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August 12, 2009

Evaluating Patients With Persistent Chest Pain and No Obstructive Coronary Artery Disease

JAMA. 2009;302(6):622-624. doi:10.1001/jama.2009.1095

To the Editor: Dr Phan and colleagues1 presented 2 interesting patients with chest pain and normal coronary angiograms, speculating that for one patient the symptoms were due to microvascular coronary dysfunction and, for the other, due to abnormal cardiac nociception. I do not believe they have justified their conclusion that both patients illustrate the value of coronary reactivity testing. Indeed, the details of their diagnostic investigations are a reminder of the old saw that a well person is one who has not been completely worked up.2

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