Atherosclerosis is a progressive disease that can cause clinical manifestations in middle and late adulthood. Coronary artery atherosclerosis can result in stable angina pectoris complaints, but also in acute onset or worsening of complaints, captured under the name of acute coronary syndrome. Frequently, and specifically in the elderly and diabetic patients, severe coronary atherosclerosis can be asymptomatic or present with complaints of exertional dyspnea and fatigue instead of the typical chest discomfort complaints. Although severe coronary artery narrowing causes myocardial ischemia, it is not always felt by the patient nor recognized as a symptom of the heart. When myocardial ischemia is objectified without complaints, we tend to call this silent ischemia.