number 112 (in the US: 911). Every minute counts.
Sex — men usually develop it earlier; women catch up after the menopause
Family history — a heart attack in first-degree relatives at a young age
4. Diagnosis
Medical history and physical examination: typical symptoms, risk factors, exertion profile.
Resting ECG: can be unremarkable at rest. Shows signs of a previous heart attack or rhythm disturbances.
Exercise ECG (ergometry): ECG under physical exertion — can reveal circulation problems on exertion.
Echocardiography (heart ultrasound): assesses heart function, the heart valves and wall-motion abnormalities.
Stress imaging: stress MRI or myocardial scintigraphy — can show circulation problems more precisely than the exercise ECG.
CT coronary angiography: non-invasive imaging of the coronary arteries. Can rule out CHD with a high degree of certainty.
Cardiac catheterization (invasive coronary angiography): the gold standard for imaging the coronary arteries. Usually carried out when an intervention (stent) is planned or the non-invasive diagnostics were not conclusive.
Laboratory: lipid profile (LDL, HDL, triglycerides), blood sugar/HbA1c, kidney values, troponin (if a heart attack is suspected).
Medications form the basis of CHD treatment — they lower the risk of a heart attack and improve the prognosis.¹
BasisLipid lowering & platelet inhibition
Statins
Lower LDL cholesterol and demonstrably reduce the risk of a heart attack and cardiovascular death. They are part of the standard treatment for CHD. More: Lipid metabolism disorder.
Antiplatelet agents
Acetylsalicylic acid (ASA, aspirin) in a low dose — inhibits the clumping of platelets and lowers the risk of a heart attack. Standard treatment with known CHD. After a stent, usually temporary dual antiplatelet therapy (ASA + a P2Y12 inhibitor such as clopidogrel or ticagrelor).
CirculationBeta blockers, ACE inhibitors, ARBs
Beta blockers
Lower the heart rate and blood pressure. Used for angina pectoris and after a heart attack.
ACE inhibitors / ARBs (sartans)
Protect the heart and blood vessels. Recommended especially with accompanying high blood pressure, heart failure or diabetes.
AcuteNitrates (as-needed medication)
Nitroglycerin spray
Widens the coronary arteries and can relieve an acute angina pectoris attack. Used as as-needed medication.
AdditionalFurther agents
Depending on the individual risk and accompanying conditions: calcium channel blockers, ranolazine, ezetimibe, PCSK9 inhibitors, bempedoic acid.
A small wire mesh is introduced into the narrowed vessel via a cardiac catheter and widens it. Usually drug-eluting stents (DES) are used. The procedure is mostly carried out via the wrist artery and is generally minimally invasive.
Bypass surgery
A surgical procedure in which narrowed coronary arteries are bridged with the body's own vessels (the internal thoracic artery, a leg vein). Usually recommended for severe multivessel disease or a left main stenosis.
A procedure does not replace the medications
A stent and a bypass treat the narrowing but not the underlying disease (atherosclerosis). Medications and lifestyle changes remain permanently necessary even after a procedure.
7. Lifestyle
Lifestyle changes are a central part of CHD treatment — they can considerably improve the prognosis.¹
Stopping smoking — the most effective single measure; the risk drops as early as the first weeks after quitting
Regular exercise — moderate endurance training, usually at least five times a week; cardiac exercise groups (in Germany "Herzsportgruppen") offer a structured programme
A heart-healthy diet — a Mediterranean diet: plenty of vegetables, fruit, legumes, nuts, olive oil, fish; little saturated fat, sugar and salt
A heart attack happens when a coronary artery is suddenly completely blocked (usually through the rupture of a plaque and the formation of a clot). The heart muscle no longer gets oxygen — every minute counts.
Warning signs
Severe, persistent chest pain (lasting longer than five minutes) — pressure, tightness, burning
Radiation into the left arm, jaw, back, upper abdomen
Cold sweats, pale skin
Shortness of breath
A fear of dying, a sense of impending doom
In women often atypical: nausea, upper abdominal pain, shortness of breath without typical chest pain
If a heart attack is suspected: 112 immediately (in the US: 911)Don't wait. Don't drive yourself. Every minute of delay costs heart muscle tissue. The emergency number 112 (in the US: 911) sends an ambulance with an emergency doctor — the initial care begins immediately.
How brite helps you with CHD
A statin in the evening, ASA in the morning, a beta blocker with it, an ACE inhibitor separately — and if a stent has been placed, a second antiplatelet agent is added for a time. CHD treatment is teamwork between many agents over a long time. brite holds the plan together.
Medication reminder — take the statin, ASA, beta blocker and ACE inhibitor on time. Especially with dual antiplatelet therapy after a stent, reliable intake is crucial to avoid a stent thrombosis. Set up a reminder
Interaction check — ASA plus NSAIDs (e.g. ibuprofen, can increase the bleeding risk)? A statin plus grapefruit or a macrolide antibiotic? Clopidogrel plus pantoprazole? brite shows what can be problematic. Check now
Health history — document blood pressure, LDL, blood sugar and your exercise capacity over time. That way, at your next appointment, you can clearly show whether the treatment goals are being reached — and whether an adjustment is needed. Track your history
Digital medication plan — all your medications clearly laid out for cardiology, your family doctor, rehabilitation and the emergency department. In an emergency (e.g. a suspected heart attack), the emergency services immediately know which medications you are taking. Go to medication plan
Angina pectoris is a temporary circulation problem — the symptoms occur on exertion and improve at rest. In a heart attack, a coronary artery is completely blocked — the symptoms persist and do not improve. A heart attack is an emergency (call 112; in the US: 911).
Usually yes. CHD is a chronic disease. Medications such as statins and ASA permanently lower the risk of a heart attack and cardiovascular death. They should not be stopped on your own.
Yes — regular moderate exercise is expressly recommended and improves the prognosis. Cardiac exercise groups offer a supervised programme. The exertion intensity should be agreed with cardiology.
A small wire mesh that is introduced into a narrowed coronary artery via a cardiac catheter and holds it open. After a stent, time-limited dual antiplatelet therapy (ASA + a second agent) is usually necessary.
Lifestyle changes (diet, exercise, stopping smoking) can slow the progression of atherosclerosis and lower the risk of a heart attack. A complete reversal of existing plaques is usually not realistic — but a stabilization and risk reduction certainly is.
A surgical procedure in which narrowed coronary arteries are bridged with the body's own vessels. Usually recommended for severe multivessel disease when a stent is not enough. The procedure is bigger than a stent implantation but offers better long-term results in certain constellations.
With severe chest pain that lasts longer than five minutes, with radiation, cold sweats, shortness of breath or a fear of dying — call 112 immediately (in the US: 911). Even with atypical symptoms (nausea, upper abdominal pain, breathlessness), when in doubt it is better to call once too often.
Women usually develop it later than men (after the menopause) but more often show atypical symptoms (nausea, upper abdominal pain, breathlessness instead of typical chest pain). As a result, a heart attack is more often recognized late in women.
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. If a heart attack is suspected, immediately call the emergency number 112 (in the US: 911). CHD medications should not be stopped or dosed on your own. Treatment planning is always determined individually by the treating cardiology or family medical practice. Last updated: April 2026.
