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O seu mecanismo fisiopatológico básico é simples: um desfasamento entre a oferta e a procura de oxigénio pelo miocárdio, levando a uma isquémia mais ou menos extensa, manifestada por angina estável ou instável, enfarte do miocárdio ou morte súbita cardíaca. Anteriormente considerada como uma doença exclusivamente aterosclerótica, em que os factores de risco cardiovascular, tais como : tabagismo, diabetes, dislipidemia, etc.
, uma acumulação de colesterol na parede da artéria coronária (placa aterosclerótica) provoca uma redução do lúmen interno, conduzindo a um desequilíbrio e a sintomas. A isto acresce a associação de fenómenos tromboembólicos aquando da rutura desta placa, que agravam este desequilíbrio e o precipitam sob a forma de síndromes coronários agudos (SCA).
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