Re: Syndrome X

Posted By CCF CARDIO MD - CRC on June 25, 1998 at 13:52:44:

In Reply to: Syndrome X posted by Rocco on June 23, 1998 at 08:39:02:






I would appreciate information concerning syndrome x, and its long term implications.
I have a history of angina, especially under stress, or in very cold weather. I have
been examined by cardiologists, been catheterized, and found to have no blockage of
main heart arteries. The diagnosis has been syndrome x. I have been on beta blockers
and calcium channel blockers, and am now on Imipramine 50 mg plus Pravastin 20mg.
I currently feel fine, although I do have agina on occassion. I wondered about the
adequacy of the current medications, its utility over the long term, and the expected
long term prognosis. I am also on Allopurinol 300 mg for a long term gout problem.
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Dear Rocco,
Thank you for your question.  We often get questions about rare illnesses and Syndrome X fits into this category.  The good news is that the long term prognosis of persons diagnosed with syndrome X is good and you are on good medical therapy for this condition.  Below is a brief desription of what syndrome X is and some articles and their abstracts for additional reading.  Your local medical library should be able to help you find these articles.  
The term "syndrome X" is now widely used to specify a group of patients with anginal chest pain, ischemia-like electrocardiogram, normal coronary angiograms, and no evidence of coronary spasm. Though chest pain and exercise-induced myocardial ischemia may both be present in patients with syndrome X and those with coronary artery disease, the underlying pathogenesis of these two disease entities is different. In patients with syndrome X, the causes of angina and myocardial ischemia are multifarious while coronary angiograms are normal. Coronary microvascular function has been shown to be impaired in these patients. However, the presentation of myocardial ischemia may be varied and even subclinical, suggesting dynamic characteristics and regional distribution of coronary microvascular insufficiency in them. Recently, there is increasing evidence that chest pain may develop without detectable myocardial ischemia and has been attributed to abnormal pain perception in at least some of the patients. Thus, there is a heterogeneous group of patients with syndrome X. The rational patient management should be related to individual clinical presentation and depend upon the proper identification of the underlying mechanisms of anginal chest pain or myocardial ischemia or both in these patients.

Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist
Articles about the diagnosis and treatment of syndrome X.
Unique Identifier
95372258
Authors
Chauhan A.
Institution
Department of Medicine, University of Edinburgh, Royal Infirmary, UK.
Title
Syndrome X--angina and normal coronary angiography. [Review] [54 refs]
Source
Postgraduate Medical Journal.  71(836):341-5, 1995 Jun.
Abstract
It is clear that angina pectoris with normal coronary arteries is a heterogeneous and ill-defined syndrome that encompasses different pathogenic entities. Differences in patient selection and in definition of 'syndrome X' has made comparison between different study groups rather difficult. Two decades of investigations have not revealed a specific cause of this syndrome. There is now a general belief that syndrome X probably encompasses several pathophysiological disease entities and the mechanisms involved in syndrome X remain to be fully elucidated. [References: 54]

Unique Identifier
96238153
Authors
Zell KA.  Reis SE.
Institution
Department of Cardiology, University of Pittsburgh Medical Center, PA 15213, USA.
Title
Syndrome X: a discussion of angina and normal coronary arteries.
Source
American Journal of Critical Care.  5(2):99-101, 1996 Mar.
Abstract
Syndrome X was diagnosed in a female patient who presented with typical angina and a non-Q wave myocardial infarction, yet demonstrated normal coronary arteries. Syndrome X has been described as an impairment in normal endothelial function of the coronary microvasculature, resulting in inappropriate vasoconstriction and inadequate coronary flow reserve. In this article we review pathophysiology, diagnosis, treatment, and prognosis in a single case.
Unique Identifier
96066854
Authors
Kaski JC.  Elliott PM.
Institution
Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom.
Title
Angina pectoris and normal coronary arteriograms: clinical presentation and hemodynamic characteristics. [Review] [48 refs]
Source
American Journal of Cardiology.  76(13):35D-42D, 1995 Nov 2.
Abstract
Up to 30% of patients undergoing coronary angiography for the assessment of chest pain suggestive of coronary artery disease have "normal" studies. Several reports have indicated that a proportion of patients with angina and normal coronary arteriograms have reduced coronary flow reserve. The interpretation of these findings is, however, controversial as the majority of patients do not have definitive evidence for myocardial ischemia and have a good long-term prognosis. The clinical presentation of patients with angina and normal coronary arteriograms differs in different series and this may be just a reflection of the heterogeneous nature of the syndrome. A diversity of pathogenetic mechanisms have been postulated to explain "syndrome X" (chest pain and normal coronary arteriograms) but little is known at present about the true nature of the syndrome. The present article discusses the clinical and hemodynamic features of this intriguing disorder with particular reference to patients with syndrome X and microvascular angina. [References: 48]
Unique Identifier
95193762
Authors
Radice M.  Giudici V.  Marinelli G.
Institution
Metodologia Clinica Universita' di Milano, Italy.
Title
Long-term follow-up in patients with positive exercise test and angiographically normal coronary arteries (syndrome X).
Source
American Journal of Cardiology.  75(8):620-1, 1995 Mar 15.