Until development of coronary angiography, angina pectoris was regarded almost exclusively as the result of atherosclerosis of the large coronary arteries. This supposition is no longer tenable. Chest pain indistinguishable from classical angina pectoris has been described in patients having normal coronary vessels.1-3 Further, typical angina was described in a woman who, during attacks of chest pain, had monophasic current of injury with accompanying life-threatening arrhythmia, yet had normal coronary angiograms.4 Acute myocardial infarction was verified in two young men in whom subsequent arteriography showed normal coronary vasculature.5,6 Ischemic signs and symptoms with normal coronary angiograms have been ascribed to deranged oxyhemoglobin dissociation,7 as well as to small-vessel disease.2,8 The purpose of this case report is to add thrombocythemia to this dossier.
A 40-year-old white woman, the mother of two, was referred for evaluation of disabling chest pain of recent onset. She had