Coronary arteries are the arteries that supply blood to the heart, including the anterior interventricular artery, the circumflex artery originating from the left coronary artery, and the right coronary artery. Coronary artery disease is a disease of these arteries, mainly due to atherosclerosis causing narrowing of the coronary lumen, which can lead to dangerous events such as myocardial infarction. Coronary artery disease is a disease of the modern era, with the highest incidence and mortality rates worldwide (above cancer, stroke, etc.).

Currently, with many advances in cardiovascular interventions and medications, the mortality rate of coronary artery disease has improved significantly. Coronary artery disease is divided into two main groups: acute coronary syndrome (ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, unstable angina) and stable angina (stable coronary artery disease).

Coronary artery disease can be caused by a combination of factors, the primary cause being atherosclerotic plaques in the coronary arteries:

- Coronary artery obstruction due to atherosclerotic plaques: Atherosclerotic plaques narrow the coronary arteries to a certain extent, causing myocardial ischemia and manifesting as chest pain clinically. If the plaque suddenly ruptures, the clotting process is initiated, creating blood clots that block the coronary artery, at which point a myocardial infarction will occur.

- Localized or diffuse spasm of the coronary arteries

- Coronary microvascular dysfunction

The main symptom of coronary artery disease is angina.

Coronary angina is described as having three characteristics:

- A feeling of strangulation, tightness, or pressure behind the sternum, radiating to the chin, left shoulder, and down the left arm.

- Appears regularly, intensifies after exertion, strong emotions, or exposure to cold, lasting 3-15 minutes.

- Chest pain improves with rest or with the use of nitroglycerin.

If all three characteristics are present, it is called typical angina; if only two out of three criteria are present, it is called atypical angina; if only one or none of the criteria are present, other non-coronary causes should be investigated.

Chest pain with the above characteristics is called stable chest pain. If chest pain appears suddenly, occurs even at rest, or occurs during activities that normally do not cause chest pain, it is called unstable chest pain. Severe chest pain lasting more than 20 minutes should raise suspicion of an ongoing myocardial infarction (heart attack).

In elderly patients, or especially those with diabetes, chest pain may be atypical, vague, or indistinct. Patients may present with heart failure without prior chest pain, and coronary artery examination may reveal significant narrowing. Such cases are referred to as silent myocardial ischemia.

Groups at high risk for coronary artery disease include: Men; Older age; Smoking; Obesity; Diabetes; Dyslipidemia; Hypertension; Sedentary lifestyle. 

To prevent coronary heart disease, you should:

- Quit smoking

- Lose weight if you are overweight.

- Exercise regularly: at least 30 minutes a day, 5 days a week

- Healthy diet: plenty of green vegetables and fruits, limit animal fats and replace them with vegetable oils, limit animal offal, reduce salt in food, and avoid pickled foods such as pickled cucumbers and pickled carrots…

- Control blood pressure by making dietary changes and taking medication regularly.

- Control blood sugar and blood lipids.

For acute chest pain

Electrocardiogram: Immediate recording is necessary upon patient arrival at the hospital, looking for ST-T wave changes suggestive of acute myocardial infarction such as ST elevation, mirror-image ST depression in other leads, or tall, peaked T waves in the hyperacute phase.

Blood tests: Cardiac enzymes Troponin T or Troponin I are markers of myocardial necrosis and are the criteria for definitively diagnosing acute myocardial infarction.

Emergency echocardiography: In inconclusive cases, emergency echocardiography may be necessary to look for regional myocardial motion abnormalities.

Cases of chronic, stable chest pain:

Electrocardiogram: Electrocardiogram (ECG) is the first and most essential diagnostic tool for coronary artery disease. It may reveal ST segment depression, negative T waves, and necrotic Q waves indicative of a previous myocardial infarction. Furthermore, if these ECG changes occur during an attack of pain, it further confirms ischemic heart disease.

Exercise electrocardiogram (using a treadmill, bicycle, etc.): Continuous electrocardiogram (ECG) recording is performed while the patient is active, searching for changes in the ECG during exertion, when coronary artery disease is suspected but the resting ECG is normal and shows no suggestive signs.

Echocardiography and stress echocardiography: Doppler echocardiography can reveal regional wall motion abnormalities, reduced or absent myocardial wall motion according to the coronary artery's blood supply region. If the echocardiography is normal, stress echocardiography can be performed, and the patient will be given inotropic agents (such as dobutamine). The presence of regional wall motion abnormalities on stress echocardiography is also valuable in diagnosing ischemic heart disease.

Multislice computed tomography: It allows for the assessment of coronary artery images, the degree of stenosis, and the location of the stenosis. However, it may not be accurate in cases of extensive coronary artery calcification.

Percutaneous coronary angiography: This is an invasive, high-tech procedure. A catheter is inserted through a blood vessel to image the coronary arteries. The degree of stenosis and coronary reserve can be determined through intravascular ultrasound (IVUS) and FFR measurement.

Tests: Cardiac enzymes (Troponin T or Troponin I, CK, CK-MB) to rule out acute coronary syndrome, cholesterol, triglyceride, LDL-C, HDL-C, glucose, HbA1C, liver and kidney function tests, etc., to diagnose diseases and associated risk factors.

Treatment for coronary artery disease is divided into two groups: acute myocardial infarction and stable coronary artery disease.

- Acute ST-elevation myocardial infarction: Acute ST-elevation myocardial infarction presenting within 12 hours of onset requires emergency intervention. Intervention involves inserting a catheter via a peripheral artery (radial or femoral artery) to the affected coronary artery and placing a coronary stent. If presenting later than 12 hours, routine intervention may still be possible within 48 hours.


- Non-ST elevation myocardial infarction and unstable angina: risk stratification based on the GRACE score to determine the timing of intervention.


General medical treatments for both stented myocardial infarction and stable coronary artery disease will be specifically prescribed by the doctor in each case. Indications for revascularization in patients with stable coronary artery disease: when optimal medical treatment does not improve symptoms, percutaneous revascularization or coronary artery bypass grafting may be considered depending on the specific case. Revascularization may also be considered in patients with 2-3 coronary artery disease, left main coronary artery stenosis >50%, and concomitant heart failure to improve prognosis.