Cardiac syndrome X: Clinical characteristics revisited
Babu Ezhumalai1, Ajith Ananthakrishnapillai2, Raja J Selvaraj2
1Department of Cardiology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India.
Insights
Cardiac Syndrome X, characterized by chest pain despite normal coronary arteries, affects a notable percentage of patients. Specific diagnosis and treatment are crucial for managing microvascular angina in these individuals.
Area of Science:
- Cardiology
- Internal Medicine
- Vascular Medicine
Background:
- Cardiac Syndrome X presents as angina with normal epicardial coronaries on angiography.
- This condition represents a heterogeneous group of patients with unexplained chest pain.
Purpose of the Study:
- To investigate the clinical characteristics of patients diagnosed with Cardiac Syndrome X.
- To understand the prevalence and presentation of this syndrome in patients undergoing coronary angiography.
Main Methods:
- Retrospective analysis of coronary angiography data over one year.
- Inclusion criteria: patients with chest pain and normal or non-obstructive coronary arteries.
Main Results:
- 8.7% (105/1203) of patients met the criteria for Cardiac Syndrome X.
- Patients exhibited typical or atypical angina, with varying ECG findings (ST-T changes common).
- Most patients had normal ventricular function on echocardiography, though some showed inducible ischemia on TMT.
Conclusions:
- Cardiac Syndrome X is a significant patient subset requiring specific management for microvascular angina.
- Despite atherosclerotic risk factors, their presentation differs from obstructive coronary artery disease.
- Early identification and tailored treatment are vital for improving outcomes in these patients.
Background:
Cardiac syndrome X includes a heterogenous group of patients with angina but normal epicardial coronaries in angiography.
Objective:
Our objective was to study the clinical characteristics of patients with cardiac syndrome X.
Methods:
Data of patients who underwent coronary angiography over a period of one year was retrospectively analyzed. Those with normal or non-obstructive coronaries in angiography with chest pain were included in this study.
Results:
1203 patients underwent coronary angiography during the study period. 105 (8.7%) patients fulfilled the inclusion criteria. There were 52 (49.5%) males and 53 (50.5%) females including 31 (29.5%) postmenopausal women. Many patients had atherosclerotic risk factors. Typical angina and atypical chest pain were reported by 63 (60%) and 42 (40%) patients, respectively. ECG was normal in 46 (43.8%) and abnormal in 59 (56.2%) patients. The most common abnormal finding in ECG was ST-T changes seen in 49 (46.7%) patients. Regional wall motion abnormality with mild left ventricular systolic dysfunction was seen in 4 (3.8%) patients while 101 (96.2%) patients had normal ventricular function in echocardiography. TMT was positive for inducible ischemia in 35 (33.3%) patients and inconclusive in 10 (9.5%) patients. Angiography showed normal epicardial coronaries in 85 (80.9%) patients.
Conclusions:
Cardiac syndrome X constitutes a significant subset of patients undergoing coronary angiography. It is essential to identify and treat them specifically for microvascular angina. Many of them have atherosclerotic risk factors but their presentation is different from those with obstructive coronaries.
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