Angina pectoris with normal coronary angiograms.

Of patients with angina pectoris who undergo cardiac catheterization, angiographically normal-appearing coronary arteries are found in a significant minority. Multiple etiologies have been proposed to explain chest pain in this setting, including psychiatric illness, esophageal motility disorders or acid reflux, and limited coronary flow response to stress. A fundamental abnormality in this patient population may be abnormal visceral pain perception. Evidence for and against various etiologies as well as a management strategy for the patient with chest pain are presented in this article, both with respect to the decision for performing cardiac catheterization and the management after demonstration of angiographically normal coronary arteries.