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| {{Chronic stable angina}}
| | #redirect:[[Syndrome X]] |
| {{CMG}}; Associate Editor-In-Chief: {{CZ}}
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| ==Overview==
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| One of the clinical subsets of [[angina]] <ref>{{cite book |last= Braunwald |first= Eugene |coauthors= Lee Goldman |title= [[Primary Cardiology]] |publisher= [[Saunders]] |year= 2003 |isbn= 0-7216-9444-6}}</ref> is described below.
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| ==Syndrome X==
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| *Syndrome X is defined as the '''presence of typical anginal chest pain with angiographically normal coronary arteries.'''
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| *Although the syndrome originally referred to patients in whom 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 nearly so on coronary angiography.
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| *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.
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| :*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 rather than removes lactate during stress.
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| *The syndrome may be more common in patients with hypertrophied myocardium secondary to any cause.
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| *The prognosis in terms of major coronary events appears to be benign.
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| ==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>==
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| {{cquote|
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| ===Class I===
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| '''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)''
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| ===Class IIb===
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| '''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)''
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| '''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)''}}
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| ==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>==
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| {{cquote|
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| ===Class I===
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| '''1.''' Therapy with [[nitrates]], [[beta blockers]], and [[calcium channel blockers]] alone or in combination. ''(Level of Evidence: B)''
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| '''2.''' [[Statin]] therapy in patients with [[hyperlipidaemia]]. ''(Level of Evidence: B)''
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| '''3.''' [[ACE inhibitors]] in patients with [[hypertension]]. ''(Level of Evidence: C)''
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| ===Class IIa===
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| '''1.''' Trial of therapy with other anti-anginals including nicorandil and metabolic agents. ''(Level of Evidence: C)''
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| ===Class IIb===
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| '''1.''' [[Aminophylline]] for continued pain, despite Class I measures. ''(Level of Evidence: C)''
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| '''2.''' Imipramine for continued pain, despite Class I measures. ''(Level of Evidence: C)''}}
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| ==Sources==
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| *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>
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| ==References==
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| {{reflist|2}}
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| [[Category:Disease state]]
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| [[Category:Ischemic heart diseases]]
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| [[Category:Cardiology]]
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| [[Category:Emergency medicine]]
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