Coronary Artery Disease
Coronary artery disease is a condition caused by reduced blood flow through the coronary arteries, which limits the supply of oxygen to the heart muscle. When the heart does not receive the oxygen it needs, it can experience ischemia, a condition that over time may impair its function. In the most severe cases, a sudden blockage of a coronary artery can lead to a myocardial infarction (heart attack), one of the most serious cardiovascular emergencies.
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Emergency: If you experience persistent chest pain, severe shortness of breath, or fainting (syncope), call emergency services immediately. Do not wait.
Services for the diagnosis and treatment of coronary artery disease are available at:
- IRCCS ISMETT (Palermo).
- UPMC Salvator Mundi International Hospital (Rome).
On this page
- What Is Coronary Artery Disease?
- What Are the Symptoms of Coronary Artery Disease?
- How Do You Diagnose Coronary Artery Disease?
- How Do You Treat Coronary Artery Disease?
What Is Coronary Artery Disease?
Coronary artery disease, also known as coronary ischemia, is a cardiovascular condition characterized by an insufficient supply of blood and oxygen to the heart muscle. This occurs when the coronary arteries become narrowed or blocked, restricting normal blood flow to the heart.
The heart requires a constant supply of oxygen to function properly. When the myocardium’s oxygen demand exceeds the amount of blood delivered through the coronary arteries, the heart tissue experiences ischemia. If this imbalance persists, it can progressively impair cardiac function and increase the risk of heart failure.
The most serious complication is the sudden occlusion of a coronary artery, which causes a myocardial infarction (heart attack). This is a medical emergency that requires immediate treatment and may result in cardiac arrest and other life-threatening complications.
Causes of coronary artery disease
Approximately 90% of coronary artery disease cases are caused by coronary atherosclerosis, a progressive buildup of fatty plaques within the coronary arteries that reduces their diameter. These plaques develop over years or decades, gradually narrowing the arterial lumen. If a plaque ruptures suddenly, it can trigger acute thrombosis and complete coronary artery blockage.
Coronary artery spasms are temporary, sudden constrictions of the coronary arteries that briefly reduce the oxygen supply to the heart muscle. They account for fewer than 5% of cases and are often associated with emotional stress, exposure to cold, or substance abuse.
Risk factors for coronary artery disease
The main factors that increase the risk of developing coronary atherosclerosis include:
- High blood pressure (hypertension) – Accelerates endothelial damage and plaque formation.
- High cholesterol (hypercholesterolemia) – Elevated LDL cholesterol directly promotes atherosclerosis.
- Diabetes mellitus – Increases vascular inflammation and endothelial dysfunction.
- Smoking – Causes direct endothelial injury and promotes blood clot formation.
- Physical inactivity – Contributes to metabolic risk factors associated with atherosclerosis.
- Family history/genetic predisposition – Increases susceptibility to premature atherosclerosis.
Effective management of these risk factors is essential for reducing the likelihood of developing coronary artery disease and its complications.
What Are the Symptoms of Coronary Artery Disease?
Symptoms depend on the severity and duration of myocardial ischemia. In many cases, the disease develops silently over several years, without obvious signs or symptoms, until more serious complications arise.
Stable Angina (partial and chronic reduction in blood flow)
- Chest pain or discomfort described as pressure, heaviness, tightness, or squeezing, typically occurring during physical exertion or emotional stress.
- Pain that radiates to the shoulder, left arm, neck, jaw, or back.
- Shortness of breath accompanying the chest discomfort.
- Unusual fatigue.
- Symptoms usually improve with rest or nitroglycerin.
Unstable Angina or Heart Attack (acute or near-complete blockage)
- Severe, sudden, and persistent chest pain that does not improve with rest.
- Profuse cold sweating.
- Nausea and vomiting.
- Weakness, dizziness, or fainting (syncope).
- Severe shortness of breath.
If you experience severe chest pain that does not subside within a few minutes, severe shortness of breath, or fainting, call emergency services immediately. Do not wait or take over-the-counter medications.
How Do You Diagnose Coronary Artery Disease?
