A normal major-vessel angiogram does not assess every coronary mechanism
Coronary microvascular dysfunction can cause ischemic-type symptoms without large epicardial stenoses, requiring clinician-directed evaluation.
Several explanations may be worth exploring
- Microvascular angina / INOCAImpaired coronary microvascular function may limit blood flow without a large-vessel blockage.
- Vasospastic anginaTransient coronary artery constriction may produce pain with otherwise normal-looking arteries.
- Myocardial or other cardiac problemSelected structural or inflammatory heart conditions can cause persistent symptoms.
- Esophageal spasm or refluxEsophageal disorders can resemble cardiac chest discomfort.
- Chest-wall or musculoskeletal painTenderness or movement may suggest a noncardiac source, after suitable evaluation.