Coronary artery disease treatment

As coronary artery disease usually develops over the course of several years, symptoms aren’t usually seen until the late stages of the disease. These symptoms include:

• Angina, a type of temporary chest pain that occurs when coronary arteries are partially blocked. It’s commonly triggered by physical activity or strong emotions, and causes chest pain that can spread to your left arm, jaw, neck or back.
• Shortness of breath (dyspnoea)
• Fatigue
• Nausea
• Heart palpitations (fluttering, fast or irregular heartbeat)
• Swelling of your hands and feet

Coronary artery disease occurs when a substance called plaque builds up in your arteries – a condition known as atherosclerosis.

This build-up of plaque damages your arteries, making them stiff and narrow and reducing blood flow to certain parts of your body, including your coronary arteries. When your coronary arteries become narrowed or blocked, it prevents your heart muscle from getting enough blood, oxygen and nutrients, stopping your heart from working properly.

What are the risk factors for coronary artery disease?

There are many factors that can increase your risk of developing coronary artery disease. Some of them, like smoking, diet and alcohol intake can be controlled, while others such as your age and family history, cannot.

You may have a higher risk of developing coronary artery disease if you:

• Are older: Your risk of coronary artery disease increases as you age
• Are male
• Have a family history of heart disease
• Smoke
• Have certain health conditions such as high blood pressure, high cholesterol, diabetes, and chronic kidney disease
• Are overweight or obese
• Don’t get enough exercise
• Eat an unhealthy diet high in sugar, refined carbohydrates, trans fat and saturated fat
• Have a lot of stress
• Drink excessive amounts of alcohol
• Sleep too much or too little

Our fixed-price packages include the cost of your surgery and all appropriate aftercare appointments. However, any pre-surgery diagnostic tests and your consultant's outpatient appointment consultation fee are charged separately.

Our flexible payment options help you spread the cost of your payment across a time period that suits you.

Your consultant will ask you about your symptoms, general health, medical and family history, and any medications you take regularly. They may ask about your lifestyle, from questions about your diet and how often you exercise, to how much alcohol you drink and whether you smoke.

Your consultant will then perform a physical examination that involves checking your blood pressure and listening to your heart with a stethoscope. They may also require you to have one or more of the following scans or tests:

• Blood tests to check your overall health and test for any underlying health conditions such as diabetes and high cholesterol
• Electrocardiogram (ECG)
• Echocardiogram
• Cardiac stress tests
• CT coronary angiography
• Imaging tests such as an MRI, or CT scan
• Myocardial perfusion imaging

At Circle Health Group, you’ll meet your consultant, the doctor responsible for your treatment, in your first session. Your consultant will spend time getting to know you, discuss your expectations for treatment and encourage you to ask any questions you may have.

Lifestyle changes

Making changes to your lifestyle can improve your overall health, reduce your risk of developing coronary artery disease and minimise your chances of having a heart attack if you’ve already been diagnosed with CAD.

To reduce your risk of coronary artery disease and heart attack:

• Follow a healthy diet with plenty of fruits, vegetables, and whole grains
• Reduce your intake of salt, sugar, refined carbohydrates, saturated fats, trans fats and alcohol
• Take regular exercise
• Lose weight if needed and maintain a healthy weight
• Stop smoking
• Reduce stress
• Practice good sleep hygiene and ensure you get adequate, good-quality sleep
• Manage any underlying health issues such as diabetes, hypertension and high cholesterol, by following your consultant’s advice and having regular check-ups

Medications

Medication is usually the first approach to treating coronary artery disease, with several types of medications available to reduce the risk of a heart attack. Your consultant will prescribe a medication, or combination of medications, depending on your symptoms, general health and any other medical conditions you have.
Medications used to treat coronary artery disease include:

• Blood thinners, or anti-coagulants, reduce your risk of a heart attack by thinning your blood and preventing it from clotting.
• Statins lower your cholesterol by reducing the amount of LDL (low-density lipoprotein, or ‘bad’) cholesterol produced by your liver. Lowering LDL cholesterol reduces plaque build-up in your arteries and lowers your risk of having a heart attack.
• Beta-blockers work by slowing your heart rate, reducing blood pressure and improving blood flow to your heart.
• Calcium channel blockers may be prescribed if you can’t take beta blockers, or if beta blockers haven’t worked to reduce your symptoms. Calcium channel blockers lower blood pressure by relaxing and dilating your blood vessels.
• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (ARBs) are used to treat high blood pressure and work by reducing the production of a hormone called angiotensin-2 which makes your blood vessels constrict (narrow) and improving blood flow to your heart.
• Diuretics decrease blood pressure by increasing the amount of urine you pass and flushing out water and salt from your body.
• Nitrates work by relaxing and dilating (widening) your blood vessels which makes it easier for blood to flow to your heart, lowers blood pressure and relieves chest pain.

Surgery for coronary artery disease

If your coronary artery disease is severe, or your symptoms haven’t improved with lifestyle changes and medication, your consultant may recommend surgery to unblock, widen or bypass your blocked arteries. Two common procedures used to treat coronary artery disease are coronary angioplasty and stent placement and coronary artery bypass graft (CABG).

Coronary angioplasty and stent placement

Also known as percutaneous coronary intervention (PCI), this minimally invasive procedure is used to widen a blocked or narrowed coronary artery. During the procedure, a tube with a tiny balloon on the end (balloon catheter) is inserted into a blood vessel and a liquid dye known as contrast medium is injected, highlighting your blood vessels and identifying any blockages. The balloon is then inflated to widen your coronary artery.

