Chronic stable angina clinical subset- syndrome X
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Chronic stable angina Microchapters | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Alternative Therapies for Refractory Angina | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
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)[1]
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Class I1. 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 IIb1. 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) |
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ESC Guidelines for pharmacological therapy to improve symptoms in patients with Syndrome X (DO NOT EDIT)[1]
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Class I1. 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 IIa1. Trial of therapy with other anti-anginals including nicorandil and metabolic agents. (Level of Evidence: C) Class IIb1. 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) |
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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 [1]
References
- ↑ 1.0 1.1 1.2 Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "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". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.