<unk>  is a diagnosis of exclusion. Typically this will necessitate both a clinical diagnosis, appropriate stress testing, and a coronary angiogram that meet the above criteria. Cardiac MRI can be used to diagnose<unk> . Studies are ongoing to validate this approach. There is growing evidence that<unk>  is caused by a functional disorder of the microvessels, coronary<unk>  dysfunction. Blood vessels either fail to dilate or constrict in response to various stressors such as exercise, the cold or emotional stress. An angiogram with acetylcholine can demonstrate<unk>  dysfunction which can affect the microvessels and larger coronary arteries leading to either<unk>  or coronary artery spasms (Prinzmetal's angina). These are considered discrete conditions though some individuals can be affected by both.<unk>  can be diagnosed using different tests and exams, but it is mainly a diagnosis of exclusion. However, sedentary and overweight individuals with a family history of type 2 diabetes should be tested regularly to determine whether they have irregular levels of glucose or lipids, or blood pressure abnormalities, factors which are usually associated with<unk> . A first test to be taken is an exercise stress test which shows if the heart is not getting blood during exertion. Angiograms may be useful and conclusive when<unk>  they offer a detailed image of the heart. However, they cannot detect potential abnormalities in the small arteries, and the doctor may ask for more tests in order to rule out other heart conditions, such as Prinzmetal's angina (variant/vasospastic angina, coronary artery spasm) which has similar symptoms. Differential diagnosis Chest pain caused by<unk>  is most of the time unpredictable and it can occur when at rest and/or during exercise. The pain associated with<unk>  is normally more intense and it lasts for longer periods of time compared to pain caused by other conditions. For example, a stable angina causes chest pain that goes away when at rest. Another difference is that while chest pain caused by any type of stable angina is relieved with nitroglycerin, this drug is not effective in most patients with<unk> .
Microvascular angina
Variant angina
Unstable angina
Renal angina
Coronary artery ectasia
Vasitis nodosa
Coronary artery aneurysm
Palisade 