Syndrome X

(Cardiac) syndrome X is angina(Chest Pain) with signs associated with decreased blood flow to heart tissue but with norman Coronary arteries. It occurs more often in young women. Some studies have found increased risk of other vasospastic disorders in Syndrome X patients, such as migraine and Raynaud's phenomenon. It is treated with calcium channel blockers, such as nifedipine, and usually carries a favorable prognosis. This is a distinct diagnosis from Prinzmetal's angina. more...

Features

While there is no formal definition for Syndrome X, the general consensus is that it entails all of the following:

• 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 opposite of those with Prinzmetal's angina. Myocardial Perfusion imaging can be abnormal in 30% of patients.
• Normal Coronary angiogram
• Other causes of chest pain must be ruled out, including:
  • Prinzmetal's angina
  • Esophageal spasm

Diagnosis

Syndrome X is a diagnosis of exclusion. Typically this will necessitate both a clinical diagnosis, appropriate stress testing, and a coronary angiogram that meet the above criteria.

Pathophysiology

While numerous physiological mechanisms have been proposed, none have been proven.

Treatment

• nitrates - can reduce chest pain
• calcium channel blockers - specifically nifedipine can be effective.
• beta blockers - also work.
• aminophylline - may work by inhibiting adenosine receptors.
• estrogen - may work in women.

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