Call 999 if you have chest pain that is severe, lasts more than 15 minutes, spreads to the arm, neck or jaw, or comes with sweating, sickness or breathlessness. Do not drive yourself to hospital.
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Coronary artery disease is the build-up of fatty deposits inside the arteries that supply the heart muscle itself. As those deposits grow, the artery narrows and the muscle beyond it can run short of blood during exertion. If a deposit ruptures and a clot forms on it, the artery can block completely — that is a heart attack. It is the most common form of heart disease in the UK, and much of the risk is modifiable.
The heart is a muscle, and like every muscle it needs its own blood supply. That supply comes from the coronary arteries — a small network of vessels sitting on the outside surface of the heart, branching off the aorta just above the aortic valve.
Coronary artery disease, sometimes called ischaemic heart disease or coronary heart disease, is what happens when those arteries become narrowed by atherosclerosis: a build-up of fatty material, cholesterol and inflammatory cells within the artery wall. The deposit is called a plaque.
The important thing to understand is that this is a disease of the artery wall, not simply a blockage in a pipe. That distinction explains a lot of what follows.
Atherosclerosis develops slowly, usually over decades, and it is silent for most of that time.
Step six is why severity is not a simple matter of how narrow an artery is. A modest plaque with an unstable surface can be more dangerous than a larger, stable, calcified one.
Coronary artery disease can present in several ways, and one of them is no symptoms at all.
Stable angina is the classic pattern: a tight, heavy or pressing discomfort in the centre of the chest that comes on with exertion or stress, may spread to the arm, neck or jaw, and eases within a few minutes of resting. Predictability is the defining feature — the same activity brings on the same discomfort.
Breathlessness can be the main or only symptom, particularly in women, people with diabetes and older adults. If breathlessness on exertion is your concern, we cover it separately in breathlessness and when it needs an echocardiogram.
Unstable symptoms — chest discomfort at rest, discomfort that is getting worse or coming on more easily, or a first episode of severe chest pain — are a medical emergency. Our guide to chest pain causes and cardiac investigation goes through this in more detail.
Silent disease is common. Significant narrowing can exist without symptoms until it causes a heart attack, which is why risk factors and family history matter even when you feel completely well.
| You can change these | You cannot change these |
|---|---|
| Smoking | Age |
| High blood pressure | Male sex (risk in women rises after menopause) |
| Raised cholesterol | Family history of early heart disease |
| Type 2 diabetes and blood sugar control | Ethnic background — South Asian heritage carries higher risk |
| Excess weight, particularly around the middle | Certain inherited cholesterol conditions |
| Physical inactivity |
Stopping smoking is the single most effective change most people can make. Blood pressure and cholesterol are both treatable and both silent, which is why they are checked rather than felt.
This is where honest expectation-setting matters, because the tests answer different questions and are not interchangeable.
Our comparison of echocardiography versus CT goes into the difference in more depth, and heart health screening tests sets out what a broader assessment includes.
The most common reason people self-refer to us with coronary disease on their mind is reassurance. Usually it is one of three things: chest discomfort they have been turning over for a while, breathlessness that has crept up on them, or worry about blocked arteries after a symptom or a family history — often after a parent or sibling had a heart attack.
That pattern shapes the conversation we have before booking anything. Reassurance is a legitimate reason to seek assessment, but it only works if the test answers the question being asked. Someone who wants to know whether their coronary arteries are narrowed will not get that answer from an echocardiogram, and we say so rather than booking the scan. What an echocardiogram can do is assess the heart structure and function, look for the consequences of coronary disease, and identify other explanations for the same symptoms — which for many people is genuinely useful, and for some is not what they came for.
Describes a general pattern in the enquiries we receive, not any individual case.
No. Ultrasound cannot image the coronary arteries. An echocardiogram assesses the heart structure and pumping function, and can show the consequences of coronary disease, but it cannot tell you whether an artery is narrowed. That question needs CT coronary angiography or invasive angiography.
Established plaque does not disappear, but progression can be slowed substantially and plaques can be stabilised. Stopping smoking, treating blood pressure and cholesterol, controlling blood sugar and regular activity all measurably reduce the risk of a heart attack.
Start with your GP for a cardiovascular risk assessment — blood pressure, cholesterol and blood sugar. That is more informative as a first step than any scan. Our guide to family history heart screening sets out what is worth doing and when.
No. Stable angina is a signal that the arteries are narrowed, and it is treatable with medication and sometimes with a stent or bypass surgery. Many people live with well-controlled stable angina for years. Symptoms that change or worsen are the ones needing urgent assessment.
It depends what you want to know. If your question is about the coronary arteries themselves, an ultrasound-based assessment is not the right test. If your question is about heart function, valves, rhythm and overall cardiovascular risk, then an assessment can be worthwhile. We would rather have that conversation before you book than afterwards.
Instant verbal results at the appointment, with the written report within 24 hours.
Call 020 3633 4902 if you would like to check whether a scan answers your particular question before booking. A standalone echocardiogram costs £350.
CQC-registered clinic · HCPC-registered sonographers · BMUS member · ICO-registered. Reports can be shared securely with your NHS GP or specialist at your request.
