T he syndrome of chest pain and/or myocardial ischemia with normal or nonobstructive coronary arteries at angiography is common and is of practical importance to the general medical audience. Many studies have tried to address this topic over the last 4 decades. Only 1 thing is clear: for patients with ongoing signs and symptoms of ischemia in acute coronary syndromes, the prognosis is not so favorable, as believed earlier in the 1990s (1,2). Yet, physicians remain confused by other patients who refer a history of effort angina or angina-like chest pain whose coronary angiograms show no evidence of obstructive coronary artery disease (CAD) and who have no structural heart disease. In these cases, diagnosis, risk stratification and management remain controversial and a matter of debate. Indeed, many patients do not experience cardiac chest pain, but the uncertainty is often difficult to allay, for their medical attendants as well as for the patients themselves, making for perpetuation of symptoms and for difficulties in management (3). Among these patients are an unknown number who can be shown to be experiencing cardiac chest pain presumed to be ischemic. In all of these patients, a diagnosis of “vasospastic angina” or coronary artery spasm may be considered.

中文翻译：

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血管痉挛性心绞痛病史 ∗

胸痛和/或心肌缺血伴正常或非阻塞性冠状动脉血管造影是常见的，对普通医学观众具有实际意义。在过去的 4 年里，许多研究试图解决这个话题。只有一件事是清楚的：对于急性冠脉综合征中持续存在缺血体征和症状的患者，预后并不如 1990 年代早期所认为的那样有利 (1,2)。然而，医生仍然对其他有努力心绞痛或心绞痛样胸痛病史的患者感到困惑，这些患者的冠状动脉造影显示没有阻塞性冠状动脉疾病 (CAD) 的证据并且没有结构性心脏病。在这些情况下，诊断、风险分层和管理仍然存在争议和争论的问题。事实上，许多患者并没有经历过心源性胸痛，但不确定性往往难以消除，无论是对他们的医务人员还是患者本身，都会导致症状的持续存在和管理上的困难 (3)。在这些患者中，有一个未知数字，他们可以被证明正在经历被认为是缺血性的心脏胸痛。在所有这些患者中，可以考虑诊断为“血管痉挛性心绞痛”或冠状动脉痉挛。