Cardiac Syndrome X

Posted by e-Medical PPT Friday, July 13, 2012
Cardiac syndrome X is angina with signs associated with decreased blood flow to heart tissue but with normal coronary arteries. Some studies have found increased risk of other vasospastic disorders in cardiac syndrome X patients, such as migraine and Raynaud's phenomenon.Cardiac syndrome X is sometimes referred to as microvascular angina when there are findings of microvascular dysfunction.

While there is no formal definition for cardiac syndrome X, the general consensus is that it entails all of the following:
    Angina: This usually does not cause dysfunction on echocardiogram and can last longer than that of heart disease.
    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.
    Coronary angiogram: Normal
Chest pain caused by cardiac syndrome X is most of the time unpredictable and it can occur when at rest and/or during exercise. The pain associated with syndrome X is normally more intense and it lasts for longer periods of time compared to pain caused by other conditions.

Cardiac syndrome X is a diagnosis of exclusion. Typically this will necessitate both a clinical diagnosis, appropriate stress testing, and a coronary angiogram that meet the above criteria. Cardiac MRI can be used to diagnose cardiac syndrome X.

The first step in management is the administration of nitrates which relieve the chest pain. They  relax the muscles of the heart and blood vessels. However, they prove to be inefficient in as much as 50% of the patients. Alternative treatments may consist from calcium channel blockers or beta blockers which reduces chest pain by relaxing the muscle cells lining the artery and improving blood flow to the heart while lowering blood pressure.Aminophylline may also work, as well as estrogen can be effective in women.
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