Cardiac Syndrome X: update 2014

Cardiol Clin. 2014 Aug;32(3):463-78. doi: 10.1016/j.ccl.2014.04.006. Epub 2014 Jun 2.

Abstract

Cardiac Syndrome X (CSX), characterized by angina-like chest discomfort, ST segment depression during exercise, and normal epicardial coronary arteries at angiography, is highly prevalent in women. CSX is not benign, and linked to adverse cardiovascular outcomes and a poor quality of life. Coronary microvascular and endothelial dysfunction and abnormal cardiac nociception have been implicated in the pathogenesis of CSX. Treatment includes life-style modification, anti-anginal, anti-atherosclerotic, and anti-ischemic medications. Non-pharmacological options include cognitive behavioral therapy, enhanced external counterpulsation, neurostimulation, and stellate ganglionectomy. Studies have shown the efficacy of individual treatments but guidelines outlining the best course of therapy are lacking.

Keywords: Angina; Cardiac syndrome X; Ischemia; Microvascular endothelial dysfunction; Myocardial hypersensitivity.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Diagnostic Imaging / methods*
  • Global Health
  • Humans
  • Microvascular Angina* / diagnosis
  • Microvascular Angina* / epidemiology
  • Microvascular Angina* / therapy
  • Morbidity / trends
  • Myocardial Revascularization / methods*
  • Prognosis
  • Vasodilator Agents / therapeutic use*

Substances

  • Vasodilator Agents