Cardiac Syndrome X

Cardiac syndrome X (CSX) was termed in 1973 by Harvey Kemp. CSX is characterized by typical or atypical anginal chest pain with no evidence of significant coronary vascular abnormalities visualized on angiogram. The condition has also been synonymous with the terms microvascular angina" and "chest pain with normal coronary arteries." It is viewed as a type of ischemic heart disease with occurrence most prevalent in perimenopausal and postmenopausal females.  Although once believed to be a benign ailment, contemporary literature has supported subjects with CSX to have unfavorable cardiovascular events and a decreased quality of life. It is a diagnosis of exclusion and is frequently challenging. Management is also complex and difficult as the pathogenesis of its onset is not fully understood. CSX is hypothesized to involve microvascular dysfunction of the coronary arteries, resulting in myocardial ischemia (MI) and irregular cardiac sensitivity to pain. The clinical manifestations of CSX are believed to be the consequence of myocardial hypersensitivity. Pharmacologic management of CSX can be initiated by conventional anti-ischemic agents such as beta-blockers, nitrates, and calcium channel blockers. Additional agents like angiotensin-converting enzyme (ACE) inhibitors, statins, and antianginals such as ranolazine may also be used. Pain management with agents like tricyclic antidepressants (TCA) and xanthine derivatives has been reported to show effectiveness. Lifestyle changes or improvements are also recommended, other treatment modalities such as cognitive-behavioral therapy (CBT) and neurostimulation may be considered.