syndrome X (angina)

Last edited 11/2019 and last reviewed 05/2021

Cardiac syndrome x

• term syndrome x is used to describe the combination of angina-like chest pain, positive objective evidence of myocardial ischaemia (eg radionucleide perfusion scan) with a normal coronary angiogram
  
  
• seen most frequently in women often in the early menopausal years
  
  
• cause of syndrome x is not established but it may be due to abnormal endothelial function in small, resistance coronary arteries. This is in contrast to established CHD where myocardial ischaemia occurs due to obstruction of coronary blood flow by atherosclerotic plaques
  
  
• treatment for syndrome x is focused on symptom control with beta blockers or calcium channel blockers as first line. Overall the prognosis is more favourable than for those with obstructive coronary disease

NICE state with respect to Cardiac syndrome X:

• in people with angiographically normal coronary arteries and continuing anginal symptoms, consider a diagnosis of cardiac syndrome X.
• continue drug treatment for stable angina only if it improves the symptoms of the person with suspected cardiac syndrome X
• do not routinely offer drugs for the secondary prevention of cardiovascular disease to people with suspected cardiac syndrome X.

Reference:

• 1) BHF Factfile (November 2010). Women and coronary heart disease.
• 2) NICE (August 2016). Stable angina.