Syndrome X! What Tests are needed? And What Drugs May Benefit?

[ginny]

Dear Doctor,
I have not been diagnosed with this condition-Syndrome X-but I think I may be suffering from it.  Questions I have about it are:
1. Does this condition cause variant angina due to microvascular ischemia?(Not Prinzmital Angina-Arterial Spasm.)
2. Since this is a dysfunction of the small arteries/blood vessels, will NSAIDs and anti-inflammatory antibiotics help to alleviate the disease process?  
3. Is there speculation that Syndrome X is an autoimmune disease process?  
4. If you suffer from other vasculitis symptoms such as Migraine with aura, Raynaud's, or Livedo Reticularis, could this indicate that you may have Syndrome X when you have Coronary Artery disease symptoms?
5. Must they do an arterial catherization to definitively diagnose this syndrome?  Or will a Thallium/Persantine/Nuclear Test be sufficient?
6. Reading on this site and others, it seems that this syndrome has a good prognosis.  Is this true?
7. Will the stress of this disease process make it more likely that you can suffer from bacterial/viral diseases to the heart as Valve dysfuntion/regurgitation does?
8. And finally, can you develop CHF  or symptoms of it when you  have high output stress on your heart due to other disease processes such as anemia, thyroiditis, kidney disease, or hypertension?
I wish to thank you and the other volunteers for all your efforts.  And I would like to make a voluntary contribution to support this effort.  Is there any way to do this on line?
Sincerely,
Ginny

[ginny]

Dear Doctor,
I am a little confused about one aspect of your response.  The aspect is the rarity of Syndrome X.  I read today about some cardiology research discussed at the American Heart Association meeting.  A cardiologist identified as Dr. James Willerson stated
that 50% of the time a MI or stroke occurs in arteries that are not significantly narrowed and therefore weren't considered a threat.  He said they usually are left alone, but their research shows they're dangerous(Plaques)and doctors need to know about them, regardless of narrowing.  He stated that their research(His associate is Dr. Ward Casscells and they both practice at the Texas Heart Institute.)shows that these unstable plaques have thin fibrous caps with inflamed cells beneath and a core of lipids. His comments imply that rather than being a rare condition, Syndrome X probably would be the diagnosis for 50% of patients examined prior to a MI or Stroke.  Could you please comment/clarify these statements for me?  Thanks!
Sincerely,
Ginny

[Cleveland Clinic, MD]

Hi Ginny,

I don't have time to individualize answers to all your questions but I have provided some information and sources that you can use to do your own research.  We don't have a mechanism that I am aware of for on-line contributions but there is information on the site about how to make a donation if you wish to support the work that we do.  Thanks.

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.

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.