Coronary Heart Disease (CHD):
Symptoms, Treatment & Prevention

1. What is CHD?

In coronary heart disease (CHD), the coronary arteries are narrowed by deposits in the vessel walls (atherosclerosis, plaques). As a result, the heart muscle receives too little oxygen on exertion — or, in severe cases, even at rest.^¹

CHD is one of the most common causes of death worldwide. The condition typically develops over decades and is promoted by the classic cardiovascular risk factors: elevated cholesterol, high blood pressure, diabetes, smoking.^¹,²

2. Symptoms

Angina pectoris (chest tightness)

• Pressure, tightness or pain in the chest — the leading symptom
• Typically occurs with physical exertion, stress or cold and improves at rest
• Possible radiation to: left arm, jaw, back, upper abdomen
• Shortness of breath on exertion

Atypical symptoms

Particularly in women, older people and people with diabetes, CHD can present atypically:

• Shortness of breath without chest pain
• Unusual fatigue
• Upper abdominal symptoms, nausea
• Reduced exercise capacity

3. Risk factors

Most risk factors for CHD are modifiable.^¹

Modifiable

• High LDL cholesterol — the most important modifiable risk factor
• High blood pressure
• Smoking — one of the strongest risk factors; stopping smoking reduces risk quickly and substantially
• Diabetes — substantially increases CHD risk
• Obesity and lack of exercise
• Unhealthy diet

Non-modifiable

• Age — risk rises with age
• Sex — men typically develop CHD earlier; women catch up after menopause
• Family history — heart attack in first-degree relatives at a young age

4. Diagnosis

• History and physical examination: typical symptoms, risk factors, exertion profile.
• Resting ECG: can be normal at rest. Shows clues to previous heart attack or rhythm disturbances.
• Exercise ECG (ergometry): ECG under physical exertion — can detect blood-flow disturbances on exertion.
• Echocardiography (heart ultrasound): assesses heart function, heart valves and wall motion abnormalities.
• Stress imaging: stress MRI or myocardial scintigraphy — can show blood-flow disturbances more accurately than the exercise ECG.
• CT coronary angiography: non-invasive imaging of the coronary arteries. Can rule out CHD with high reliability.
• Cardiac catheterisation (invasive coronary angiography): the gold standard for visualising the coronary arteries. Typically performed when an intervention (stent) is planned or when non-invasive imaging was inconclusive.
• Laboratory: lipid profile (LDL, HDL, triglycerides), blood glucose/HbA1c, kidney values, troponin (when heart attack is suspected).

5. Treatment: medications

Medications form the foundation of CHD treatment — they reduce the risk of heart attack and improve prognosis.^¹

6. Treatment: stent and bypass

Stent (percutaneous coronary intervention, PCI)

A small wire mesh is inserted via cardiac catheter into the narrowed vessel and expands it. Drug-eluting stents (DES) are typically used. The procedure is usually performed via the wrist artery and is typically minimally invasive.

Bypass surgery

A surgical procedure where narrowed coronary arteries are bypassed using the patient's own vessels (internal mammary artery, leg vein). Typically recommended for severe multi-vessel disease or left main stenosis.

7. Lifestyle

Lifestyle changes are a central component of CHD treatment — they can substantially improve prognosis.^¹

• Stop smoking — the most effective single measure; risk falls within the first weeks after stopping
• Regular exercise — moderate aerobic exercise, typically at least five times per week; cardiac rehabilitation programmes offer a structured programme
• Heart-healthy diet — Mediterranean diet: plenty of vegetables, fruit, pulses, nuts, olive oil, fish; little saturated fat, sugar and salt
• Weight control — reduce excess weight
• Stress management — relaxation techniques, adequate sleep
• Reduce alcohol intake

8. Heart attack — recognising the emergency

A heart attack occurs when a coronary artery is suddenly completely blocked (typically by a plaque rupture and clot formation). The heart muscle no longer receives oxygen — every minute counts.

Warning signs

• Severe, persistent chest pain (longer than five minutes) — pressure, tightness, burning
• Radiation to left arm, jaw, back, upper abdomen
• Cold sweats, pale skin
• Shortness of breath
• Feeling of dread, sense of impending doom
• In women often atypical: nausea, upper abdominal pain, shortness of breath without typical chest pain

How brite helps you with CHD

Statin in the evening, aspirin in the morning, beta-blocker alongside, ACE inhibitor separately — and after a stent, a second antiplatelet for a defined period. CHD treatment is teamwork between many medications over a long time. brite holds the plan together.

• Intake reminder — statin, aspirin, beta-blocker, ACE inhibitor on time. Particularly with dual antiplatelet therapy after a stent, reliable intake is crucial to prevent stent thrombosis.
• Drug interaction check — aspirin plus an NSAID (e.g. ibuprofen, can increase bleeding risk)? Statin plus grapefruit or a macrolide antibiotic? Clopidogrel plus a proton pump inhibitor? brite shows what may be problematic.
• Health journal — track blood pressure, LDL, blood glucose and exercise capacity over time. So at the next appointment it's easy to show whether treatment goals are being met — or whether an adjustment is needed.
• Digital medication plan — all medications clearly organised for cardiology, GP, rehabilitation and emergency care. In an emergency (e.g. suspected heart attack), paramedics see immediately which medications are being taken.

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