#DrKKAnswers: Blockages in the vessels (arteries) supplying blood to the heart is called coronary artery disease. There are three main coronary arteries and blockage can occur in any one of them. It takes many years to develop blockages significant enough to cause symptoms. Blockages of up to 40 % can be missed by angiography; up to 60% can be missed by stress echocardiography and up to 70% can be missed by treadmill test. Therefore a person can have a negative treadmill test and yet develop a heart attack in the coming week.
Heart attacks occur due to rupture of a blockage. Major heart attack will occur if the underlying blockage at the time rupture was less than 50 % and minor attack will occur if the blockage was above 90%. This is because a blockage of 50% will not have associated collaterals blood supply which takes time to develop. A person will 90% blockage has overtime undergo development of alternative channels in the coronary bed called collaterals.
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