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Syndrome X: Causes, Symptoms, Diagnosis, Treatment
Last reviewed: 18.10.2021
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Syndrome X is a dysfunction or constriction of the vessels of the microcirculatory bed leading to the onset of angina pectoris (angina pectoris).
Some patients with typical angina pectoris whose symptoms decrease at rest or when taking nitroglycerin have normal coronary angiography results (i.e., they do not detect atherosclerotic lesions, embolism, or induced spasm of the arteries). Some of these patients develop ischemia, which is detected during a stress test, others do not. In some patients, the cause of ischemia is probably the reflex narrowing of the intramural arteries and a reduced coronary reserve. Other patients have microvascular dysfunction within the myocardium: abnormal vessels do not expand in response to physical exertion or other cardiovascular stimuli; sensitivity to heart pain in these patients can also be increased. The prognosis is favorable, although signs of ischemia may be present for years. In many patients, the use of b-adrenoblockers reduces manifestations. This pathology should not be confused with a variant angina associated with spasm of the epicardial arteries, or with another pathology, also called "syndrome X", which refers to the metabolic syndrome.
Where does it hurt?
Iscoli ischemia
Patients with IHD (especially those with diabetes) can have ischemia without clinical manifestations. The evidence of ischemia is the transient asymptomatic changes in ST-T detected during 24-hour Holter monitoring. Scintigraphy of the myocardium sometimes also allows to detect asymptomatic ischemia during physical or mental stress (for example, with an oral count). Painless ischemia and stress angina can co-exist, manifesting at different times. The prognosis depends on the severity of IHD.