Coronary artery disease (CAD), also known as ischemic heart disease, is a serious condition that affects the blood vessels that supply the heart. It is caused when atherosclerotic plaques of the vessel wall expand towards and fill the lumen of the heart's blood vessels (coronary arteries) and block blood flow to the heart. This results in a reduced supply of oxygen and nutrients to the tissues of the heart, especially in situations where it has increased needs, thus causing "myocardial ischemia".

Most often responsible for the appearance of the disease is a condition known as atherosclerosis, which is due to the creation of atheromatous plaques that accumulate inside the coronary arteries. Atherosclerotic plaques are mainly composed of cholesterol, fatty elements, fibrous tissue and sometimes local calcium deposits. This gradual build-up, called atherosclerosis, causes narrowing or blockage of the vessels. If the plaque ruptures, it can cause a blood clot to form, leading to a blockage of a coronary artery and potentially leading to a myocardial infarction (heart attack), which can be fatal to the patient or lead to progressive deterioration of heart function. Globally, it is the leading cause of morbidity and mortality, affecting millions of adults. It is responsible for approximately 33% of all deaths, making it the most common cause of death worldwide.

Coronary artery disease symptoms can be different from person to person, even if they have the same type of coronary artery disease. However, because many people have no symptoms, they do not know they have coronary artery disease until they experience chest pain, a heart attack, or sudden cardiac arrest. Coronary artery disease causes angina. It manifests as pressure, tightness, numbness or pain in the chest, arm, neck, back or jaw. If not treated in time, it can lead to a heart attack or myocardial infarction (complete blockage of the coronary artery resulting in the necrosis of part of the heart).

Common symptoms include:

- Angina (chest pain): Pressure or tightness to the chest, often caused by physical activity or emotional stress, and may radiate to the neck, jaw, shoulder, or arm.

- Shortness of breath: Especially during physical activities.

- Fatigue: Feeling tired and lacking energy.

- Sweating.

- Dizziness or fainting: Feeling weak or losing consciousness.

- Pain in the neck and jaw: In women mainly it can also appear with this symptom.

- Burning in the region of the heart: Usually combined with shortness of breath.

Symptoms usually occur with exercise, vigorous exertion or emotional stress, last up to a few minutes, and improve with rest.

- High blood pressure: High blood pressure can damage the walls of the arteries.

- Smoking: Damages blood vessels and increases the risk of blood clots.

- High cholesterol: LDL ("bad") cholesterol contributes to atherosclerosis.

- Diabetes: Damages blood vessels and increases the risk of blood clots.

- Obesity: Increases the risk of high blood pressure, diabetes and high cholesterol.

- Heredity: Some people are more vulnerable to coronary artery disease due to family history.

- Stress: Chronic stress can negatively affect the health of blood vessels.

- Sedentary life-lack of exercise: Like every muscle in our body, the heart works better if it is exercised. Exercise also helps fight stress, reduce weight and cholesterol.

Early diagnosis of coronary artery disease is crucial to implement appropriate treatment and prevent further complications.

The diagnostic approach includes the following stages:

- Medical History and Clinical Examination: The cardiologist begins by taking a detailed medical history, focusing on your symptoms, risk factors and family history. Next comes the physical exam, where the doctor checks your blood pressure, pulse and listens to your heart for any unusual sounds.

- Laboratory Tests: Blood tests are used to measure levels of cholesterol, triglycerides, sugar and other values that are important indicators of heart health.

- Electrocardiogram (ECG): A simple and painless test that records the electrical activity of the heart. It can reveal heart rhythm abnormalities (arrhythmias) or signs of a previous heart attack.

- Stress Test: During a stresstest, the heart is monitored while you are exercising (treadmill or cycling). It helps to detect the heart's response to increased workload, revealing potential blood flow problems.

- Stress echocardiography - stress echo: Pharmacologically increasing heart rate and force of contraction to video record the movement of all myocardial walls and compare with rest data.

- Myocardial perfusion scintigraphy (SPECT): Combines the performance of a stresstest either on a treadmill or with the use of drugs (dobutamine, dipyridamole, adenosine) with imaging of myocardial perfusion.

- Imaging Tests: In cases where the doctor wants to visualize the blood vessels of the heart in more detail, he may recommend: CT scan of the heart, Coronary angiography.

Lifestyle changes and medication: they play a critical role in the management of CAD, including:

- Dietary changes, weight control.

- Physical exercise.

- Smoking cessation.

- Stress management.

- Medication: Antithrombotics, antihypertensives, statins to reduce cholesterol, drugs to control diabetes.

Interventional – Surgical treatments:

- Coronary Angioplasty: It may be decided to perform coronary angioplasty with balloon dilation and/or the placement of a stent (percutaneous coronary intervention).

- Rotational Atherectomy (rotablation): Treatment of heavily calcified plaques with a special catheter with a diamond-tipped olive-shaped burr.

- Intracoronary Lithotripsy (IVL): Dilation with a special balloon catheter which delivers pulsatile sonic pressure waves to modify calcified plaques.

- Open heart surgery by a cardiac surgeon to bypass the blocked coronary artery (coronary bypass surgery).