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Cardiac Syndrome X and Microvascular Angina

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PanVascular Medicine

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Abstract

Cardiac syndrome X is defined as the occurrence of typical chest pain and evidence of myocardial ischemia on noninvasive stress tests (mainly, ST-segment depression during exercise stress test), in the presence of normal coronary arteries at angiography and in the absence of any other cardiac diseases. This condition is now mainly defined as primary microvascular angina (MVA). Abnormalities of endothelium-dependent and endothelium-independent coronary microvascular dilation have been described in many studies, using different invasive and noninvasive methods. An increased coronary microvascular constriction is also involved. The causes of the coronary microvascular dysfunction are likely multiple and may include common cardiovascular risk factors, an abnormal cardiac adrenergic function, insulin resistance, inflammation and, in women, estrogen deficiency. Prognosis is good, but quality of life can significantly be impaired in 10–20 % of patients. Treatment includes classical anti-ischemic drugs and several other pharmacological and nonpharmacological therapeutic tools for those with symptoms refractory to standard antianginal and anti-ischemic therapy.

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Abbreviations

Cardiac syndrome X:

Clinical picture characterized by (1) Typical exercise-induced angina (2) Positive exercise stress test (3) Normal coronary arteries (4) No specific cardiac or systemic diseases

Microvascular angina (MVA):

Angina caused by abnormalities in coronary microcirculation

Primary MVA:

MVA occurring in the absence of any specific cardiac or systemic disease

Secondary MVA:

MVA occurring in the context of specific cardiac or systemic disease (e.g., cardiomyopathy, autoimmune disease, etc.)

Stable MVA:

MVA presenting with a stable (chronic) clinical pattern (mainly exercise-induced angina)

Unstable MVA:

MVA presenting with an acute and/or worsening clinical pattern, usually compatible with a non-ST-segment elevation acute coronary syndrome

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Further Reading

  • Lanza GA, Parrinello R, Figliozzi S (2014) Management of microvascular angina pectoris. Am J Cardiovasc Drugs 14(1):31–40

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  • Lanza GA, Crea F (2014) Acute coronary syndromes without obstructive coronary atherosclerosis: the tiles of a complex puzzle. Circ Cardiovasc Interv 7(3):278–281

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Authors and Affiliations

  1. Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Rome, Italy

    Gaetano A. Lanza, Rossella Parrinello & Stefano Figliozzi

Authors
  1. Gaetano A. Lanza
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  2. Rossella Parrinello
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  3. Stefano Figliozzi
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Correspondence to Gaetano A. Lanza .

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Editors and Affiliations

  1. Division of Cardiovascular Disease Department of Internal Medicine, Health Care Center Bitterfeld, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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Lanza, G.A., Parrinello, R., Figliozzi, S. (2015). Cardiac Syndrome X and Microvascular Angina. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37078-6_63

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  • DOI: https://doi.org/10.1007/978-3-642-37078-6_63

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