View source for Chronic stable angina clinical subset- syndrome X

{{Chronic stable angina}}
{{CMG}}; Associate Editor-In-Chief: {{CZ}}

==Overview==
Syndrome X is defined as the presence of anginal chest pain and myocardial [[ischemia]] in a patient with normal epicardial arteries. Syndrome X s thought to be due to an abnormality in microvascular function.

==Syndrome X== 

*Syndrome X is defined as the '''presence of typical anginal chest pain with angiographically normal coronary arteries.'''  

*Although the syndrome originally referred to patients where the [[chest pain]] was due to non coronary causes, the current, stricter definition limits it to those patients who appear to have true [[myocardial ischemia]] despite epicardial coronary arteries that are normal or closely on coronary angiography.

*To establish the diagnosis, patients must have evidence of [[myocardial ischemia]] by exercise [[ECG]], [[stress scintigraphy]], or [[stress echocardiography]] in conjunction with anginal chest discomfort.
:*Some of these patients have documented reductions in coronary vasodilator reserve presumably due to abnormalities in the [[coronary microcirculation]] and can be shown to have true [[ischemia]] because their [[myocardium]] produces lactate rather than removing it during stress. 

*The syndrome may be more common in patients with hypertrophied myocardium, secondary to any cause. 

*The prognosis in terms of major coronary events appears to be unremarkable.

==ESC Guidelines for investigation in patients with Syndrome X (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==
{{cquote|
===Class I===
'''1.''' [[Chronic stable angina echocardiography|Resting echocardiogram]] in patients with angina and normal or non-obstructed coronary arteries to assess for presence of ventricular hypertrophy and/or [[diastolic dysfunction]]. ''(Level of Evidence: C)''

===Class IIb===
'''1.''' Intracoronary acetylcholine during coronary arteriography, if the arteriogram is visually normal, to assess endothelium-dependent coronary ﬂow reserve, and exclude [[vasospasm]]. ''(Level of Evidence: C)''

'''2.''' Intracoronary ultrasound, coronary ﬂow reserve, or FFR measurement to exclude missed obstructive lesions, if angiographic appearances are suggestive of a nonobstructive lesion rather than completely normal, and stress imaging techniques identify an extensive area of [[ischaemia]]. ''(Level of Evidence: C)''}}

==ESC Guidelines for pharmacological therapy to improve symptoms in patients with Syndrome X (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==
{{cquote|
===Class I===
'''1.''' Therapy with [[nitrates]], [[beta blockers]], and [[calcium channel blockers]] alone or in combination. ''(Level of Evidence: B)''

'''2.''' [[Statin]] therapy in patients with [[hyperlipidaemia]]. ''(Level of Evidence: B)''

'''3.''' [[ACE inhibitors]] in patients with [[hypertension]]. ''(Level of Evidence: C)''

===Class IIa===
'''1.''' Trial of therapy with other anti-anginals including nicorandil and metabolic agents. ''(Level of Evidence: C)''

===Class IIb===
'''1.''' [[Aminophylline]] for continued pain, despite Class I measures. ''(Level of Evidence: C)''

'''2.''' Imipramine for continued pain, despite Class I measures. ''(Level of Evidence: C)''}}

==Sources==
*Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>

==References==
{{reflist|2}}

[[Category:Disease state]]
[[Category:Ischemic heart diseases]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Mature chapter]]

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