What condition could cause a patient to have a delayed diagnosis if they present with chest pain during stress testing?

Prinzmetal's angina, also known as variant angina, is characterized by episodes of chest pain that are typically caused by coronary artery spasm, leading to temporary reductions in blood flow to the heart muscle. This condition can cause significant chest discomfort at rest or during stress but may not always be detected during standard stress testing.

The reason it may lead to a delayed diagnosis is that stress testing typically involves increased physical activity or pharmacological agents to simulate exercise-induced conditions. Since Prinzmetal's angina is often triggered by specific conditions, such as emotional stress or cold weather, it may not occur consistently during predictable stress testing scenarios. Therefore, a patient may experience chest pain that is not replicated during the test, resulting in a misdiagnosis or a longer delay in identifying the underlying condition.

Other conditions, like stable angina, usually present similar symptoms but are typically identifiable through stress testing, as they are induced by increased myocardial oxygen demand. Unstable angina represents a more critical condition with sudden onset and is often recognized during evaluations due to the more severe nature of symptoms. Non-cardiac chest pain generally refers to pain arising from gastrointestinal or musculoskeletal sources and would not typically be evaluated through stress testing focused on cardiac issues.