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To the Editor: Dr Phan and colleagues¹ summarized the evaluation and management of patients with persistent chest pain and no obstructive coronary artery disease (CAD). This review did not include the coronary slow flow phenomenon, although the first patient described in the article exhibited many of its characteristics. The importance of properly diagnosing the coronary slow flow phenomenon relates to (1) its prompt identification from routine diagnostic angiography, without the need for additional invasive testing; (2) its well-documented clinical features and prognosis; and (3) potentially effective therapy established in a randomized, double-blind, placebo-controlled trial.

The coronary slow flow phenomenon is defined by a delayed opacification of the distal coronary vasculature during coronary angiography in the absence of obstructive CAD or coronary ectasia. This slow passage of contrast was initially considered an angiographic curiosity, but characterization of the associated clinical characteristics and prognosis² have led some investigators to propose that it . . . [Full Text of this Article]

John F. Beltrame, BSc, BMBS
john.beltrame@adelaide.edu.au
University of Adelaide
Adelaide, Australia

Peter Ganz, MD
University of California, San Francisco

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