The puzzle of normal coronary arteries in the patient with chest pain: what to do?

Over one million Americans undergo cardiac catheterization each year because of chest pain, with the expectation that coronary artery disease will be found. However, up to 30%--a subgroup that includes patients with both cardiac and noncardiac pathology--will have angiographically normal coronary arteries. While the prognosis of the group as a whole is excellent, successful management requires a clear understanding of the multiple and varied conditions that can cause this syndrome.