Cardiac syndrome X

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WHAT IS CARDIAC SYNDROME X? Cardiac syndrome X is characterized by angina-like chest pain, due to decreased blood flow to the heart, even when the coronary arteries are normal, thereby compelling the heart to work harder.  About 20,000 new cases of cardiac syndrome X are reported in the United Kingdom each year, and it is […] Read More

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Cardiac syndrome X

WHAT IS CARDIAC SYNDROME X? Cardiac syndrome X is characterized by angina-like chest pain, due to decreased blood flow to the heart, even when the coronary arteries are normal, thereby compelling the heart to work harder.  About 20,000 new cases of cardiac syndrome X are reported in the United Kingdom each year, and it is most common in women than men. Other names for cardiac syndrome X are microvascular angina and CSX. RISKS ASSOCIATED WITH CARDIAC SYNDROME X Endothelial dysfunction in cardiac syndrome X (CSX) appears to involve multiple factors and is associated with some risk factors like smoking, hypercholesterolemia (high blood cholesterol levels), obesity, and inflammation.  Cardiac syndrome X causes an angina-like chest pain that subjects you to temporal discomfort. ST depression (myocardial ischemia) as a result of micro-vascular angina has been reported during intense exercises, even at normal coronary epicardial arteries, especially in post-menopausal women. DIAGNOSIS OF CARDIAC SYNDROME X In diagnosing for cardiac syndrome X, your doctor will want to know all about:
  • The pain and its pattern, to rule out other causes of the pain.
  • Your medical history.
  • Your lifestyle habits, such as smoking, drinks, diet, and exercise.
  • Family history of CSX.
  • Blood pressure (BP) reading.
The following tests may be carried out by the doctor to diagnose if you have CSX or not:
  • Blood Test
This is used to check your cholesterol level. If angina is suspected, your doctor may give you a dose of glyceryl trinitrate (GTN) spray or tablets under your tongue when angina pain develops.  The GTN when absorbed into the bloodstream should ease the pain within a few minutes. It works by relaxing the blood vessels to reduce the workload on the heart, and also helps to widen the coronary arteries, thereby increasing the flow of blood to the heart muscle.  Temporary headache and/or flushing may occur after taking GTN. If there’s no quick relief from the pain after this medication, tell your doctor.
  • Electrocardiogram (ECG)
This is done while you are exercising. This is also referred to as a “stress test.” The doctor may be able to see a typical pattern (a downward sloping ST segment). With this, the diagnosis can be made.
  • Angiogram Test
Here, a special dye is injected into the arteries or heart (coronary arteries). With the help of x-ray equipment, the structure of the arteries can be shown, as well as the location and severity of any narrowing.  In people with CSX, the angiogram result is usually normal. The angiogram, however, may show narrowing when certain chemicals, such as acetylcholine are injected. These chemicals when injected, cause abnormalities in the angiogram and help to diagnose CSX. This is the confirmatory test for CSX. TREATMENT OF CSX Specialty: Cardiologist Cardiac syndrome X is difficult to treat. But a combination of a range of different treatments can help.  Possible treatments include reducing risk factors and bring into face certain lifestyle habits, such as exercises, and refraining from smoking and alcohol.  Certain different medications may also be of help, including:
  • Calcium-chemical blockers help lower blood pressure.
  • Beta-blockers can lower stress on the heart and blood vessels.
  • Angiotensin-converting enzyme (ACE) inhibitors, used for high blood pressure and heart failure.
  • Ranolazine (Ranexa) for chest pain.
  • Statins are used to reduce the level of cholesterol in the blood. 
They include:
  • Atorvastatin.
  • Fluvastatin.
  • Pravastatin.
  • Rosuvastatin.
  • Simvastatin.
Report any serious side effects to your doctor immediately. CONCLUSION Even though the long-term prognosis of cardiac syndrome X does not necessarily include increased mortality, the patient’s quality of life is every time affected and the frequency of cardiovascular and cerebrovascular occurrence is increased.  Aggravated and recurrent angina may also lead to physical discomfort, often hospital readmissions, or even repeat coronary angiography, putting on patient’s huge economic burden. Moreover, patients with CSX show a high measure of anxiety and depression.  Meanwhile, the etiology and pathology of CSX remain unclear, although it is claimed that the disorder is associated with endothelial dysfunction. Yet these claims lack evidence.  Even the respective curative effects of conventional drugs remain internationally controversial. Without a doubt, more committed and intense research efforts are needed in this area, if the quality of life must be assured.



The most common symptoms of cardiac syndrome X include:

  • Aches.
  • Arterial spasms.
  • Tightness.
  • Chest pain.
  • Pains in the arms, jaw, neck, or stomach.


Certain factors may likely make cardiac syndrome X develop. Such factors may include:

  • Obesity.
  • Smoking.
  • Mild arthritis.
  • High blood pressure.
  • High cholesterol level in the blood.
  • Women during and after menopause.
  • Abnormal pain perception (leading to chest pain).
  • Diabetes mellitus (contributing to endothelial dysfunction).



Some mechanisms that have been proposed to result in cardiac syndrome X include:

  • Endothelial dysfunction (MVA).

At present, this seems to be the prevailing theory.

  • Abnormal autoimmune control.
  • Myocardial ischemia.
  • Insulin resistance.
  • Altered cardiac sensitivity.
  • Estrogen deficiency.


Is cardiac syndrome X genetic?

CSX is currently accepted to be a heterogeneous clinical diagnosis that includes genetic, coronary micro-vascular, metabolic, hormonal, and cardiovascular risk factors.

What are the symptoms of cardiac syndrome X?

CSX (cardiac syndrome X), a condition characterized by angina-like chest discomfort, ST-segment depression during exercise, and normal coronary epicardial arteries at angiography, has the highest prevalence in post-menopausal women. The most common symptoms of cardiac syndrome X include aches, tightness, chest pain, and pains in the arms, jaw, neck, or stomach.

What causes cardiac syndrome X?

CSX is associated with endothelial dysfunction, inflammation, oxidative stress, or estrogen deficiency. The underlying causes may be sudden narrowing (spasm) of normal coronary arteries without any thermal.

Is there a cure for cardiac syndrome X?

CSX is treated with lifestyle modification, including diet, exercise, smoking cessation, and weight reduction. A cardiac-prudent diet is advised. Pharmacotherapy may involve the use of anti-anginal agents like beta-blockers (first line of therapy), calcium channel blockers, and nitrates.

Is micro-vascular angina a heart disease?

A type of cardiovascular disease known to physicians as microvascular angina affects the heart’s tiniest arteries and causes chest pain. The disease is sneaky in that it does not show up on traditional heart scans but is linked to serious health outcomes, like heart attacks