<International circulation>  : What are the reasons for chest pain if the Coronary artery angiography (CAG) is normal?

Mieres:If the coronary artery angiography is normal and your patient – the woman – continues to have chest pain; maybe you may have done some sort of non-invasive testing – such as exercise stress – and you see mild ischemia， thinking it might be a false positive.  Further testing is indicated.  We know that there are gender differences with women and heart disease.  We know that the distribution of arthrosclerosis is different.  In women there is much more vessel wall disease and diffuse disease that will not be picked up on regular angiogram and the luminogram will miss the vessel wall.  New techniques with low-dose radiation for just coronary angiography CT may give you a better idea of what the plaque burden is in the vessel wall.  So we know from the wise that men have more discrete focal senosis that are picked up by the regular angiography， but with women we have much more diffuse disease.   If you go to the cath-lab doing an intravascular ultrasound or doing a fractional floor reserve procedure: getting an idea of what the vessel wall is like and what the coronary reserve is like will give us a much more information about women and their burden of arthrosclerosis， giving us insight as to how to treat them. 

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