Understanding atherosclerosis, recognising symptoms and choosing prevention.
When the heart’s arteries become diseased
The coronary arteries supply oxygen to the heart muscle. Coronary artery disease most often develops through atherosclerosis, in which lipids, inflammatory cells and fibrous tissue accumulate within the artery wall. The problem involves more than narrowing: a plaque can become unstable and trigger a clot that suddenly reduces blood flow.
Angina and heart attack
Chest pressure or discomfort during exertion may indicate an inadequate blood supply to the heart. In an acute coronary syndrome, symptoms may develop at rest or change rapidly. Breathlessness, sweating, nausea and profound weakness may accompany chest discomfort or sometimes dominate the presentation, particularly in older people and those with diabetes.
How the diagnosis is made
Assessment begins with symptoms, examination and an estimate of the likelihood of coronary disease. Suspected acute coronary syndrome requires urgent ECG assessment and high-sensitivity cardiac troponin testing. For stable symptoms, coronary CT angiography or functional tests for ischaemia may be appropriate, depending on the clinical setting. Invasive angiography is reserved for selected situations.1
Symptoms without a major narrowing
Angina or ischaemia can occur even without obstructive disease in the large coronary arteries. Problems involving the small vessels or coronary spasm may require a different diagnostic and treatment approach. Persistent symptoms deserve assessment even when an initial angiogram shows no major obstruction.1
Prevention addresses several factors
Stopping smoking, controlling blood pressure, managing cholesterol and diabetes, appropriate physical activity and a balanced diet all contribute to prevention. After a coronary event, cardiac rehabilitation and secondary prevention form part of treatment rather than an optional addition.
Treatment is individual
Antianginal medicines, lipid-lowering treatment, antiplatelet drugs and revascularisation have different roles. A visible narrowing does not automatically mean that a stent is needed. Symptoms, anatomy, documented ischaemia, prognosis, bleeding risk and shared decision-making all matter. Acute presentations require a different, time-sensitive pathway.1,2
Continue exploring cardiovascular health
Understand cardiovascular risk and SCORE2, hypertension and coronary CT angiography. For warning symptoms and emergency care, see the heart attack guide.
About Massimo Fioranelli · Cardiology and internal medicine · Clinical practice at Sanatrix, Rome
References
Read the heart attack guide · Italian version
Reviewed 23 October 2026. Educational information does not replace individual medical assessment.