other cardiovascular risk factors such as - smoking cigarettes, family history of heart attacks, high blood pressure and cholesterol levels, age and diabetes. The doctor will perform a physical examination on the patient paying special attention to the heart and any abnormal sounds or beats.

Routine tests include an electrocardiogram (ECG), blood pressure measurements, blood and urine tests and a chest X-ray. The doctor may require during the ECG the patient walks on a treadmill (exercise bike) while hooked up to a machine that records the heart's electrical activity. The level of exercise is slowly increased until the patient feels pain and there is a change to the ECG pattern. Further tests may include a coronary angiogram. This entails a fine tube inserted into your heart via an artery in your groin. A special dye is then inserted into the arteries clearly displaying any narrowing (blocked) arteries on the X-ray images.

Angina responds well to drug treatment. The most common drugs used to treat angina are the following:

• Nitrates - These drugs come as fast-acting sprays or tablets that are placed under the tongue to ease the pain during an angina attack. Long-acting tablets taken daily reduce the need for the sprays.

• Beta-blockers - These tablets lessen the workload of the heart by allowing it to beat slower and less forcefully than usual. These tablets prevent pain and slow down the gradual worsening of angina.

• Calcium antagonists - Helps to dilate the arteries allowing more blood flow through

them. They lower blood pressure; reduce the heart's workload to help prevent pain.

A standard treatment is a low, daily dose of aspirin to prevent anymore atheroma from building up in the heart arteries.

Once an artery has become blocked or narrowed by plaques of atheroma, there are two levels of intervention needed for reinstating blood supply to the heart muscle. The intervention chosen will depend on how badly the artery is blocked or narrowed. 1) Angioplasty - This procedure is performed only when the arteries are not completely blocked. A fine tube (catheter) is inserted into the heart. On the tip of the tube is a tiny balloon, which is then inflated and deflated a few times to squash the plaque and widen the artery. This procedure is performed under local anesthetic and is carried out on an outpatient basis. 2) Bypass surgery - This procedure is carried out only if the arteries are completely blocked or very narrow. A new route for the blood supply is made using a bypass graft. For the bypass graft, surgeons have two options - they either use an existing artery that lies within the chest or they use a piece of vein removed from the leg.

Sometimes a person may have up to four blockages to bypass. Bypass surgery is performed under local anesthetic and can take from three to five hours to complete the surgery. Today it has become one of the most frequently performed surgical procedures.

Michael Russell Your Independent guide to Heart Disease