Syndrome X: pathophysiology and clinical management

Area of Science:

• Cardiology
• Clinical Medicine
• Pathophysiology

Background:

• Syndrome X presents with anginal chest pain and ECG changes, but normal coronary angiograms and no coronary spasm.
• While sharing symptoms with coronary artery disease, Syndrome X has distinct underlying mechanisms.
• Patients often exhibit normal coronary angiograms despite experiencing chest pain and myocardial ischemia.

Purpose of the Study:

• To elucidate the heterogeneous nature of Syndrome X.
• To differentiate the pathogenesis of Syndrome X from coronary artery disease.
• To highlight the importance of identifying underlying mechanisms for effective patient management.

Main Methods:

• Review of clinical presentations of patients diagnosed with Syndrome X.
• Analysis of studies investigating coronary microvascular function in Syndrome X.
• Examination of evidence regarding abnormal pain perception as a cause of chest pain.

Main Results:

• Coronary microvascular dysfunction is a key finding in Syndrome X.
• Myocardial ischemia in Syndrome X can be varied, subclinical, and regionally distributed.
• Abnormal pain perception contributes to chest pain in some Syndrome X patients.
• Syndrome X is a heterogeneous condition with multifactorial causes.

Conclusions:

• Effective management of Syndrome X necessitates personalized approaches based on individual clinical presentation.
• Identifying the specific mechanisms of anginal chest pain and/or myocardial ischemia is crucial for Syndrome X patients.
• Understanding the heterogeneity of Syndrome X, including microvascular dysfunction and altered pain perception, is key for treatment strategies.