Coronary Heart Disease

Heart and cerebrovascular disease rank second after cancer as a cause of death in Hong Kong. Coronary heart disease is a major type of heart disease. According to statistics from the Department of Health, coronary heart disease deaths accounted for 66.6% of all deaths caused by heart disease in 2015.
Recent years have seen early onset of coronary heart disease at younger ages. It is not unusual for a person to develop this disease in his40’s. Patients can have no symptoms before the first episode of heart attack and  thus the possibility of developing the disease is easily overlooked.


Coronary arteries are a system of blood vessels that supply heart muscles with oxygen and nutrients to keep the heart functioning. It is so called because the system of arteries is in the shape of a corona.
If, for any reason, the coronary arteries become narrowed or blocked, blood flow to the heart will diminish and the supply of oxygen to the heart muscles will decrease or stop.  The patient will have chest pain and in the severe case a heart attack.


Many risk factors have been recognized for coronary heart disease.  They can be categorized into 3 types.

  • Lifestyle
    • Unhealthy diet (A healthy diet should be low salt, low sugar, low fat and high fibre; five portions of vegetable and fruit should be eaten per day)
    • Lack of exercise
    • Overweight and obesity
    • Smoking
    • Stress
  • Chronic diseases
    • Hypertension
    • Diabetes
    • Hyperlipidaemia
  • Environmental
    • Air pollution
    • Noise pollution

A healthy lifestyle and regular health check for early treatment of chronic diseases are crucial.
Healthy lifestyle:

  • Healthy diet
    • Low salt: Excessive consumption of salt will increase blood pressure. Food with high salt content such as processed food and sauce should be avoided.  Consume not more than 2g of sodium (i.e. one teaspoon of salt) per day.
    • Low sugar: Avoid food and drinks with high sugar content. Should consume less than 10% of total energy intake from sugars which is equivalent to 50g (i.e. around 12 level teaspoons) for a person of healthy body weight.
    • Low fat: Should consume less than 30% of total energy intake from fats.  Unsaturated fats (found in fish, avocado, nuts, sunflower, canola and olive oils) are preferable to saturated fats (found in fatty meat, butter, palm and coconut oil, cream and cheese).  Industrial trans fats (found in processed food, fast food, snack food, fried food, cookies and margarines) should be avoided.
    • High fibre: Consume 5 portions of vegetables or fruits per day. 
  • Do at least 30 minutes of moderate-intensity exercise 5 days a week or a total of 150 minutes of moderate-intensity exercise every week
  • No smoking
  • Stay relaxed and avoid being over-stressed. Engage in healthy activities to reduce tension and stress.

Regular check-up for early detection chronic diseases:

  • Check blood pressure
  • Take blood for lipids
  • Take blood for sugar
In coronary heart disease, coronary arteries are narrowed or even blocked by plaque formed by the process of atherosclerosis.
It takes a long time for atherosclerosis to develop. There may not be any symptom before the first episode of heart attack.  Patients may have the following symptoms:
  • Chest pain: Patients may have chest pain after vigorous exercise or under emotional stress. They may feel tightness across the chest as if pressured by a rock. The pain may extend to the arm, shoulder, neck and lower jaw and may lessen after the patient has taken a few minutes of rest.
  • Shortness of breath: Patients may develop shortness of breath and fatigue upon physical exertion.
  • Patients with heart attack may have severe chest pain which persists even after rest.
  • Other symptoms include palpitations, light-headedness and sweating.
  • Taking the medical history of patients
  • Physical examination including blood pressure
  • Blood tests including sugar and lipid
  • Electrocardiogram (ECG)
  • Exercise ECG
  • Echocardiogram (ultrasound of the heart    
  • Computerized tomography coronary angiogram
  • Magnetic resonance imaging of the heart
  • Coronary angiogram
Apart from adopting a healthy lifestyle and treatment for underlying chronic illnesses, like hypertension, diabetes and hyperlipidaemia, specific treatment for coronary heart disease may include medications, catheter intervention and cardiac surgery.
  • Aspirin and other anti-platelet drugs
  • Beta blockers
  • Vasodilators
  • Angiotensin-converting enzyme inhibitors (ACEI)
  • Calcium channel blockers
  • Lipid lowering drugs
Catheter intervention:
Percutaneous coronary intervention (commonly known as “balloon angioplasty”): If there is severe narrowing or blockage revealed during coronary angiogram, the doctor will perform balloon angioplasty by using a special balloon to dilate the blood vessel and a suitable stent will be placed there to maintain the patency of the blood vessel.  Complications of this procedure includes bleeding, heart attack, stroke and death.
Cardiac surgery
Coronary artery bypass surgery (commonly known as “bridging surgery”): It is a major open-heart surgery. The doctor creates a bypass using a vessel from another part of your body to allow blood to flow around the blocked area through the main artery to the damaged heart muscles. The surgery may cause severe complications and thorough discussion with the doctor is needed.
  • Heart attack: It occurs when blood flow is completely or almost completely blocked. Heart muscle will be severely or permanently damaged if the blood vessel is not opened up urgently.
  • Heart failure
  • Arrhythmia (abnormal heart rhythm)


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