The fate of women with normal coronary arteriograms and chest pain resembling angina pectoris

Abstract The clinical and laboratory findings and subsequent fate of 100 women with unexplained chest pain, having some or all of the features of angina pectoris, and normal selective coronary arteriographic findings were studied. Some basis for the chest pain was discovered in only 14 percent (14 of 100) and included the unusual conditions of systolic click syndrome, primary myocardial disease, rheumatic heart disease and a cystic duct neuroma. Of the remaining 86 patients with no readily apparent cause for their symptoms, the average age was 44 years. Atypical angina was noted in 76 percent (65 of 86); 46 percent (40 of 86) gained relief of pain from nitroglycerin, and 40 percent (34 of 86) manifested anxiety neurosis. Of 44 patients who exercised, 16 had a positive electrocardiographic response of S-T segment depression of more than 1 mm, yet this group did not differ significantly from those with a negative response to exercise. Follow-up study of these 86 patients from 6 months to 2 1 2 years revealed that 50 percent had a decrease or disappearance of pain. More important, there was no instance of sudden death or myocardial infarction. It is suggested that chest pain with normal coronary arteriographic findings should be clearly distinguished, especially as to its benign prognosis, from the angina pectoris associated with large vessel obstructive atherosclerosis and that it most likely is related to neurocirculatory asthenia, although other possible explanations are discussed.