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Syndrome - X
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Syndrome - X


  : After experiencing debilitating chest pain, a "highly abnormal" stress test with "ischemic episodes" as well as lateral q-waves and a cardiac cath that revealed "angiographically smooth coronary arteries", the cardiologist has decided that I have "Syndrome-X" and that the previous tests where false positives.  I have been trying to get as much information on this Syndrome as possible and from what I have learned, insulin resistance is a major component of the Syndrome and the possiblity of having early stage atherosclerosis that is undetectable on angiography is pretty good.
  : My question is this:  To confirm or reject the Cardio's diagnoses of Syndrome X , shouldn't my insulin levels be checked for hyperinsulinemia?  I had a glucose tolerance test in April of this year and, at that time, I had elevated glucose levels (but not elevated enough to be considered diabetic).  I had the test done because my father, brother and mother are diabetic, I am hypertensive with multiple family members who are hypertensive (father and mother, all grandparents, all aunts and uncles) and I was experiencing symptoms of hypoglycemia.  I was on a beta blocker at the time the test was taken and I asked my doctor to switch my blood pressure medicine when I learned that Beta Blockers elevate blood glucose.  I also requested the switch because the chest pains and breathing trouble were unbearable and I figuered it was as a result of my blood pressure (my daily readings were in the 160's - 170's/90's to low 100's)
  : My second question is: Is Syndrome-X a valid condition and if, so, since it appears to affect many systems in the body, should I be content with someone saying this is what you have, see you later?  My research shows that the condition is not life threatening (except for the potential increased risk of atherosclerosis and diabetes) so, I am content to just live with the increased chest pain and the shortness of breath upon exertion if that is indeed what is going on with my body.  
  : 1 year prior to having the GTT, I changed my eating habits and cut out sugar, white flour, potatoes and potatoe products, corn and corn products, and cheese.  I eat very few carbohydrates but I eat lots of vegetables, fish (some shell fish) and poultry.  Despite this, I have gained 20 pounds.
  : Do you know anything about Syndrome-X?  Should I assume my heart is okay and my symptoms stem from another body part?  Since diabetes and hypertension are vascular diseases should I see a general vascular dr. as opposed to a cardiologist?  I have angered the cardiologist with my questions, suggestions what-if's and could it be's but I need to know if his diagnoses is accurate and, if not, what is wrong with me.  The caridologist feels that if there is no atherosclerosis, there is no significant heart disease.  Any information you can provide would be gratefully accepted.
  **********************************************************************
  My total cholesterol is 115 with my LDL at 66 and my HDL at 49
  The doctor who did the GTT said I needed to lower my LDL and raise my HDL even though my total cholesterol is good.  Should this be considered in diagnosing or rejecting the the diagnoses of Syndrome-X?

Dear Lori,
Thank you for your question.  Your question refelects a case of "mistaken idenity" and highlights the disadvantages of undertaking courses of self treatment.  There are actually 2 very different "syndrome Xs".  One type is in obese people who have resistance to insulin, hyperinsulinemia and high lipid levels.  This is not related at all to the other syndrome X which is a cardiac condition.
The good news is that the long term prognosis of persons diagnosed with syndrome X is good.  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.  In addition be sure to discuss any treatment courses you plan very carefully with your doctor before embarking on them.
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.





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