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coronary syndrome X (microvascular angina)
Angina pectoris with normal or near normal coronary arteries by angiography. Syndrome X is associated with abnormal endothelial function & control of vascular tone.
Pathology:
1) ischemia due to abnormal microvascular endothelial function
2) increased myocardial nociception
3) may be related to estrogen deficiency
Clinical manifestations:
1) low pain threshold
2) a sense of seriousness or panic attack
3) aching chest pain lasting 10-30 minutes
4) sensation of fatigue after the pain has subsided
5) abnormalities in esophageal motility
Laboratory:
- elevated left ventricular end diastolic pressure
Management:
1) estrogen replacement therapy for postmenopausal women
2) beta-blockers may be tried, but are often ineffective
3) Ca+2 channel blockers are generally ineffective
4) nitroglycerin relief is inconsistent
5) imipramine may be useful for refractory cases
6) anxiolytic agents may decrease associated panic attacks, but have little effect on the angina
7) exercise training [2]
Related
angina pectoris
General
syndrome
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Journal Watch 20(24):192-93, 2000
Eriksson et al, J Am Coll Cardiol 36:1619, 2000