Chest pain starts unexpectedly

[Avia7981]

I need your advice. I have been having chest pain for 5 years-unrelated to exercise but sometimes related to stress.  I have had three angiograms with varying results. First angiogram: surgeon diagnosed a 70% blockage at the main branch of my left anterior descending artery. Upon followup, my cardiologist read the same xray and diagnosed 50% blockage. Second angiogram (2 years later): the surgeon diagnosed 30% blockage in the same area. Third angiogram: surgeon reported that there was no arterial blockage. I have just been discharged from a cardiac unit after 24 hours of observation due to chest pain.  I did not have an angiogram. The cardiologist on call diagnosed my condition as Syndrome X and told me that my problem was probably microvascular in nature. I feel concerned that I may have been misdiagnosed. Do you think the new heart scan tomography would be helpful in identifying the source of my chest pain? Any advice?

[kenkeith]

You refer to the two previous angiograms (cath or CT scan?) as dx'd by a "surgeon".  Why a surgeon?

The previous angiograms are inconsistant with Syndrome X.  Your cardiologist dx seems to be referencing as it relates to Syndrome X.In women with Cardiac Syndrome X, despite the fact that they describe symptoms typical of angina and often have ECG changes suggesting coronary artery blockages, are found to have "normal" appearing coronary arteries on catheterization. These women are often told they are normal, and that their symptoms are due to anxiety.

However, evidence has recently accumulated suggesting that many of these women have pathology in the small coronary arteries. Now evidence has been presented from the Women's Ischemia Syndrome.
Evaluation study showing that many women with Cardiac Syndrome X have objective findings on a test called magnetic resonance spectroscopy (MRS,) that demonstrate that they have true ischemia - oxygen starvation in the cardiac muscle - despite having "normal" large coronary arteries. Further, women who have abnormal MRS scans had a 50 - 60% probability of having to be admitted to the hospital for unstable angina over the next few years. This is the same risk as for women who had classic, large vessel coronary artery disease. Despite the high risk of hospitalization for true angina, however, women with positive MRS scans had a favorable overall prognosis...if you have Syndrome X, MRS my be enlightening.

For some insight, MRS is a powerful corroborative evidence that women with Cardiac Syndrome X are not merely anxious, flighty, or hypochondriacs. They appear to have true (though poorly characterized) small vessel coronary artery disease that produces true cardiac ischemia and real angina. The bad news is that we still don't know the nature of this small vessel disease, or how to treat it. The good news is that - really for the first time - serious research is finally taking place to identify the nature of the problem and to devise effective treatments for it.