Over 90% of patients with ischaemic heart disease have severe coronary atherosclerosis with greater than 75% stenosis of any or all of the major vessels.
A 75% stenosis prevents the augmentation of coronary flow required to meet even moderate increases in the oxygen demand of the myocardium.
Any or all of the three major arteries of the heart may be affected. The LAD and the circumflex arteries are usually stenosed close to their origin - left mainstem lesions being particularly ominous. The right coronary artery is narrowed in the proximal or distal thirds of it course.
There is little correlation between the degree of atherosclerosis and the intensity of the anginal pain.
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