August 6, 2026
The Valley Hospital is pleased to offer advanced invasive coronary function testing for patients who continue to have chest pain or discomfort, even when standard heart tests appear normal or medications have not relieved their symptoms. This advanced testing helps diagnose angina with non-obstructive coronary arteries (ANOCA), a condition in which patients have real, often disabling chest pain even though a coronary angiogram shows no major blockages.
A coronary angiogram is a minimally invasive X-ray procedure that shows the heart's blood vessels and detects blockages. When that test comes back clear, but symptoms persist, ANOCA may be the underlying cause.
“ANOCA disproportionately affects women and younger patients,” said Steffne Kunnirickal, MD, interventional cardiologist. “The condition is frequently undiagnosed because standard cardiac testing isn't designed to detect it.”
“For patients who have chest pain and undergo testing with no obvious obstructive coronary disease but still have symptoms, it is important to find a true diagnosis,” continues Dr. Kunnirickal. “Finding the correct diagnosis allows cardiologists to tailor the appropriate therapy to patients, thus reducing readmission rates for chest pain.”
How to Test for ANOCA
Diagnosing ANOCA requires advanced, invasive testing. The procedure builds on a standard cardiac catheterization, in which a thin, flexible catheter is guided into the heart's blood vessels, by adding two additional assessments:
- Pressure wire assessment: A thin wire with a pressure sensor is passed through one of the heart arteries to measure blood flow within the artery. This helps detect microvascular dysfunction, a condition in which the blood vessels cannot widen enough, resulting in a spasm that causes chest pain.
- Spasm provocation testing: A small amount of medication is injected into the coronary arteries to intentionally trigger a brief, controlled spasm. This can reproduce the patient's chest pain and help determine whether coronary artery spasm (vasospastic angina) is the cause. The effect is quickly reversed.
The procedure is performed in an outpatient setting, and patients go home the same day.
Diagnosis Leads to Treatment
Many conditions identified through this advanced coronary function testing can be treated with medication and other targeted therapies. Patients will be referred to the appropriate specialist for further evaluation and care if needed.
“If you have chest pain but have had a normal stress test or cardiac catheterization and have been put on medications but are still symptomatic, this testing may be recommended for you,” said Dr. Kunnirickal. “The results of this testing can help tailor treatment plans and give you some answers to your discomfort before additional concerns arise.”
If you think this testing is right for you, please speak with your cardiologist. To find a Valley cardiologist, please visit ValleyHealth.com/Cardiology.