The most common cause of myocardial ischemia and angina is coronary stenosis by atheromatous lesions in the epicardial arteries. However, a significant percentage of patients with angina and ischemia demonstrated by tests to induce it not present coronary obstructions on angiography. For this reason, the case of a 68-year-old woman is presented, who consulted for chest pain with typical oppressive characteristics, associated with autonomous symptoms, with electrocardiographic changes and elevated cardiac enzymes, given the above she received anti-ischemic, antiplatelet, and analgesic, which required coronary stratification, which was later reported within normal limits. Likewise, outpatient follow-up was carried out 3 months after the cardiovascular event, reporting within normal limits. In these cases, it is attributed to coronary spasm, endothelial dysfunction, and myocardial metabolism disorders as responsible for ischemia and its clinical manifestations. This situation constitutes a frequent and costly clinical problem, contributes to diminishing the quality of life, and presents a challenge in the diagnosis and treatment. This form of angina is not as benign as it was previously considered. We present a case in which it was not possible to demonstrated ischemia by tests performed and coronary angiography revealed no obstructive lesions.