Chronic stable angina clinical subset- syndrome X

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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 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.

References

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