syndrome x/triglycerides

[christine m. smith]

Hi!

I have symptoms of exertional angina when I walk uphill and climb stairs. A sestamibi scan showed mild ischemia in the area of the left anterior descending artery.  I tried imdur which relieves the symptoms quite well but I wanted to know for sure so my cardiologist did a cardiac cath recently. Unfortunately I have just as many questions. The cath was completely normal!  I asked the cardiologist who did the procedure if this could be "syndrome x" and he said "it could be, but personally I don't believe it  exists". He even went on to say that the pain I am experiencing is not from my heart and that the scan was a false positive. (yet it fits the description of exertional angina, is relieved by imdur, and I don't appear to have any gi symptoms. Shy would my esophagus spasm only when walking uphill and climbing stairs)  My own cardiologist appears to believe syndrome x exists but isn't ready to label me with that, its very hard to diagnose and doesn't feel any additional testing is necessary. He agrees that I can continue taking the imdur.

One  question I have is:  Can you have microvascular angina without having all the features of syndrome x? I do have hypertension (50mg toprol xl) and my triglycerides are now elevated. I am normal weight (although do carry the extra pounds in my upper area) and my blood sugar appears to be normal, although my pcp office has not gotten back to me on that yet.

If I don't have Syndrome X, could the oral estrogen I started in June be responsible for the rise in triglycerides I have had? Before June they were 179, in October 225, and in November 400.  I started lipitor in September and my cholesterol has not improved. My LDL has come down to 94 but my pcp says that is not valid with elevated trigs. If not due to syndrome x or estrogen, could the rise in trigs be due to the fact I am eating too many carbohydrates?  How do you feel about the theory that in some people the low fat high carbo diet will not improve blood lipids?
I have been working on this for two years with no improvement and now I am looking at a lifetime of medication for a condition no one agrees I have. Discouraging!

Thank you for reading this. It's taken awhile to get in to post a question and I have no one to ask as it seems my cardiologist has dismissed me and my pcp just doesn't know. I also welcome any comments from other readers about their experiences with angina/negative caths and elevated triglycerides. Thank you!

Chris S.

[Lauro]

I failed to add that I am also looking into the Ornish Diet.

I have 25 lbs. of 'fat' to lose...like now.

I also see ads for the Weight Watchers Point System.  Has anyone tried this and had success?

Thanks

[Lauro]

Very Interesting Info on Syndrome X.

I suspect this is what I have. I do not think I have both types as my triglycerides have always been normal and Glucose is always between 90-110.  it is my LDL that is never ever below 150.  Cannot seem to get it lower and meds have too many side effects for my body.

Harriet, the Atkins Diet, I am going to investigate this.

Thanks,

Happy New Year to all.

[Tom S.]

I've been trying to sort my way through the chaos of information on diets as well. I seem to have most of the diet-version of "Syndrome X" (I didn't know there was even a cardiac-version of Syndrome X", so I've been migrating towards the Ornish/McDougall plan for better cardiac health. I'm having a lipid profile done tomorrow, so I'll know how this is working...I've been following the Ornish plan for about a month now.

Note to Harriet C.: I'm not too sure about the Atkins diet. I think that lowering carbs has the effect of helping with weight loss, but putting the body into a state of ketosis almost seems extreme to me. This isn't at all a criticism, and I'm very pleased for your success. My wife (slightly overweight) to some success, but when I see all that dietary fat being eaten, I'm always a little suspicious. My real concern is how much of an effect that much fat in a diet has on arterial health, in particular, coronary arteries.

The Ornish diet is tough to start, particulary if you've been a carnivore in the past, like I was. However, he's certainly has some scientifically quantifiable results when it comes to either reversing or halting coronary disease, and lots of positive results from folks on it. Pretty much the same set of positives that come from folks on the McDougall plan. Like I said though, they are pretty big lifestyle changes.

