Chest pain with angiographic clear coronary arteries: A provider's approach to cardiac syndrome X

BACKGROUND: Cardiac syndrome X is a subject with yet unsettled etiology and management. Conventional investigations have not been able to establish that chest pain is due to myocardial ischemia. Magnetic resonance imaging has higher resolution and is more accurate for detecting ischemia. AIMS AND OBJECTIVES: To establish subendocardial ischemia as the cause of chest pain in cardiac syndrome X by virtue of stress perfusion cardiac MRI. METHODS: Contrast enhanced cardiac MRI was performed in 15 cases and 7 matched controls both at rest and during a six minute infusion of adenosine. Both visual and quantitive analysis were performed. In quantitative analysis both myocardial perfusion index and myocardial perfusion reserve index was measured. RESULTS: There was a significant increase in myocardial perfusion in both subendocardium as well as in subepicardium in both cases as well as in controls upon stress with adenosine. In controls the subendocardial perfusion index rose from 0.13 0.3 to 0.18 .03 and in the subepicardium from 0.12 .02 to 0.18 .03. In patients with cardiac syndrome X subendocardial perfusion index rose from 0.14 .03 to 0.19 .03 and subepicardial perfusion index rose from 0.13+.03 to 0.19 .03. Visual analysis showed short lasting subendocardial dark rim artificats in both cases and controls which lasted for only 3 to 5 beats. CONCLUSION: Our cardiovascular MR study of patients with cardiac syndrome X demonstrated significant and almost similar magnitude adenosine induced increase in both subendocardial and subepicardial myocardial perfusion indices in both study as well as control group. We found no evidence of subendocardial ischemia in patients with cardiac syndrome X. JMS 2011;14(2):46-51

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Is the chest pain in cardiac syndrome X due to subendocardial ischaemia?

European Heart Journal ◽

10.1093/eurheartj/ehm167 ◽

2007 ◽

Vol 28 (13) ◽

pp. 1539-1540 ◽

Cited By ~ 9

Author(s):

P. G. Camici

Keyword(s):

Chest Pain ◽

Syndrome X ◽

Cardiac Syndrome X ◽

Cardiac Syndrome

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Angina pectoris and normal coronary arteries: cardiac syndrome X

Heart ◽

10.1136/hrt.2003.020594 ◽

2004 ◽

Vol 90 (4) ◽

pp. 457-463 ◽

Cited By ~ 79

Author(s):

F. Crea

Keyword(s):

Angina Pectoris ◽

Coronary Arteries ◽

Syndrome X ◽

Cardiac Syndrome X ◽

Normal Coronary Arteries ◽

Cardiac Syndrome

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Increased coronary vasoconstrictor response to acetylcholine in women with chest pain and normal coronary arteriograms (cardiac syndrome X)

Clinical Research in Cardiology ◽

10.1007/s00392-012-0442-4 ◽

2012 ◽

Vol 101 (8) ◽

pp. 673-681 ◽

Cited By ~ 44

Author(s):

Peter Ong ◽

Anastasios Athanasiadis ◽

Heiko Mahrholdt ◽

Gabor Borgulya ◽

Udo Sechtem ◽

...

Keyword(s):

Chest Pain ◽

Syndrome X ◽

Cardiac Syndrome X ◽

Cardiac Syndrome ◽

Vasoconstrictor Response ◽

Coronary Vasoconstrictor

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Clinical profile of patients with cardiac syndrome X in a tertiary care hospital

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20173019 ◽

2017 ◽

Vol 5 (7) ◽

pp. 3231

Author(s):

Bhavya R. ◽

Suresh G. ◽

Subramanyam K.

Keyword(s):

Chest Pain ◽

Clinical Characteristics ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Systemic Hypertension ◽

Syndrome X ◽

Care Hospital ◽

Treadmill Test ◽

Cardiac Syndrome X ◽

Cardiac Syndrome

Background: Abnormalities in coronary microcirculation may lead to symptoms of chest pain which mimics angina. Symptoms of chest pain along with evidence of ischemia on non-invasive tests like electrocardiography (ECG), echocardiography or treadmill test (TMT) but with normal coronary angiogram (CAG) is referred to as cardiac syndrome X (CSX). Previous studies have shown favourable prognosis in such patients. However recent studies have not shown good prognosis. We intend to understand whether such adverse cardiovascular outcomes could be secondary to any change in the clinical characteristics of patients with CSX in the current era.Methods: This is a retrospective study which was conducted at a tertiary care hospital. CAG of patients who underwent coronary angiography between November 2013 and October 2016, for suspected ischemic heart disease was reviewed. Clinical characteristics of patients with normal or non-obstructive coronaries (less than 50% stenosis) in angiography with chest pain were analyzed. Further clinical characteristics, ECG, echocardiography, treadmill test and CAG findings were compared among males and females.Results: 410 patients were included in the study. 212 were females and 198 were males. Mean age of presentation was 53.46±10.5 years for males and 55.04±9.3 years for females. Patients presenting with atypical chest pain were higher (70.7%). There were 195 subjects with systemic hypertension, 103 with diabetes mellitus and 57 had dyslipidemia. In the study, most 260 subjects had ST-T changes on ECG. Abnormal echocardiography was seen in only 35 patients. 30.5% patients showed positive stress test for inducible ischemia.Conclusions: CSX is prevalent in significant number of patients who present with symptoms of chest pain. Unlike previous studies, there is no significant difference among males and females, in prevalence and risk factors for this syndrome. Further non-obstructive lesions were found to be higher in females.

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