Angina, “Normal” Coronary Angiography, and Vascular Dysfunction: Risk Assessment Strategies

February 2007 | Volume 4 | Issue 2 | e12 Chest pain may be associated with coronary arteries that appear “normal.” Normal is defi ned here as no visible disease or luminal irregularities (less than 50%) as judged visually at coronary angiography. Normal angiography in patients with chest pain is fi ve times more common in women than in men [1]. Among patients with chest pain and normal angiography, an unknown number are suffering from cardiac pain of ischemic origin. Uncertainty is often diffi cult to allay, for medical attendants as well as for patients, resulting in perpetuation of symptoms, diffi culties in management, and establishment of risk of subsequent coronary events [2]. In this article, we discuss how to stratify risk in patients with chest pain and a normal coronary angiogram. We based our article on a literature review, using the key words “angina with normal angiography,” “angina with normal coronary arteries,” “non-obstructive coronary disease,” or “chest pain of non-cardiac origin,” plus “[a]etiology,” “pathophysiology,” “diagnosis,” “classifi cation,” “prognosis,” or “therapy.” A longer, more detailed version of this paper is found in the supplementary fi le S1.