Best regards,

Tom

[Harriet C]

Yes, Chris, I restricted carbs and sugars by going on the Atkins diet last year after running it past my physician.  She heartily encourged me to try it since my cholesterol was too high, weight too high, and the hunger in the middle of the night worried her as a possible diabetes red flag although my sugars were currently okay.

My present physician's (insurance forced a change in providers) first words were "Of course you lose weight on Atkins, but it wrecks your heart!"  Hmmm.  Here are my stats and I fail to see how Atkins is going to wreck my heart:
46 yr old woman, 5'7", began at 200 lbs.  Over 7 months lost 20 lbs and more inches.  Cholesterol went from:
TOTAL: 246 down to 239...not enough, but in the right direction at least!
GOOD: 35 up to 58...just what they want to see.
BAD: 150 up to 168.  No, not the right direction BUT
TRIGL: 292 down to 79, an eyepopping amount
RATIO: 6.5 down to 4.35 just almost where they want it to be.
Blood pressure is always rather low for a hefty woman and it dropped even lower.  
So, let's see...to protect our hearts we are supposed to:
not smoke (I don't),
don't use the pill (I don't),
lose weight (I did),
lower our BP (I did),
lower our cholesterol (All items in the lipid panel went the right direction except the 'bad' but supposedly when your trigliceride levels drop a larger number than your 'bad' had increased your overall picture is improved.)
Everything 'they' always tell us to do to improve our heart longevity was or is being attained...I just didn't do it the politically correct way using 'their' preferred method of LOW FAT/HIGH HUNGER/EXACERBATED CARBOHYDRATE CRAVINGS.  I may have increased my OVERT fat intake (meats, cheese,cream,cream cheese), but my COVERT fat intake (cookies, brownies, breads with lots of butter, candy, ice cream, bananas, apples, juice, dried fruits) coupled with loads of sugar bottomed out.

I bagged the diet during a bad cold (eating for comfort), Thanksgiving and Christmas.  Not only did some weight come back on, but I felt bloated, gassy, achey, fuzzy brained and had multiple episodes of PVC's which had virtually disappeard while on Atkins.  I can't wait to start back again on January 2nd because I FELT SO MUCH BETTER while restricting my carbs.  I will have my yearly woman's physical in May and will again have my cholesterol panel checked.  One must be on Atkins for about 3 months before the improvements actually register in the blood stream.  I expect my doctor will again want to put me on Lipitor, not so much because my values were so high (they are high, but not THAT high)but because he disapproves of the way I am lowering them.  If you have questions do read The New Diet Revolution by Dr. Atkins.  I did before I committed to this and was impressed with how he supports his claims.  This wasn't just an emotional pitch to fatsos everywhere...it was supported by scientific research and countless other physicians in the field who are lesser known.  
I felt better, I lost weight and significant size AND my overall lipid panel and blood pressure improved.  I will continue on this pathway.

[christine m. smith]

Now I get it. There are *two* disorders called "syndrome x". One is the cardiological disorder and the other one characterized by hypertension, elevated triglycerides, elevated blood sugar, obesity and insulin resistance. The "other one" can also have heart disease as part of it. Talk about confusing! I asked another cardiologist on line if you can have microvascular angina (the cardiological syndrome x) without the other features of syndrome x. (I was thinking mainly of elevated blood sugar and insulin resistance) He said that microvascular angina and syndrome x were one and the same. I now realize that there are two disorders with the same name and he was referring only to the cardiological disorder. Now I'm wondering if one person can have both disorders.

Does anyone have any experience with lowering triglycerides by reasonably cutting down on carbohydrates?

Chris S.

[Cleveland Clinic, MD]

Dear Chris,

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.

This should be differentiated from the other syndrome x which is an endocrine disorder consisting  of  diabetes, high triglycerides, hypertension and obesity.  This is a completely different syndrome with (unfortunately) the same name.  Therefore the diagnosis and treatment are different for this condition and the two should not be confused with each other.

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.