Cardiac syndrome X: Relation to microvascular angina and other conditions

Cardiac syndrome X (CSX) describes patients with angina-like chest pain, positive stress ischemia, and nonobstructive coronary angiograms. Microvascular angina (MVA) is an etiologic mechanism in women with cardiac symptoms and abnormal vascular dysfunction without obstructive coronary artery disease, although not all patients with MVA show detectable ischemia. CSX is more prevalent in women than men, with an average age in the mid-to-late 50s. Many additional cardiac and noncardiac mechanisms have been proposed for CSX over the past three decades. The uncertainty and inconsistency of data for determining diagnosis and causality along with the unusual response to traditional antianginal treatment hinder the development of effective treatment strategies. Many researchers believe that women with MVA do not have a benign prognosis and may be better classified as intermediate risk. Better understanding of the disease characteristics; its relation to traditional and novel risk factors, especially in women; identification of reliable, accurate diagnostic procedures; and a comprehensive preventive therapeutic approach are all important for optimizing management strategy for MVA and CSX.