ABSTRACT
To clarify the difference between pain of a cardiac origin and non-cardiac chest pain (NCCP), this chapter gives an overview of coronary disease and how it can be excluded. There is an underlying abnormality of the endothelium, the inner lining of blood vessels, leading to the development of atheroma in medium and large arteries, including those around the heart. Atheroma initially causes no significant encroachment on the inside space of a coronary artery, but starts to reduce blood flow on exercise when it reduces the inner diameter by about 70" or more. There are two main coronary arteries, the right coronary artery and the left main stem. The traditional gold standard is coronary angiography which produces an X-ray image of the interior of the artery with atheroma shown as indentations. Functional tests are useful since they detect the presence of abnormalities of flow leading to ischaemia, which is the underlying mechanism of angina.
