Unraveling the mystery of syndrome X

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The term 'syndrome X' is used to describe patients with anginal chest pain who are found to have normal coronary arteries at angiography. Although syndrome X likely has different causes, there is evidence that, in at least some patients, it is due to myocardial ischemia secondary to a dysfunction of small coronary arteries (ie, microvascular angina). This theory is supported by findings of ischemic ECG changes during spontaneous or provoked angina, transient alterations during other noninvasive diagnostic techniques (eg, stress scintigraphic tests), and reduced coronary flow reserve. However, the mechanisms responsible for the microvascular abnormality are poorly understood at present. Patients with syndrome X have an excellent prognosis, but they often are severely limited by their chest pain. Conventional antianginal drugs are often ineffective, although some benefits can be obtained with the use of beta blockers and/or calcium antagonists. Several alternative therapies, including alpha-blocking agents, aminophylline, estrogens, angiotensin-converting enzyme inhibitors, and imipramine, have been proposed but must be evaluated more extensively before being recommended routinely.

Original languageEnglish
Pages (from-to)10-21
Number of pages12
JournalJournal of Myocardial Ischemia
Issue number7
Publication statusPublished - 1994

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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