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To the Editor: Dr Phan and colleagues¹ presented 2 interesting patients with chest pain and normal coronary angiograms, speculating that for one patient the symptoms were due to microvascular coronary dysfunction and, for the other, due to abnormal cardiac nociception. I do not believe they have justified their conclusion that both patients illustrate the value of coronary reactivity testing. Indeed, the details of their diagnostic investigations are a reminder of the old saw that a well person is one who has not been completely worked up.²

The first patient, with cardiac syndrome X, had already had a negative radionuclide perfusion stress test (usually positive in this syndrome³) and 2 normal coronary angiograms before commencing the workup discussed by the authors, which included repeat coronary angiography and insertion of an intracoronary flow wire followed by intracoronary infusion of vasoactive agents. The authors dismissed the negative stress test as reflecting the . . . [Full Text of this Article]

Steven W. Seiden, MD
stevens@southshoreheart.com
Division of Cardiology
South Nassau Communities Hospital
Oceanside, New York

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