The Anginal Syndrome With Normal Coronary Arteries

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Abstract
THE INCREASING application of coronary angiography to the evaluation of patients with angina pectoris has led to the identification of a group of patients who experience anginal-type chest pain despite the presence of normal coronary artery anatomy by arteriography. Indeed, such patients may constitute up to 20% of those who have undergone elective coronary arteriography for suspected coronary artery disease.1Although initially believed to be primarily an affliction of women, the syndrome has been detected with increasing frequency in men and in some studies has been found to be equally prevalent in both sexes. Despite the presence of normal coronary arteries, persons with this syndrome may have major functional impairment. They may often require hospitalization for chest pain evaluation and management and may even present a condition of unstable angina. Recently, coronary artery spasm has been demonstrated to be responsible for many chest pain syndromes, including variant angina pectoris,