My ECG was normal. Does that rule out a blockage?

No. A resting ECG is often completely normal in someone with significant coronary narrowing, because at rest the blood supply may still be adequate. A normal ECG is reassuring about what is happening at that moment; it is not a clean bill of health for the arteries. If the history suggests angina, testing under exertion or imaging the arteries is what answers the question.

Is a stent permanent, and will I need medicines afterwards?

The stent itself stays in place permanently and becomes lined by the vessel's own tissue over a few months. Medication afterwards is not optional — blood-thinning medication for a defined period protects the stent, and cholesterol and blood pressure treatment continues long term because the stent treats one narrowing, not the underlying disease.

I get sharp chest pain that lasts a few seconds. Is that angina?

Usually not. Angina from coronary disease is typically a dull pressure or heaviness that builds over minutes with exertion and eases with rest, rather than a stab lasting seconds. Brief, sharp, well-localised pain more often comes from the chest wall, the ribs or the gullet. That said, chest pain has many causes and the pattern is worth describing to a doctor rather than self-interpreting.

Can coronary artery disease be reversed?

Progression can be slowed substantially, and plaque can be stabilised so it is less likely to rupture, with cholesterol lowering, blood pressure control, stopping tobacco and regular activity. Describing this as reversal overstates it. The realistic and worthwhile goal is that the disease stops advancing and the risk of a heart attack falls.

Also called CAD, Ischaemic heart disease, Blocked arteries

Coronary artery disease

Narrowing of the arteries that supply the heart muscle itself, usually from gradual cholesterol build-up, which can cause chest discomfort on exertion and, if an artery closes, a heart attack.

When to seek urgent care

Chest pain, pressure or heaviness lasting more than a few minutes, or coming back
Chest discomfort with sweating, nausea, or breathlessness
Chest discomfort that comes on at rest, or wakes you from sleep
Chest discomfort that is more severe or more easily provoked than your usual pattern
Fainting, or collapse

Call 108 for an ambulance, or go straight to the nearest emergency department. Do not wait for a reply from this website.

What it is

The heart is a muscle, and like every muscle it needs its own blood supply. That supply comes from the coronary arteries, which sit on the outside surface of the heart and branch into it. Coronary artery disease is what happens when those arteries narrow.

The narrowing builds up slowly, over years, as a mixture of cholesterol, inflammatory cells and calcium collects in the artery wall. This deposit is called plaque. For a long time it causes nothing at all. Symptoms usually begin when a narrowing becomes tight enough that the heart muscle cannot get extra blood when it needs it — climbing stairs, walking uphill, hurrying.

That is why classic angina appears with exertion and settles with rest. The supply is adequate when the heart is idle and inadequate when it is working.

A heart attack is a different event. Rather than gradual narrowing, a plaque cracks open, a clot forms on it, and the artery closes abruptly. Heart muscle downstream begins to die within minutes. This is why time matters so much in a heart attack, and why chest pain that does not settle is an emergency rather than something to observe at home.

Fig.A coronary artery in cross-section. The wall thickens inwards and the channel blood travels through closes — usually over years, and usually silently.

What people notice

Chest tightness, heaviness or pressure — more often described as a weight or a band than a sharp pain
Discomfort brought on by walking, stairs, exertion or emotional stress, and relieved within a few minutes of rest
Pain that spreads to the left arm, both arms, the jaw, the neck, the upper back or the upper abdomen
Breathlessness on exertion, sometimes without any chest pain at all
Unusual fatigue, sweating or nausea with exertion
In people with diabetes and in older adults, symptoms are often blunted or absent — breathlessness or fatigue may be the only sign

What raises the risk

High blood pressure over years
Diabetes, which accelerates arterial disease and can mask its symptoms
High LDL cholesterol, and low HDL
Smoking and tobacco in any form, including chewed tobacco
A parent or sibling with heart disease at a young age — under 55 in men, under 65 in women
Central obesity and physical inactivity
Chronic kidney disease
Age, and being male — neither is modifiable, but both change how aggressively the modifiable risks are treated

How it is assessed

A careful history — what the discomfort feels like, what brings it on and what relieves it is often more informative than any single test
Examination, blood pressure in both arms, and an ECG
Blood tests including lipid profile, blood sugar, HbA1c, kidney function and haemoglobin
Echocardiography to assess how well the heart muscle and valves are working
A treadmill stress test, where the ECG is recorded while walking on a graded incline, to see whether the heart shows signs of inadequate blood supply under load
Where the picture warrants it, coronary angiography — a catheter study that shows the arteries directly and defines exactly where and how tight any narrowing is

Not everyone needs every test. The purpose of the consultation is to work out which of these will actually change what happens next.

How it is treated

Risk-factor treatment, which does most of the long-term work: blood pressure control, cholesterol lowering, diabetes control, and complete tobacco cessation
Medication to reduce the heart's workload and prevent clot formation, chosen for the individual
Angioplasty and stenting — opening a significantly narrowed artery with a balloon and supporting it with a stent
Primary angioplasty in an acute heart attack, where opening the artery quickly is the treatment
Bypass surgery, where the pattern of disease is better served by it than by stenting
Structured follow-up, because coronary disease is a long-term condition rather than a single event

Whether a narrowing needs a stent depends on how tight it is, which artery it is in, how much muscle it supplies and what symptoms it is causing. It is a decision made with the patient, not a foregone conclusion.

Reducing the risk

Know your blood pressure, and treat it if it is high — it does no harm and gives no warning until it does damage.
Have a lipid profile and blood sugar checked, particularly if a parent or sibling had heart disease early.
Stop tobacco completely. This single change does more than any medication.
Aim for regular moderate activity — brisk walking on most days is enough to matter.
Treat diabetes as a cardiac condition, because that is largely what it becomes.

The things people most often ask in the consulting room.

Related conditions

Tests you may be offered

Discuss coronary artery disease with a cardiologist

Bring your previous reports and current medicines. A consultation turns a general guide into an answer about you.

Book an appointment

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