Cardiac Syndrome X

Cardiac syndrome X (also known as microvascular angina), a condition characterized by angina-like chest discomfort, ST segment depression during exercise, and normal coronary epicardial arteries at angiography, has the highest prevalence in post-menopausal women.

In a large percentage of patients, there is a finding of systemic microvascular abnormalities, causing reduced blood flow in the microvasculature of the cardiac muscles. When the blood vessels constrict and fail to dilate there is decreased oxygen levels to the cardiac muscles resulting in hypoxia (myocardial ischemia) which leads to chest pain.

Signs and Symptoms

 * Angina: This usually does not cause dysfunction on echocardiogram and can last longer than that of heart disease.
 * Abnormal cardiac stress test: ST changes are typically similar to those of coronary artery disease, and the opposite of those of Prinzmetal's angina. Myocardial perfusion imaging can be abnormal in 30% of patients.
 * Coronary angiogram: Normal
 * Other causes of chest pain must be ruled out, including:
 * Prinzmetal's angina aka vasospastic or variant angina / Coronary artery spasm.
 * Esophageal spasm


 * {| class="wikitable"

!Angina pectoris!!Cardiac syndrome X
 * exercise-induced angina||exercise-induced angina
 * exercise-induced ischemia detected by ECG||exercise-induced ischemia  detected by ECG
 * stenosis proved by coronary angiography||coronary angiography - no abnormalities
 * positive provocative test (as in Prinzmetal's AP)||negative provocative test
 * pathological alternation in epicardial coronary arteries||pathological alternation in prearteriolar vessels
 * chest pain disappears spontaneously, is relieved with nitroglycerin||pain is not relieved with nitroglycerin
 * }
 * positive provocative test (as in Prinzmetal's AP)||negative provocative test
 * pathological alternation in epicardial coronary arteries||pathological alternation in prearteriolar vessels
 * chest pain disappears spontaneously, is relieved with nitroglycerin||pain is not relieved with nitroglycerin
 * }
 * chest pain disappears spontaneously, is relieved with nitroglycerin||pain is not relieved with nitroglycerin
 * }

Cause
Chest pain caused by microvascular angina is most of the time unpredictable and it can occur when at rest and/or during exercise. The pain associated with microvascular angina is normally more intense and it lasts for longer periods of time compared to pain caused by other conditions. For example, a stable angina causes chest pain that goes away when at rest. Another difference is that while chest pain caused by any type of stable angina is relieved with nitroglycerin, this drug is not effective in most patients with microvascular angina.

The major cause of microvascular angina is the pathological alternation (microvascular dysfunction) in prearteriolar vessels.

Treatment

 * β-blockers,
 * L-Arginine - increases release of NO at vascular level, thus leading to vasodilatory effect
 * calcium channel blockers - specifically nifedipine and diltiazem can be effective,
 * antidepressants

Related Articles

 * Angina pectoris
 * Myocardial Infarction