Pathophysiology and Management of Patients With Chest Pain and Normal Coronary Arteriograms (Cardiac Syndrome X)

@article{Kaski2004PathophysiologyAM,
  title={Pathophysiology and Management of Patients With Chest Pain and Normal Coronary Arteriograms (Cardiac Syndrome X)},
  author={Juan Carlos Kaski},
  journal={Circulation: Journal of the American Heart Association},
  year={2004},
  volume={109},
  pages={568-572}
}
  • J. Kaski
  • Published 2004
  • Medicine
  • Circulation: Journal of the American Heart Association
Patients with cardiac syndrome X (CSX)—typical chest pain and electrocardiographic changes suggestive of myocardial ischemia despite normal coronary arteriograms–represent a diagnostic and therapeutic riddle. CSX is not associated with an increased mortality or an increased risk of cardiovascular events, but it often severely impairs quality of life and represents a substantial cost burden to the healthcare system. This syndrome of chest pain with normal coronary arteries encompasses a variety… Expand
Cardiac syndrome X: Relation to microvascular angina and other conditions
TLDR
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. Expand
Ischaemia and outcome with normal coronary arteries.
This editorial refers to ‘Long-term survival of patients with chest pain syndrome and angiographically normal or near-normal coronary arteries: the additional prognostic value of dipyridamoleExpand
Cardiac syndrome X: pathogenesis and management
TLDR
The present article reviews the possible pathogenic mechanisms responsible for CSX and briefly summarizes current therapeutic strategies. Expand
Reduced survival in patients with "coronary microvascular disease".
TLDR
Coronary µVD as a cause of chest pain and positive stress test is common, and all-cause mortality in patients with coronary µVD is worse than in an age- and gender-matched population control, but better than those with significant epicardial CAD. Expand
Cardiac Syndrome X Prognosis
TLDR
Cardiac Syndrome X has an adverse prognosis and health care cost expenditure comparable to obstructive CAD in both stable angina and unstable acute coronary syndrome patient populations and potential links between MCD and heart failure with preserved systolic function are suggested. Expand
Cardiac syndrome X and microvascular coronary dysfunction.
TLDR
New data provide improve understanding of coronary vascular dysfunction and resultant myocardial ischemia that characterize MCD among patients with cardiac syndrome X. Expand
Clinical characteristics of patients with suspected cardiac chest pain and angiographically normal coronary arteries in a secondary care hospital
TLDR
It is suggested that premenopausal women with suspected cardiac chest pain could be considered for non-invasive coronary imaging as a first step in clinical practice. Expand
Microvascular coronary dysfunction in women: pathophysiology, diagnosis, and management.
TLDR
Early identification of MCD by coronary reactivity testing may be beneficial in prognostication and stratifying these patients for optimal medical therapy, as well as further research in MCD needed. Expand
Chest pain with angiographic clear coronary arteries: A provider's approach to cardiac syndrome X
TLDR
The causes of CSX remain unknown; however, CSX is easy to diagnose and can be treated, and medication therapy and risk factor modification can greatly improve the quality of life by decreasing pain occurrence and lessening pain intensity. Expand
Refresher corner Cardiac syndrome X : pathogenesis and management
The term Cardiac Syndrome X (CSX) describes patients presenting with typical exertional chest pain suggestive of myocardial ischemia, a positive exercise stress test result, and angiographicallyExpand
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References

SHOWING 1-10 OF 30 REFERENCES
Overview of gender aspects of cardiac syndrome X.
  • J. Kaski
  • Medicine
  • Cardiovascular research
  • 2002
TLDR
Current knowledge regarding the role of oestrogen deficiency in the pathogenesis of syndrome X and the potential therapeutic role of Oestrogen replacement therapy in women with chest pain and normal coronary arteriograms is reviewed. Expand
Cardiac Syndrome X and Microvascular Angina
TLDR
The heterogenous nature of syndrome X, the possibility of more than one etiologic cause and the fact that a different form of myocardial ischemia could play a pathogenic role in this condition are highlighted. Expand
Cardiac syndrome X: clinical characteristics and left ventricular function. Long-term follow-up study.
TLDR
Syndrome X, as defined in this study, occurs predominantly in postmenopausal women and patients usually have chest pain typical for angina, but conventional antianginal treatment is not often successful. Expand
Chest Pain With Normal Coronary Arteries: Psychological Aspects
TLDR
An interactive model is suggested below, in which psychological and physical factors interact in a variety of ways to precipitate, and especially to maintain, physical symptoms, which indicates a place for psychological approaches in the management of patients with chest pain and normal coronary arteries. Expand
Imipramine in patients with chest pain despite normal coronary angiograms.
TLDR
Imipramine improved the symptoms of patients with chest pain and normal coronary angiograms, possibly through a visceral analgesic effect. Expand
Central neural contribution to the perception of chest pain in cardiac syndrome X
TLDR
Chest pain and ECG changes were not accompanied by demonstrable myocardial dysfunction in syndrome X patients, but altered central neural handling of afferent signals may contribute to the abnormal pain perception in these patients. Expand
Effect of oral aminophylline in patients with angina and normal coronary arteriograms (cardiac syndrome X).
TLDR
Oral aminophylline has a favourable effect on exercise induced chest pain threshold in patients with syndrome X, and the disparate effects on symptoms and ST segment changes are intriguing and further study is warranted. Expand
C-reactive protein, clinical presentation, and ischemic activity in patients with chest pain and normal coronary angiograms.
TLDR
The hs-CRP correlates with symptoms and ECG markers of myocardial ischemia in CPNCA patients and is related to the pathogenesis of angina in these patients deserves further investigation. Expand
Abnormal myocardial phosphorus-31 nuclear magnetic resonance spectroscopy in women with chest pain but normal coronary angiograms.
TLDR
The results provide direct evidence of an abnormal metabolic response to handgrip exercise in at least some women with chest pain consistent with the occurrence of myocardial ischemia but no angiographically significant coronary stenoses. Expand
A controlled trial of cognitive behavioural therapy for non-cardiac chest pain.
TLDR
It is concluded that there is a need for 'stepped' further care following reassurance in the cardiac clinic and that cognitive behavioural treatment is effective with those with persistent disabling symptoms. Expand
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