Endothelin: An Important Mediator in the Pathophysiology of Syndrome X?

  • Ian D. Cox
  • Juan Carlos Kaski
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 213)


Angina pectoris with normal coronary arteries is a common clinical entity with up to 30% of patients undergoing invasive assessment for anginal chest pain having normal coronary angiograms [1,2]. The term cardiac syndrome X to describe patients with chest pain and normal coronaries was first introduced by Kemp in 1973 [3] and is now generally confined to patients with exertional angina, completely normal coronary angiograms and a positive electrocardiographic response (> 0.1 mV of ST segment depression) to exercise testing [4]. The pathophysiology of chest pain in this patient group appears to be heterogeneous and remains the subject of considerable debate [5, 6, 7]. A non-cardiac source of pain, often originating in the gastrointestinal or musculoskeletal system, may be identified by further investigation. However, around 20% of patients appear to have objective evidence of myocardial ischemia in most series, and a mechanism involving a primary cardiac abnormality remains the most likely explanation for the symptoms in this subgroup.


Coronary Flow Reserve Left Bundle Branch Block Atrial Pace Normal Coronary Artery Normal Coronary Angiogram 
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© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Ian D. Cox
  • Juan Carlos Kaski

There are no affiliations available

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