If stress echo, nuclear scan, lung function test cannot determine the cause of angina, and angiography shows good vascularisation, then what would normally be the next course of action? Would a detailed CT scan of the heart anatomy
be of use? Are there cases where a Cardiologist would not be able to find a cause of angina and just leave the patient as comfortable as possible on medication?
Yes it may be of use, if a congenital coronary anatomy is suspected, or a disorder of the aorta or other great vessels. Apart from that if there is any anginal type sympotms it may be related to spasm, intra myocardial course or small vessel disease, which is usually responsive to medical therapy alone. If medical therapy is not sufficient, then either Trans myocardial laser revascularization, ranolazine or peripheral balloon counterpulsation therapy can be of use.
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