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Il suo meccanismo fisiopatologico di base è semplice: uno squilibrio tra la domanda e l'offerta di ossigeno del miocardio, che porta a un'ischemia più o meno estesa, manifestata da angina stabile o instabile, infarto miocardico o morte cardiaca improvvisa. Precedentemente considerata una malattia esclusivamente aterosclerotica, in cui i fattori di rischio cardiovascolare come : fumo, diabete, dislipidemia, ecc.
un accumulo di colesterolo nella parete dell'arteria coronaria (placca aterosclerotica) provoca una riduzione del lume interno, con conseguente squilibrio e sintomi. A ciò si aggiunge l'associazione di fenomeni tromboembolici quando questa placca si rompe, che aggravano questo squilibrio e lo fanno precipitare sotto forma di sindromi coronariche acute (SCA).
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