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Coronary Artery Disease (CAD) — also known as ischemic heart disease (IHD) — is a condition caused by atherosclerosis of the coronary arteries, leading to myocardial ischemia, which may manifest as stable angina, acute coronary syndromes (ACS), or silent ischemia. It is the leading cause of death worldwide.

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Pathophysiology

Atherosclerotic plaque formation occurs over decades due to endothelial dysfunction, lipid accumulation, and inflammation.
Plaques can become:
- Stable: fibrous cap, causes fixed stenosis → Stable angina
- Unstable/vulnerable: prone to rupture, causing thrombosis → Acute coronary syndrome (ACS)
Myocardial ischemia results when oxygen demand > supply due to impaired coronary flow.

Anatomical basis:

Coronary Vessel	Territory Supplied
LAD (Left Anterior Descending)	Anterior wall, septum, apex
LCx (Left Circumflex)	Lateral and posterior wall (left dominance)
RCA (Right Coronary Artery)	Inferior wall, RV, AV node (right dominance)

Risk Factors

Modifiable	Non-modifiable
Hypertension	Age (men >45, women >55)
Diabetes mellitus	Male gender
Hyperlipidemia	Family history of premature CAD
Smoking
Obesity, sedentary lifestyle
Metabolic syndrome

Clinical Presentations

Syndrome	Description
Stable Angina	Predictable chest pain on exertion, relieved by rest or nitroglycerin
Unstable Angina	New-onset or worsening angina, occurs at rest; no troponin rise
NSTEMI	Non-ST elevation MI: troponin ↑, ischemic symptoms, no ST elevation
STEMI	ST elevation MI: full-thickness infarction, ST elevation, troponin ↑
Silent ischemia	Asymptomatic but detected via ECG, imaging, or Holter

Complications

Complication	Details
‣ (STEMI/NSTEMI)	Most serious event; infarct size affects prognosis
‣	From ischemic cardiomyopathy
‣	VT/VF, especially in acute MI
‣	May occur from silent ischemia or massive infarct
Mechanical complications	Papillary muscle rupture, VSD, free wall rupture

Pathophysiology

Risk Factors

Clinical Presentations

Complications

Diagnostic Evaluation

1. Non-Invasive Testing