Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 1 2025 08 03 55 68 Muhammad Iqhrammullah Universitas Muhammadiyah Aceh Derren Rampengan Universitas Sam Ratulangi 2024 07 10 2025 03 02 Coronary slow flow (CSF) poses significant clinical challenges, marked by delayed coronary blood flow despite angiographically normal epicardial arteries. With a prevalence of 1% to 7%, the underlying pathogenesis and clinical manifestations of this condition remain incompletely understood. This review examines the natural history of CSF, including its pathophysiological mechanisms, ranging from inflammatory cascades to microvascular dysfunction. Diagnostic approaches, such as corrected TIMI frame count, scintigraphy, and ECG analysis, provide valuable insights into its complex presentation. Further, the review outlines management strategies, focusing on pharmacological interventions like calcium channel blockers and anti-inflammatory agents. Understanding CSF’s natural history is crucial for implementing effective preventive measures, spanning primary to tertiary prevention. Still, further research is essential to fully elucidate its pathophysiology and optimize therapeutic strategies for improving patient outcomes in this complex disorder. https://rhythm.tums.ac.ir/index.php/jthc/article/view/2125 https://rhythm.tums.ac.ir/index.php/jthc/article/download/2125/1197