E. A. Asbury; P. Collins

Disclosures

Int J Clin Pract. 2005;59(9):1063-1069. 

In This Article

Summary and Introduction

Summary

Cardiac syndrome X, the triad of angina pectoris, a positive exercise electrocardiogram for myocardial ischaemia and angiographically smooth coronary arteries, is frequently associated with debilitating symptomology, increased psychological morbidity and a poor quality of life. While various avenues of research have been undertaken, there are as yet no definitive conclusions regarding the exact pathogenesis of the condition. A number of physiological mechanisms have been explored, including the existence of underlying myocardial ischaemia, suggested endothelial dysfunction, abnormal pain perception, hormonal irregularities and insulin resistance, while the psychological impact of the condition has also been explored. Various treatment regimens have also been the subject of research with varying degrees of success. The heterogeneous nature of the patient population suggests that the mechanistic pathway may be multifactorial, while a comprehensive treatment regimen including both psychosocial and pharmacological interventions may offer the best outcome for patients with cardiac syndrome X.

Introduction

For nearly three decades, researchers and clinicians have tried to identify the cause of cardiovascular symptoms experienced by patients with cardiac syndrome X, the triad of angina pectoris, a positive exercise test for myocardial ischaemia and angiographically smooth coronary arteries.[1] Although patients with syndrome X have a good cardiovascular prognosis, patients can suffer from debilitating and excruciating chest pain which robs them of their quality of life. While various avenues of research have been undertaken in order to more comprehensively explore the symptoms associated with syndrome X, there are as yet no definitive conclusions regarding the exact pathogenesis of the condition (Figure 1).

Figure 1.

(A) An electrocardiogram demonstrating downsloping ST-segment depression, indicative of syndrome X among patients with chest pain and a normal coronary angiogram. (B) An angiographic image showing normal coronary arteries.

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