Chest Pain with Normal Coronary Arteries

Coronary angiography is generally regarded as the "Gold Standard" for diagnosing coronary artery disease (CAD). If a patient has symptoms suggestive of angina and the angiogram is said to be "negative" (which means no significant areas of discrete blockages have been identified in the coronary arteries), most of the time those symptoms are written off as being non-cardiac in origin.

• Here is a review of chest pain and its causes, both cardiac and non-cardiac.

However, in at least four conditions, coronary angiography can look "normal" in patients who actually have significant CAD. All of these conditions are especially likely in women, though they are sometimes seen in men. And all four of these conditions have features that ought to alert the doctor (and the patient) that the patient's symptoms are cardiac in nature, despite the ostensibly "normal" angiograms - and should lead to further evaluation and ultimately to appropriate therapy. These four conditions are:

• Prinzmetal's angina - severe spasm of the coronary arteries
• Cardiac Syndrome X (CSX) - a condition involving the small, invisible (invisible, that is, on coronary angiography) coronary arteries
• Female-pattern CAD. - a poorly recognized form of atherosclerotic CAD that is seen mainly in women
• Coronary artery erosions - an ulcer-like lesion in coronary arteries that is next to impossible to see on angiography, but which can lead to acute coronary syndrome.

Especially if you are a woman, if you are having symptoms strongly suggestive of angina, but you have been given a "clean bill of heart health" after a "normal" angiogram, you need to make sure your doctor has carefully considered each of these four conditions before pronouncing you healthy.

_Sources:

_{Mosca, L, Manson, JE, Sutherland, SE, et al. Cardiovascular disease in women: a statement for healthcare professionals from the American Heart Association. Writing Group. Circulation 1997; 96:2468.}

_{Pepine CJ, Ischemic heart disease in women: facts and wishful thinking. J Am Coll Cardiol Pepine 43 (10): 1727.}