CHEST PAIN AND ANGIOGRAPHICALLY NORMAL CORONARY-ARTERIES - IMPLICATIONS FOR TREATMENT

Approximately 20% to 30% of patients who undergo coronary arteriograph y for the evaluation of chest pain are found to have normal coronary a rteries. These patients have a survival rate comparable to that of the normal population, yet they continue to complain of symptoms on exten ded follow-up, and about half of this group are disabled on account of chest pain. Once other clinically obvious disorders have been ruled o ut, common diagnostic considerations include microvascular angina, eso phageal dysfunction, and perhaps fibromyalgia. Panic disorder however is the most common condition affecting these patients and can be diagn osed in at least one third of the group, with or without the presence of the other conditions mentioned Appropriate diagnosis and treatment can reduce the psychosocial morbidity so frequently seen in these pati ents.