"Assessing the Need for Mental Stress Testing in ANOCA"

Mental stress induced a greater degree of myocardial ischemia among women with angina without obstructive coronary artery disease (ANOCA) than among those without ANOCA. Mental stress–induced myocardial ischemia (MSIMI) was not statistically related to coronary microvascular dysfunction (CMD). Routine mental stress testing in patients with ANOCA seems necessary. ANOCA patients may benefit from treatment with escitalopram. Clinicians should conduct the gold standard workup ― provocative physiologic testing ― for women who continue to have chest pain when results of other tests are negative.