In some cases, a wire mesh tube called a stent is placed in your artery to keep it open. Coronary angioplasty and stent placement surgery is normally carried out under local anaesthetic and takes between 30 minutes and two hours.

Coronary artery bypass graft (CABG) surgery

Coronary artery bypass grafting is an open-heart surgery where a large incision (cut) is made in your chest to move your ribs and access your heart. During CABG, a vein or artery is taken from somewhere else in your body and used to divert blood away from the blocked or narrowed coronary artery allowing blood to flow to your heart. Coronary artery bypass graft surgery is performed under general anaesthetic and takes between three to six hours.

To help make your recovery go smoother, it’s recommended you follow your consultant’s post-operation instructions carefully. Call the hospital if you have any questions or concerns.

Recovering from coronary angioplasty and stent placement surgery

You may be able to go home on the same day as your coronary angioplasty and stent placement surgery, or you may need to spend a night in hospital.

After your surgery, you might have some soreness and bruising around the area where the catheter was inserted. This usually subsides within a few days.

Keep your wound clean and dry, and call the hospital immediately if your wound isn’t healing or you notice any signs of infection, such as:

• Redness and soreness that is getting worse or lasts for more than a few days
• Yellow or green discharge from your wound
• A strong, unpleasant smell

You may also feel some discomfort and tenderness in your chest area after your coronary angioplasty and stent placement. Over-the-counter painkillers, such as paracetamol, can help relieve any pain.

Following your coronary angioplasty and stent placement, you can gradually resume most day-to-day activities, although it’s recommended you avoid strenuous activity and heavy lifting for around a week after your procedure. Whenever moving around, listen to your body and stop if you experience any pain or feel tired.

If you drive an HGV, such as a bus or lorry, you’ll need to inform the Driver and Vehicle Licensing Agency (DVLA) about your surgery. They will organise some tests to check your health before you can return to work.

Most people are fully recovered from coronary angioplasty and stent placement within a few weeks.

Recovering from coronary artery bypass graft (CABG) surgery

You can expect to spend around a week in hospital after your CABG surgery. You’ll be monitored closely and will be given painkillers regularly to manage any pain or discomfort after your surgery.

A member of our physiotherapy team will work with you to gradually increase your activity level after your bypass surgery. This normally involves getting out of bed and sitting in a chair the day after your surgery, walking short distances after around three days and walking up and down stairs after five to six days.

Your healthcare team will offer guidance on continuing your recovery after you’re discharged from hospital, from caring for your surgical wound to gradually building up your activity level. You’ll be given a follow-up appointment to check your progress around six to eight weeks after your surgery, and in the meantime must take any medication given as prescribed.

You’ll need to arrange for someone to stay with you to help with tasks like cooking, cleaning, shopping and driving for the first week or two after your coronary artery bypass graft surgery.

You can participate in non-strenuous activities when you feel able after being discharged, such as walking for short distances and light household duties. Increase your activity level slowly and stop if you feel tired. Avoid strenuous activity, driving, heavy lifting and sex for around six weeks after your procedure, or until you get the all-clear from your consultant.

Depending on your recovery and the type of job you do, you may be able to return to work in around six to eight weeks, although this may be longer if you have a very active or manual job. Most people make a full recovery within three months of coronary artery bypass graft (CABG) surgery.

Cardiac rehabilitation

Cardiac rehabilitation is a specialised programme aiming to help patients who have had heart surgery recover and improve their long-term health through a combination of education, exercise and stress management techniques. Cardiac rehabilitation normally starts around two to six weeks after surgery and continues for around six weeks.

As with all types of surgery, coronary artery disease surgery carries a risk of complications. Your consultant will explain all the possible risks of your surgery before your procedure, and answer any questions you may have.

It’s important to be fully informed about any possible risks and complications before your coronary artery disease surgery to make an informed decision. You can help minimise the risk of complications by following the instructions given on preparing for your procedure and what to do afterwards.

Possible complications of any type of surgery may include:

• Adverse reactions to the anaesthetic
• Bleeding
• Blood clots in the legs or lungs
• Wound infection
• Damage to nearby structures
• Chest infection

In addition, potential complications specific to coronary angioplasty and stent placement include:

• Haematoma: A collection of blood under the skin
• Arteriovenous fistula: An abnormal connection between an artery and a vein
• Damage to the artery where the catheter was inserted or to an artery in your heart
• Allergic reaction to the contrast dye
• Kidney damage: The contrast dye may damage the kidneys, especially in people with prior kidney problems
• The stent may move out of position
• Cardiac arrhythmias
• Cardiac tamponade: When blood leaks into the sac that surrounds the heart
• Heart attack
• Stroke
• Stent restenosis: A late complication where the coronary artery can narrow again due to excess tissue growth inside it, potentially leading to a heart attack that may require further surgery
• Stent thrombosis: Blood clots forming in the stent or blood vessel

Potential complications specific to coronary artery bypass graft (CABG) surgery include:

• Bleeding during or after the surgery
• Infection
• Breathing problems
• Problems with memory and concentration
• Kidney problems: Your kidney function may be reduced after surgery, but this is usually temporary
• Atrial fibrillation: An abnormal heart rhythm that can usually be treated with medication
• Heart attack
• Stroke
• Failure of the graft
• Death

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about coronary artery disease treatment, book your appointment online today or call a member of our team directly on 0808 189 5499.

Content reviewed by Circle in-house team in December 2024. Next review due December 2026.

1. Coronary Heart Disease Treatment National Heart, Lung and Blood Institute
2. Coronary heart disease: Treatment NHS
3. Coronary heart disease: Overview NHS
4. Treatments for coronary heart disease British Heart Foundation
5. Coronary Artery Disease Treatment Johns Hopkins Medicine