Chest pain and the sensitive heart.

The origin of symptoms and appropriate management of patients who have chest pain despite normal coronary angiograms remain controversial. In the past, research has focused on the possibility that abnormal coronary flow reserve caused by microvascular dysfunction may cause myocardial ischaemia during stress in a subset of patients, particularly those with abnormal exercise electrocardiograms. However, recent evidence suggests that the majority of patients with chest pain and normal coronary angiograms, including those with ischaemic-appearing exercise electrocardiograms, may have exaggerated or abnormal cardiac pain perception. A shift in therapy from anti-ischaemic medications to drugs that are useful in managing chronic pain syndromes may be more efficacious in managing chest pain symptoms.