The diagnostic process follows a stepwise approach based on symptoms, cardiovascular risk factors, and the results of initial tests.
Phase 1: Initial Assessment
- Medical history and physical examination – Evaluation of symptoms, cardiovascular risk factors, and physical findings.
- Electrocardiogram (ECG) – Records electrical activity of the heart and can identify abnormalities consistent with acute ischemia or a previous heart attack.
- Blood tests – Including troponin (a marker of acute myocardial injury), cholesterol levels, blood glucose, and kidney and liver function tests.
Phase 2: Functional Testing (to assess for inducible myocardial ischemia)
- Exercise stress test (ergometry) – Monitors ECG changes and symptoms during physical activity to detect inducible ischemia.
- Myocardial perfusion imaging (nuclear stress test) – A nuclear medicine examination that identifies areas of the heart muscle with reduced blood flow. It is used less frequently today and has largely been replaced by coronary CT angiography in many clinical settings.
Phase 3: Structural Imaging
- Echocardiogram – An ultrasound examination that evaluates cardiac structure and myocardial contractility; it can identify regional wall motion abnormalities caused by a previous heart attack.
- Coronary CT angiography (CCTA) – An imaging study that directly visualizes the coronary arteries and quantifies atherosclerotic plaque burden. It has largely replaced myocardial perfusion imaging as a preferred second-line diagnostic test in many cases.
- Cardiac magnetic resonance imaging (Cardiac MRI) – Provides high-resolution images of cardiac function and myocardial perfusion and is useful for assessing damage caused by chronic ischemia.
Phase 4: Diagnostic and Therapeutic Gold Standard
- Coronary angiography (cardiac catheterization) – An invasive procedure that directly visualizes the coronary arteries using contrast dye. It allows physicians to determine the severity of arterial narrowing and, when appropriate, perform angioplasty during the same procedure. It is typically indicated in patients with moderate-to-high risk profiles or when noninvasive testing suggests significant ischemia.
The combination of these diagnostic tests enables physicians to confirm the diagnosis, assess cardiovascular risk, and determine the most appropriate treatment strategy.
How Do You Treat Coronary Artery Disease?
Treatment depends on the clinical presentation, whether stable angina, unstable angina, or heart attack, as well as the severity of myocardial ischemia.
Stable Angina – Medical Therapy and Prevention
Key medications:
- Antiplatelet agents (aspirin) – Reduce the risk of blood clot formation.
- Beta-blockers – Lower heart rate and reduce the heart’s oxygen demand.
- ACE inhibitors or ARBs – Help protect heart function and lower blood pressure.
- Statins – Control cholesterol levels and slow the progression of atherosclerosis.
- Nitrates – Dilate the coronary arteries and reduce cardiac workload; used as needed or as preventive therapy.
Lifestyle modifications (essential):
- Smoking cessation.
- Blood pressure and blood glucose control.
- A Mediterranean-style diet low in salt and saturated fats.
- Regular physical activity (at least 30 minutes per day, five days per week).
- Stress management.
Unstable Angina or Heart Attack – Urgent Intervention
In these situations, in addition to the medications listed above, immediate treatment is required to restore coronary blood flow:
- Coronary angioplasty with stent placement – A minimally invasive procedure that reopens the blocked artery using an inflatable balloon and a metal mesh support device (stent). In patients with ST-segment elevation myocardial infarction (STEMI), primary angioplasty should be performed as quickly as possible, typically within 120 minutes of first medical contact.
When Medical Therapy Is Not Sufficient – Surgery
If ischemia is extensive and involves multiple coronary arteries, or if angioplasty is not feasible or has been unsuccessful:
- Coronary artery bypass grafting (CABG) – A surgical procedure that creates an alternative pathway for blood flow using a blood vessel taken from another part of the body, such as the internal mammary artery, radial artery, or saphenous vein. This allows blood to bypass the blocked section of the coronary artery.
The choice of treatment is determined by the cardiologist and, when appropriate, the cardiac surgeon, based on the extent of the disease, the severity of ischemia, the patient’s age, and overall health status.
Reviewed September 2026.