Symptoms of Coronary Heart Disease

Although the symptoms associated with coronary heart disease may be pronounced, the condition may also exist without any noticeable symptoms (known as silent CHD).

The first warning sign of coronary heart disease often comes with chest pain (angina) during physical exercise or emotional upset. This pain is often characterised by a heavy or squeezing feeling under the sternum (breast bone), known as typical chest pain. Angina may also present itself as a sharp, stabbing pain in the left chest or abdomen, which may extend down the left arm or upwards into the throat and lower jaw (known as atypical chest pain). Typical chest pain is relieved by rest or nitroglycerin, whilst atypical chest pain is not. Atypical chest pain is more common in women.

Sufferers may also experience shortness of breath, due to the failure of the heart to remove fluid from the lung circulation. This may be accompanied by swollen feet and ankles.

However, in many cases, the first sign of CHD is a heart attack (myocardial infarction), which takes places when an atherosclerotic plaque or a blood clot blocks the coronary artery to the heart. This cuts off the supply of blood (and therefore oxygen) to a section of heart muscle, which dies as a result.

For a few weeks before such an attack, patients may feel tired or vaguely unwell and may have increasingly serious attacks of angina. The attack itself starts suddenly, usually after a heavy meal, physical effort, an emotional upset or when the weather has suddenly turned cold. The pain associated with a heart attack is usually extremely severe, and may be accompanied by other symptoms such as weakness, sweating, nausea, vomiting and arrhythmia. However, approximately 30% of all heart attacks are silent, without chest pain or other symptoms. This usually occurs with elderly patients and patients with diabetes.