Angina with normal coronary arteriograms. Clinical status at one year

Despite encouraging reports that patients with normal coronary arteries (NCA) have a benign prognosis in terms of progression of disease and mortality they suffer considerable functional disability following their arteriogram and continue to attend cardiac departments and general practitioners. Some may have coronary spasm and respond to calcium antagonists, others have abnormalities of lactate metabolism on atrial pacing and respond to beta blockade and nitrates. We have observed the psychosocial characteristics of 30 patients with NCA (17 women and 13 men). At one year only one patient was entirely free of chest pain, in 16 (54 p. 100) it had lessened, 10 (33 p. 100) noted no change and in 3 (10 p. 100) it was worse. 15 were initially unable to work at one year, 3 were still unemployed because of pain, 25 (84 p. 100) were reassured when told of NCA. At one year 16 (54 p. 100) were still attending clinics and 2 had sought further cardiac tests elsewhere. In spite of the NCA 7 (23 p. 100) attend casualty with pain and 2 (7 p. 100) were re-admitted. 7 (23 p. 100) had psychiatric morbidity and 6 (20 p. 100) were assigned a psychiatric diagnosis. 15 patients (50 p. 100) reported phobic symptoms at follow-up. 53 p. 100 reported symptoms of breathlessness that could not be explained on the basis of organic disease. This study shows that unexplained breathing disorders and psychiatric morbidity pursue a chronic course and can be detected in 53 p. 100 and 23 p. 100 of NCA patients one year post angiogram. These findings have implications for the management of patients with chest pain and NCA since breathing disorders and psychiatric morbidity are amenable to treatments already demonstrated to be effective.