In the final segment of the Cath Lab Guide to Coronary Reactivity Testing, Dr Robert Jay Widmer (The McKinney Heart Hospital, US) brings the case together. In summary, Dr Widmer and team observed normal epicardial coronaries, normal CFR and IMR, a negative acetylcholine spasm test, absence of myocardial bridging, and strong vasodilator responses—all findings consistent with a normal coronary reactivity study.

Dr Widmer then expands the discussion to explore alternative causes of chest pain in young women, including pericarditis, gastrointestinal conditions, and musculoskeletal or neuropathic sources. He highlights the role of further investigations such as cardiac MRI or stress CMR, along with targeted specialist referrals.

The chapter concludes with operator-focused reflections on the practical use of invasive coronary function testing—how it guides shared decision-making, supports diagnostic confidence, and helps reassure patients and families.
 

Key learning points:

• Integrating angiographic, physiologic, vasoreactivity, and IVUS findings into a unified interpretation in INOCA/ANOCA assessment.
• Effectively communicating a “normal” invasive coronary function result and redirecting evaluation toward non-coronary causes of chest pain.
• Operator insights: the value of a structured 30‑minute protocol, strategies to avoid misclassification, and using these tools to deliver patient-centred care and uphold quality standards.