Coronary heart disease—sometimes referred to as ischaemic heart disease (IHD) or coronary artery disease (CAD)—is chronic heart disease that is usually progressive and not curable. It occurs when the coronary arteries become narrowed, causing less blood going to the heart muscle than is needed. This is most commonly caused by atherosclerosis of the coronary arteries, which is a progressive build-up of fatty material (plaque) in the arteries. Lack of blood supply to the heart can cause chest pain and discomfort (angina), and this sometimes occurs during exercise or when the heart rate is evaluated. However, if the coronary artery is completely blocked this can cause a heart attack and is a medical emergency.
--What causes coronary heart disease?
Coronary heart disease is a chronic disease that is mostly seen as people age and is more common in males than females. The most common modifiable risk factors are smoking, high blood pressure, high cholesterol, diabetes, poor diet, lack of exercise and obesity. The most common symptom is chest pain. However, the symptoms of coronary heart disease can be silent until angina or a heart attack occurs, and therefore many people do not realise they have coronary heart disease.
Coronary heart disease is caused by a combination of both modifiable risk factors and non-modifiable risk factors.
- Modifiable risk factors include smoking, high blood pressure, high cholesterol, diabetes, poor diet, lack of exercise, obesity, depression and social isolation.
- Non-modifiable risk factors include older age, being male, family history of cardiac disease and coming from an Aboriginal and Torres Strait Islander background.
Taking steps to reduce the occurrence and severity of the modifiable risk factors is an important part of prevention and management of coronary heart disease.
--How do I know if I have coronary heart disease?
A GP will help diagnose coronary heart disease. Often the symptoms are silent and, therefore, if you have any of the risk factors for coronary heart disease, you should discuss these with your GP. Your GP may do a variety of tests to try to determine if you have coronary heart disease and how severe it is, and may send you to a specialist medical doctor (such as a cardiac doctor) for assessment and treatment. Coronary heart disease is diagnosed based on a history of symptoms (chest pain, such as angina) and results of a number of tests, including blood tests, an electrocardiogram (ECG), an echocardiogram and an angiogram. Because coronary heart disease cannot be cured, the treatment is focused on managing the condition and preventing the risk of future heart events, attacks or death.
In stable coronary heart disease, there are many things that people can do to keep healthy. Important components of management include stopping smoking, exercising (cardiac rehabilitation), managing weight and diet, and, sometimes, taking medications to reduce blood pressure and cholesterol. For people with unstable or more severe disease, the medical management may also include heart surgery.
--How can physiotherapy help with coronary heart disease?
Physiotherapy is important in the management of coronary heart disease. The cornerstone of physiotherapy management is cardiac rehabilitation. In patients undergoing heart surgery, physiotherapy can also help with recovery after surgery. Your physiotherapist may see you before and after your surgery to help prevent a chest infection and regain your mobility and walking as soon as possible.
--What is cardiac rehabilitation?
Cardiac rehabilitation is a program for people with a variety of cardiovascular diseases. The cornerstone of cardiac rehabilitation is exercise training. The program also involves education and support about managing the disease, including reducing risk factors, getting back to your usual life, managing your medications, psychological issues, maintaining a good diet and stopping smoking. Joining a cardiac rehabilitation program (widely available throughout Australia) is the easiest way to learn about how to exercise with your disease. At the cardiac rehabilitation program, a physiotherapist will measure your exercise capacity, your symptoms and your safety for exercise. They will teach you how to do the exercises and then supervise you exercising in the group environment once or twice a week for 6-8 weeks. The programs are located at local hospitals or community centres around Australia. Speak to your doctor or physiotherapist for more information and to get a referral to your local program—it is the best thing you can do.
--When should I start cardiac rehabilitation?
There are three types of cardiac rehabilitation.
- Phase I occurs in the hospital straight after surgery. A physiotherapist will teach you some gentle exercises and provide education on the things to do and not to do to help your recovery. They may also provide you with a home-exercise program to start once you get home. Phase I usually runs multiple times per week on the hospital ward from the first day after your surgery.
- Phase II cardiac rehabilitation occurs in the outpatient setting after discharge from hospital following surgery and stenting. As well, people with coronary heart disease not requiring surgery are suitable for cardiac rehabilitation once cleared by a medical doctor. This phase usually runs once or twice a week for 6-8 weeks.
- Phase III is a long-term maintenance program running in the community for people who have already completed the other phases.
Find out more information about cardiac rehabilitation.
--What is the role of physiotherapy before and after heart surgery?
Physiotherapy before heart surgery may involve breathing exercises and education. Physiotherapy after surgery usually commences on the first day after, and involves helping you get out of bed and start walking, as well as the prescription and supervision of exercise in the Phase I cardiac rehabilitation class. A physiotherapist will also give you advice on what to do and not do after surgery during the recovery.
--How effective is physiotherapy for coronary heart disease?
There is a large body of research to confirm the effectiveness of physiotherapy improving many aspects of life for people with coronary heart disease. Research has supported the development of a number of clinical practice guidelines for clinicians about how to best manage their patients. In particular, the Australian Cardiovascular Health and Rehabilitation Association (ACRA) has developed guidelines for secondary prevention and cardiac rehabilitation. These are evidence-based guidelines for the management of coronary heart disease and recommend both physiotherapy and cardiac rehabilitation.
There is strong evidence that cardiac rehabilitation reduces hospital readmissions and death within the first year of a cardiac event. It also speeds up recovery, reduces risk factors (such as high blood pressure and cholesterol), improves fitness levels, reduces smoking, reduces further hospitalisations or cardiac events, and improves quality of life. There is also growing evidence that shows breathing exercises (muscle training) before and after cardiac surgery results in faster recovery after surgery, including fitness, anxiety and quality of life:
Cardiac rehabilitation guidelines
Evidence for cardiac rehabilitation for people with coronary heart disease
Evidence for exercise training immediately after heart surgery
Evidence for breathing exercises before and after heart surgery
--What can I do at home?
Managing your coronary heart disease at home is important. Discuss with your GP or physiotherapist about having a self-management plan to help prevent or manage crises. Take all your medication as recommended and be able to recognise the signs of worsening disease or angina, so you can respond quickly before it gets worse. It is best to speak to your GP or physiotherapist about a self-management plan if you do not already have one.
The best thing to do at home is to exercise daily and lead an active lifestyle. A good aim is to undertake at least 30 minutes of exercise on most days of the week. Brisk walking is a safe and easy way to achieve this if you are not used to exercising. You can pace yourself using the ‘talk test’ (ie, if you can walk and talk without being short of breath, that is the correct pace for you).
In addition, avoiding too much sedentary time during the day is important (eg, avoid sitting down for too long, watching television). Some people wear activity trackers such as Fitbits, pedometers or smartphones to track the number of steps they take each day. This is a great way to monitor your activity levels and ensure you are keeping up an active lifestyle. Aim to do 10 000 steps every day.
Remember to listen to your body, as it sets the safe limits for you. Ensure your coronary heart disease is well controlled before you start exercising and talk to your doctor or physiotherapist before you start, to check that it is safe to do so.
