Cardiac Ischemia and Angina Pectoris without Flow-Limiting Coronary Artery Disease (Coronary Syndrome X)

Coronary ischemic disease (CID) is a worldwide frequent pathology with increasing prevalence. Angina pectoris (AP) is a cardinal symptom of CID. Typical AP meets all of the following criteria: retrosternal chest discomfort of characteristic quality and duration; provoked by exertional or emotional stress; is relieved by rest and/or nitrates within minutes .It was stated that ‘no patient with AP failed to show occlusion in at least one of the major coronary arteries’ andflow-limiting coronary artery disease (CAD) causing ischemia was accepted asthe cause of AP. 

However, this assumption is not unconditional because AP may also occur in other diseases, such as e.g. hypertrophic cardiomyopathy, severe aortic stenosis, profound anemia, and carboxy hemoglobin intoxication.

In 1967 two papers described patients with typical AP and sometimes dyspnea and neurovegetative symptoms (e.g. perspiration, tachycardia and dizziness) without epicardial CAD (CAD). This cardiac pathology is usually called cardiac syndrome X (CSX) and is not rare. Read more...................