coronary syndrome X (microvascular angina)

Introduction

Angina pectoris with normal or near normal coronary arteries by angiography. Syndrome X is associated with abnormal endothelial function & control of vascular tone.

Pathology

• ischemia due to abnormal microvascular endothelial function
• increased myocardial nociception
• may be related to estrogen deficiency

Clinical manifestations

• low pain threshold
• a sense of seriousness or panic attack
• aching chest pain lasting 10-30 minutes
• sensation of fatigue after the pain has subsided
• abnormalities in esophageal motility

Laboratory

• elevated left ventricular end diastolic pressure

Management

• estrogen replacement therapy for postmenopausal women
• beta-blockers may be tried, but are often ineffective
• Ca+2 channel blockers are generally ineffective
• nitroglycerin relief is inconsistent
• imipramine may be useful for refractory cases
• anxiolytic agents may decrease associated panic attacks, but have little effect on the angina
• exercise training

More general terms

• syndrome

Additional terms

• angina pectoris