Abstract: The authors reported a case of diagnosis of microvascular dysfunction with vasospastic angina pectoris in patient with ischaemia and non-obstructive coronary arteries (INOCA) using radionuclide coronary vascular reactivity test. The characteristics of the disease were introduced from clinical symptoms, laboratory examination results, and radionuclide myocardial perfusion imaging. Through literature review, the recognition of microvascular dysfunction was deepened. The combination of coronary angiography and radionuclide myocardial perfusion imaging has complementary advantages, and the combination of the two can also accurately evaluate whether INOCA patients have limited vasodilation (microvascular dysfunction) or increased contraction (coronary spasm), has high specificity, and can diagnose and classify INOCA, guide treatment, and predict prognosis.