There was a 50-year-old male patient with a clear past history of hypercholesterolemia and hypertension, a lack of exercise, a love of fatty foods, and a long history of smoking. He had never experienced chest tightness, chest pain, or panic at rest or during activity. A week before admission, a routine resting electrocardiogram was performed during physical examination and myocardial ischemia was found. After admission to the Cardiovascular Medicine Department, an active plate ECG was performed and was positive. Left ventricular diastolic hypoplasia was detected by echocardiography. Nuclear myocardial imaging revealed a sparse distribution of the anterior interventricular wall of the left ventricle, suggesting mild myocardial ischemia. Finally, the cardiologist performed coronary angiography for the patient and found that there was about 50% stenosis in the middle segment of the anterior descending branch of the left coronary artery, which was clearly coronary artery disease. However, the patient still felt strange, why is coronary heart disease even without chest pain and chest tightness? Currently, the World Health Organization classifies coronary heart disease into five types, namely asymptomatic myocardial ischemia, angina pectoris, myocardial infarction, ischemic cardiomyopathy, and sudden death. This patient belongs to the asymptomatic myocardial ischemia type. Patients with this disease are mostly seen in middle age or older, usually without symptoms of myocardial ischemia such as chest pain and chest tightness, but the electrocardiogram (resting, dynamic or stress test) may have ST-segment depression, T-wave inversion, etc., or radionuclide myocardial imaging shows myocardial ischemia. This disease requires echocardiography and cardiac stress test to exclude hypertrophic cardiomyopathy and autonomic dysfunction, and finally percutaneous selective intracoronary angiography to confirm the diagnosis. The difference between patients with asymptomatic myocardial ischemic coronary artery disease and patients with other types of coronary artery disease is that there are no clinical symptoms, but there are objective manifestations of myocardial ischemia, i.e., the heart has been affected by insufficient coronary artery blood supply, which can be considered as early coronary artery disease. Sudden death may occur. Therefore, it should be taken seriously in clinical practice. For people above middle age, especially those with hypertension, hyperlipidemia, diabetes and smoking, they should not think that they have never had chest pain or tightness, so they should not pay attention to the myocardial ischemia on ECG. Instead, they should take it seriously and seek medical attention in a timely manner. Clinicians should also perform further serious and timely investigations, such as radionuclide myocardial imaging, echocardiography, percutaneous selective intracoronary angiography, etc., to clarify the lesion. Once the diagnosis is clear, various measures to prevent and treat atherosclerosis can be adopted to prevent the aggravation of atheromatous plaque lesions and instability, to strive for the regression of atheromatous plaques and to promote the establishment of coronary collateral circulation. Patients should be advised to quit smoking and be given a low-fat diet; apply lipid-regulating drugs such as statins; add nitrates, ß receptor blockers or calcium channel blockers for the treatment of myocardial ischemia. And add antiplatelet therapy such as aspirin, and also apply drugs to promote myocardial metabolism and improve myocardial microcirculation such as salvia, energy synergists (vitamin C, coenzyme A, inosine, etc.), fructose 1,6 diphosphate, etc. as appropriate. If necessary, further revascularization treatment can be decided according to the condition of coronary artery lesions, and if the lesion is further aggravated, percutaneous intracoronary intervention and intracoronary stent implantation can be performed.