Chronic stable angina clinical subset- syndrome X
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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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
One of the clinical subsets of angina [1] is described below.
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 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.
- 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 rather than removes lactate 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 benign.
ESC Guidelines for investigation in patients with Syndrome X (DO NOT EDIT)[2]
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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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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 [2]
References
- ↑ Braunwald, Eugene (2003). Primary Cardiology. Saunders. ISBN 0-7216-9444-6. Unknown parameter
|coauthors=ignored (help) - ↑ 2.0 2.1 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.