BACKGROUND AND OBJECTIVES: The purpose of this study was to analyze the patterns of coronary artery flow, using transthoracic Doppler echocardiography(TE), in subjects with chest pains and normal coronary angiograms. SUBJECTS AND METHODS: 93 patients(M:F=34:59, mean age:57+/-11 years) ith chest pains and normal coronary angiograms were included in this study. After obtaining baseline clinical data, an exercise treadmill test(TT) as performed, according to the Bruce protocol. The peak diastolic coronary artery flow velocity(DV), at rest, and the coronary flow reserve(FR), in the distal left anterior descending coronary artery(AD), were estimated, using dipyridamole, with TTE. After the administration of angiotensin II receptor(AT II) lockers to 12 patients with a CFR <2.1. The ETT and CFR were followed up. RESULTS: Of the 93 subjects 63(7.7%) ere female, and 53(6.9%) ad a history of hypertension and 61(5.5%) howed ST or T abnormality on their resting ECG. Five subjects(30.3%) ad metabolic or hematologic problems, such as hyperthyroidism or anemia. Twenty-seven(0.3%) of the 89 subjects showed a reduced CFR value less than 2.1. The subjects with horizontal or down-sloping ST depression on their ETT showed a decreased CFR, compared with those with no ST shifting or an up-sloping ST depression(<0.05, respectively). Twenty-six(7.9%) f the 93 subjects showed a slow coronary flow velocity <14 cm/sec, and 15(3.3%) f 18 subjects who estimated CFR had CFR > or =2.1. In 7(8.3%) of 12 subjects with a CFR <2.1, their CFR increased, with an improvement of the ETT results, following the administration of the AT II blocker, after an average 19+/-9 months. CONCLUSION: The patients with chest pains and normal coronary angiograms have a heterogeneous clinical spectrum, such as hypertensin, slow flow, reduced CFR, and so on. These subjects need treatment according to the etiology and pathogenesis of their condition, which can be followed up by coronary flow measurements, using TTE.