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| {{Chronic stable angina}} | | __NOTOC__ |
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| {{CMG}} | | {{CMG}} |
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| ''The terms '''Syndrome X''' or '''Metabolic syndrome X''' may also be referring to [[metabolic syndrome]].''
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| '''''Synonyms and key words:''''' Microvascular angina
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| ==Overview== | | ==Overview== |
| '''(Cardiac) syndrome X''' is [[Angina pectoris|angina]] (chest pain) associated with objective evidence of myocardial ischemia in the absence of epicardial [[coronary artery disease]]. The disorder has been hypothesized to be a disorder of the coronary microvasculature rather than the large caliber epicardial coronary arteries.
| | Syndrome X may refer to [[cardiac syndrome X]], [[metabolic syndrome]] and single X syndrome, where an individual has a single X chromosome, typically described as [[Turner syndrome]]. The otherwise unidentifiable rare disease afflicting [[Brooke Greenberg]] and only about half a dozen other people in the world. |
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| ==Pathophysiology==
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| In a large percentage of patients, there is microvascular dysfunction.
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| ==Epidemiology and Demographics==
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| Syndrome X occurs more often in young women. Some studies have found an increased risk of other vasospastic disorders in syndrome X patients, such as [[migraine]] and [[Raynaud's phenomenon]].
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| ==Natural history, complications, and prognosis==
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| Syndrome X does not appear to be associated with an excess of major coronary events.
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| ==Risk Factors==
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| Female gender and hypertrophy of the myocardium are associated with an excess risk of Syndrome X.
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| ==Other Conditions to Distinguish Syndrome X From==
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| Syndrome X should be distinguished from [[Prinzmetal's angina]], a disorder which involves spasm of the main epicardial coronary arteries. Syndrome X involves dysfunction of the downstream microvasculature. Syndrome X must also be distinguished from [[esophageal spasm]].
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| ==Diagnosis==
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| Syndrome X is a diagnosis of exclusion. The diagnostic criteria are as follows:
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| *There must be evidence of [[myocardial ischemia]]: Diagnostic studies include an exercise [[ECG]], [[stress scintigraphy]], or [[stress echocardiography]] in conjunction with anginal chest discomfort.
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| * [[Angina pectoris|Angina]]: Angina pectoris must be present. The angina pectoris associated with Syndrome X may last longer that the anginal discomfort associated with the fixed epicardial stenoses of atherosclerotic heart disease.
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| * 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.
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| * [[Coronary angiogram]]: There is no narrowing of the epicardial arteries. However, Syndrome X may be associated with a reduction in coronary [[vasodilator reserve]] presumably due to abnormalities in the [[coronary microcirculation]]. During stress, sampling of the [[coronary sinus]] demonstrates the production of [[lactate]] by the [[myocardium]]. Intracoronary [[acetylcholine]] can be administered to evaluate endothelium-dependent [[coronary flow reserve]].
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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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| ==Treatment==
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| The mainstay of treatment in patients with Syndrome X are [[calcium channel blocker]]s, such as [[nifedipine]] and [[diltiazem]]. Other therapies include:
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| *[[Nitrates]]
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| *[[Beta blockers]]
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| *[[Aminophylline]] - may be effective via inhibition of adenosine receptors.
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| *[[Estrogen]] - may be effective in women.
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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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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |
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| ==Review Articles==
| | {{WH}} |
| *[http://www.hosppract.com/issues/2000/02/kaski.htm Cardiac Syndrome X: An Overview]
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| *[http://heartdisease.about.com/cs/coronarydisease/a/CSX.htm Cardiac Syndrome X]
| | [[Category:Disease]] |
| *[http://www.texasheartinstitute.org/HIC/Topics/Cond/CardiacSyndromeX.cfm Texas Heart Institute]
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| *[http://content.nejm.org/cgi/content/full/347/17/1377 New England Journal of Medicine Editorials]
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| {{Circulatory system pathology}} | |
| {{SIB}} | |
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| [[Category:Ailments of unknown etiology]] | |
| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Disease state]]
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| [[Category:Ischemic heart disease]]
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| [[Category:Mature page]]
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