Cardiac Syndrome X -Causes, Symptoms, Diagnosis, Treatment, and Prognosis

What Is Cardiac Syndrome X?

Cardiac syndrome X (CSX) is defined broadly as chest discomfort that is very similar to angina. It is a heterogeneous syndrome. The heterogeneous syndrome refers to the condition where the problematic genes are multiple in number. The usual diagnostic criteria for cardiac syndrome X involves an exercise-induced angina-like chest discomfort. The abnormalities in the electrocardiogram (ECG) should also be identified. This condition is also being termed microvascular angina.

Whom Does Cardiac Syndrome X Affect?

Approximately 20%-30% of patients who undergo coronary angiography to evaluate angina get diagnosed with non-obstructive coronary artery disease. Cardiac syndrome X is very common in women when compared to men. Cardiac syndrome X frequently occurs in the category of perimenopausal and postmenopausal females.

What Are the Causes of Cardiac Syndrome X?

The exact cause of this condition has still not been definitively established. More research is needed to find out the causes of cardiac syndrome X. Current pieces of evidence suggest that the condition is very often related to the following causes.

• Low circulating levels of the female hormone estrogen. Estrogen acts as one of the essential factors that protect the blood vessels and the health of the heart of a female. It prevents many cardiovascular diseases in females during their reproductive period. The decrease in estrogen causes cardiac problems in women.

• A condition known as microvascular angina is an abnormality of the small vessels such as arterioles and venules. In this condition, the vessels supplying the cardiac muscle tighten or constrict.

• Autonomic nervous system dysfunction.

What Are the Symptoms Experienced by Patients With Cardiac Syndrome X?

The symptoms experienced by the patient who is having cardiac syndrome X are:

• Sweating.

• Anxiety.

• Cough.

• Crushing type of chest pain.

How Does Cardiac Syndrome X Occur?

There are several mechanisms proposed as to the issues of cardiac syndrome X by many types of medical research. This condition might occur through any one of the following or even involve more than one mechanism in the following list.

• Endothelial Dysfunction:

It can happen due to microvascular angina. It is related to several risk factors such as obesity, high blood cholesterol levels, and any inflammatory condition in the affected individual. In this condition, low levels of high-density lipoprotein (HDL) in the blood will lead to abnormalities. It will be clinically present with elevated serum c- reactive protein levels. This c- reactive protein level serves as a viable marker to note endothelial dysfunction.

• Myocardial ischemia.

• Insulin Resistance:

Several studies have shown that symptoms related to hyperinsulinemia are closely associated with cardiac syndrome X. Metformin has also proven to be very beneficial in improving blood vessels’ function. Surprisingly, it also benefits individuals who are not diagnosed with diabetes, even without a past medical history of diabetes in any part of their life.

• Abnormal Autonomic Control:

Multiple studies have proven the presence of abnormal pain perception in patients. Though these patients experience chest pain, they were always normal findings on coronary angiography.

• Estrogen Deficiency:

Research shows that women who are treated with estrogen replacement therapy showed improvement in their health significantly. The replaced estrogen improves the functioning of the heart and the blood vessels and decreases the frequency of heart conditions like angina pectoris.

What Are the Important Factors to Be Noted in Cardiac Syndrome X?

1. History Taking:

There are no significant details that can be collected in patients affected by cardiac syndrome X. The recording of details includes the patient's age and gender to check if they belong to the perimenopausal or postmenopausal females.

2. Physical Examination:

In the physical examination, it can be noted that the patients will have typical anginal symptoms. The physician has to check whether the symptoms can be relieved by rest or with the sublingual administration of Nitroglycerin. These patients show normal coronary arteriograms with no signs of atherosclerosis, cardiac embolism, or any inducible arterial spasm.

How Is It Diagnosed?

There could be an occurrence of cardiac valve diseases such as aortic or mitral valve stenosis, apparently to cardiac syndrome X. It might also include other conditions, such as high blood pressure, abdominal problems, or muscular pain. The diagnosis of cardiac syndrome requires laboratory investigations, and they are:

• An electrocardiogram (ECG).

• A cardiac stress test.

• A radionuclide test.

• A coronary angiogram.

Additional tests might be necessary to rule out any other conditions causing the abnormal symptoms.

What Is the Differential Diagnosis?

This disorder is often confused with an angina variant or myocardial metabolic syndrome. In order to eliminate misdiagnosis, proper history and physical examination must be done thoroughly. The related disorders also have to be ruled out with the help of an electrocardiogram (ECG) or laboratory blood tests.

What Are the Treatment Options?

Management of this condition tends to be a challenge for physicians. The main goal is to improve the quality of life of these patients.

The primary treatment of cardiac syndrome X is by controlling risk factors such as obesity, diabetes, and high cholesterol levels with the help of lipid-lowering therapy and adequate glycemic control. In many patients, anti-ischemic treatment, which includes beta-blockers such as Propranolol, Carvedilol, and calcium channel blockers like Diltiazem, is beneficial to subside the acute symptoms.

Also, patients must be informed that these medicines should not be administered without proper medical prescription as these drugs can cause side effects such as toxicity and nightmares. Psychological support to the affected individuals and cognitive behavioral therapy appears to be very good for the patients to accept their illness and to lead a happy life.

Relaxation practices such as transcendental meditation and yoga can provide good results for patients who are affected by cardiac syndrome X. These practices reduce the frequency and intensity of chest pain.

How Is the Prognosis?

Prognosis in cardiac syndrome X is far better than in patients who are affected with coronary artery disease. The disadvantage is that the symptoms of ischemia may recur for years in cardiac syndrome X. Although this disease does not affect the survival rate of the patients, it affects the patient's lifestyle. There is no increased rate of mortality identified.

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