Coronary artery disease (CAD)-related mortality is decreasing in the United States but it nonetheless remains the principal cause of death in American adults.

The worldwide prevalence of CAD and its risk factors is increasing.

Most major CAD risk factors (diabetes, high blood pressure, cigarette smoking, and hyperlipidemia) are reversible, treatable, or preventable.

Coronary artery atherosclerosis is a diffuse multisystem process that produces the vulnerable and fibrotic subendothelial atheromatous plaques that cause acute coronary syndromes and stable angina, respectively.

The clinical history provides the foundation for the diagnosis of CAD.

Angina, or chest pain secondary to myocardial ischemia, is the most commonly reported symptom in CAD. It is frequently described as pressure-like, squeezing, or heavy, although an inability to adequately describe the sensation is also suggestive of angina. Angina tends to localize to the mid-chest over a broad area and it commonly radiates to the neck, jaw, or arms. Associated symptoms such as diaphoresis or dyspnea are common.

It is important for clinicians to try to characterize chest pain as typical for angina, atypical for angina, or nonanginal chest pain.

Certain groups of patients are more likely to present with atypical angina symptoms, including women, the elderly, and diabetics.

ECG findings suggestive of the presence of CAD: