Cardiac syndrome X

Area of Science:

• Cardiology
• Internal Medicine
• Clinical Research

Background:

• Angina pectoris typically results from atherosclerotic obstructive lesions in coronary arteries.
• However, angina can also manifest in the absence of significant obstructive disease, presenting diagnostic challenges.
• Cardiac Syndrome X (CSX) is a condition characterized by angina with normal coronary angiograms.

Purpose of the Study:

• To explore conditions causing angina pectoris without obstructive atherosclerotic lesions.
• To define Cardiac Syndrome X (CSX) and its diagnostic criteria.
• To review the pathophysiology, prognosis, and therapeutic approaches for CSX.

Main Methods:

• Review of literature on non-atherosclerotic causes of angina.
• Analysis of diagnostic criteria for true CSX, including Bertrand et al.'s definition.
• Discussion of proposed pathogenic mechanisms, focusing on microvascular dysfunction.
• Evaluation of survival data and current therapeutic strategies.

Main Results:

• Angina can arise from non-atherosclerotic coronary obstructions or normal coronary angiography (CSX).
• True CSX is defined by anginal pain, positive exercise tests, evidence of ischemia, and normal coronary angiography.
• Pathogenesis likely involves microvascular dysfunction.
• CSX is associated with an excellent survival prognosis.

Conclusions:

• Angina pectoris can occur in the absence of obstructive coronary atherosclerosis, with CSX being a key example.
• While CSX has a favorable prognosis, its underlying mechanisms, primarily microvascular, require further understanding.
• There is a lack of standardized therapeutic protocols for managing CSX, highlighting a need for further research and clinical guidelines.