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The purpose of this study was to determine the prevalence of musculoskeletal disorders in patients with chest pain and angiographically normal coronary arteries. The authors studied 40 consecutive patients with chest pain presenting at an Internal Medicine Clinic who had undergone coronary angiography and were found to have < 30% stenosis of all major coronary arteries. Patients with any known noncardiac cause of chest pain were excluded from the study. Each patient underwent a complete rheumatologic examination with x-rays and blood tests when indicated. The diagnosis of fibromyalgia was based on the presence of at least eight paired tender points. The diagnosis of costochondritis was made when palpation of the costal cartilages elicited tenderness. In the normal coronary artery group, 30% of the patients had fibromyalgia and 10% had costochondritis. In the control group of 40 patients with coronary artery disease, only 1 patient had fibromyalgia and none had costochondritis (P < 0.04). Other rheumatologic disorders were uncommon, with no statistical difference between the two groups. The authors conclude that many patients with chest pain and angiographically normal coronary arteries suffer from rheumatologic disorders with fibromyalgia being the most common.