In many patients, the first symptom of coronary artery disease is heart attack or sudden death, with no preceding chest pain as a warning. Screening tests are of particular importance for patients with risk factors for coronary heart disease. The gold standard for coronary artery disease is coronary angiogram, used to identify the exact location of disease, anatomical details and the severity of disease.

Coronary artery disease (atherosclerotic heart disease) is due to accumulation of atheromatous plaques in the coronary vessel walls. Coronary arteries are the major blood vessels that supply the heart with blood, oxygen and nutrients. Fatty streaks or plaques will narrow the coronary arteries and reduce the blood flow to the heart. Because coronary artery disease often develops over decades, it can go virtually unnoticed until it produces a heart attack.

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The main way to prevent progressive damage is to restore blood flow quickly. Antithrombotic agents are initial treatment of choice and need to be given as soon as possible. It reduces the morbidity and mortality rates. Thrombolytic therapy is highly effective if given with in 30 min to 1 hr.

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