ABSTRACT
Cardiac syndrome X, a condition characterized by angina-like chest pain, a positive electrocardio-graphic response to stress testing, and completely normal coronary arteriograms, is relatively common and affects over 20% of angina patients undergoing diagnostic coronary arteriography.1 Interestingly, there is a high prevalence of perimenopausal and menopausal women with cardiac syndrome X and, although the reasons for this are not firmly established, estrogen deficiency may be responsible. Low estrogen has been suggested to play a role in the pathogenesis of the condition mainly, but not exclusively, via endothelial dysfunction. The term cardiac syndrome X encompasses heterogeneous subjects and a diversity of pathogenic mechanisms. Although myocardial ischemia is certainly a potential mechanism, it is objectively found in only a relatively small proportion of syndrome X patients. In recent years, however, with the advent of more sensitive techniques it has been possible to identify subgroups of patients with documented myocardial ischemia. Other mechanisms, both cardiac and noncardiac, have also been identified. This chapter summarizes the clinical characteristics of patients with cardiac syndrome X and focuses mainly on pathogenic and diagnostic aspects of the syndrome as well as relevant aspects of its management.
