Cardiac Syndrome

What is Cardiac Syndrome X?

Cardiac syndrome X is considered a type of angina pectoris. With this problem, a person feels chest pain when the heart is working harder than usual. However, coronary arteries look normal on coronary angiography and the doctor cannot diagnose angina.

The term cardiac syndrome X is often used to describe microvascular angina. Large blood vessels in the heart remain normal. However, it is believed that much smaller vessels (microvasculature) are constricted, which causes pain attacks. Therefore, a better name for such a syndrome would perhaps be “microvascular angina”.

Pathophysiology of cardiac syndrome X

The coronary microcirculation is responsible for the regulation of the coronary, i.e. heart, blood flow. Therefore, it is reasonable to assume that a decrease in coronary reserve may cause myocardial ischemia. However, many researchers question the existence of myocardial ischemia in heart X syndrome due to the absence of hemodynamic or metabolic signs of ischemia in most patients studied.

Endothelium, i.e. the inner wall of the vessels performs important functions, including the regulation of capillary permeability, vascular tone, and blood flow velocity. The endothelium plays a dual role in the control of vascular tone, releasing both vasodilating agents, vasodilators (such as nitric oxide and prostacyclin) and vasoconstrictors, vasoconstrictors (endothelin-1 and angiotensin II), in response to hemodynamic and chemical stimuli. An adequate balance between these elements, vasoconstrictors and vasodilators, is necessary to maintain vascular homeostasis. When this balance is disturbed, the result is an increased predisposition to vasoconstriction, activation of cholesterol plaques, uncontrolled cell division, and an increase in the intensity of oxidation processes. All this leads to thrombosis, activation of coagulation (i.e. blood clotting, which, in turn, leads to thrombosis), vascular inflammation and atherosclerosis.

How common is cardiac syndrome X?

Because doctors have not been able to pinpoint exactly what cardiac syndrome X is, there is no accurate data on how many people have the condition. Every year about 20,000 people in the UK develop angina for the first time. Of these people, approximately 1 in 5 women and 1 in 10 men will be diagnosed with microvascular angina. Unlike the more common type of angina, cardiac syndrome is more common in women than in men. Certain factors increase the likelihood of developing this pathology, for example:

  • The presence of high cholesterol;
  • Smoking;
  • Overweight and obesity;
  • Presence of high blood pressure or hypertension;
  • Female, postmenopausal age;
  • As well as the presence of rheumatoid arthritis.

What are the symptoms of cardiac syndrome X?

A common symptom is pain, aches, discomfort, or tightness that a person feels in the front of the chest when exerted. Pain occurs, for example, when a person goes uphill or against a strong cold wind. In addition, there may be pain in the arms, jaw, neck, or stomach.

Sometimes pain is caused by other stimuli. So, their appearance is possible with a rapid heartbeat (during stress, excitement, after smoking), as well as after eating.

Pain in microvascular angina usually does not last long. They can pass within 10 minutes of rest. However, they can quite strongly affect the quality of life, frightening a person, disrupting the usual course of his actions.

How do doctors diagnose cardiac syndrome X?

When contacting a doctor, it is important to be prepared to answer his questions. He will clarify when the pain appears, what it is connected with, how long it lasts, how it can be removed. Pain of an anginal type (i.e., the type of angina pectoris) always has a pattern in its appearance. That is why it is so important to give the doctor as much information as possible so that he can rule out other causes of pain, such as pain in the esophagus, muscles or joints.

You should be prepared to honestly answer questions about your lifestyle: smoking, drinking alcohol, eating habits, playing sports, stress. Remember that the doctor is not asking this out of idle curiosity and will not judge you, but he needs to understand what risk factors affect the body of his patient. That is why it is best to answer such questions honestly.

In addition to the survey, the specialist conducts an examination. He measures blood pressure, listens to heart sounds. A person may be referred for an ECG and / or ultrasound of the heart, as well as for laboratory diagnostics – a biochemical blood test to assess cholesterol levels.

Not only a standard ECG study can be performed, but also an exercise study or daily monitoring. This is due to the fact that pain in cardiac syndrome X is not always “obvious” and can occur at different times of the day in different conditions.

There is also a more in-depth study – angiography. It allows using x-rays and the introduction of a contrast agent to identify the location and patency of the vessels of the heart, incl. very small. In cardiac syndrome, the angiogram may be normal, but its modification is possible: the use of pharmacological tests. A special substance is introduced into the patient’s body, which constricts blood vessels, in a dose that does not harm a person, but can cause heart pain. If pain sensations appear, and a narrowing becomes visible on the angiogram, then the diagnosis is confirmed.

Treatment of cardiac syndrome

If the doctor suspects cardiac syndrome X, he prescribes nitroglycerin, or rather its nitrate, as a measure of help. One dose, taken under the tongue, relieves pain within a few minutes, as it relieves vascular spasm and reduces the workload on the heart. If therapy does not work, another disease should be suspected.

However, the most important step on the part of the patient is still the correction of lifestyle. You should stop smoking and drinking alcohol, switch to healthy food, monitor cholesterol levels and weight. Regular physical activity is important, incl. outdoor activities, swimming, yoga.

In addition, drugs from the groups of calcium channel blockers, beta-blockers, ACE inhibitors are prescribed. Statins are used to lower cholesterol levels.


  1. Ranya N. Sweis . Syndrome X (Microvascular Angina) // MSD Manual Last full review/revision Jul 2020
  2. G A Lanza. Cardiac syndrome X: a critical overview and future perspectives // Heart. 2007 Feb; 93(2): 159–166.
  3. Subodh R Devabhaktun. Cardiac Syndrome X // The

No, in cardiac syndrome there is no damage to large coronary arteries, so even a critical narrowing cannot lead to significant ischemia, i.e. oxygen starvation, myocardial tissue. However, microvascular angina is a risk factor for the development of a more serious disease. Its presence means that there are risk factors that negatively affect the cardiovascular system.

By itself, this condition does not pose a significant danger to life. However, it indicates serious changes in the health of the body, which need to be paid attention to.

Cardiac syndrome is a condition in which blood circulation in the small coronary vessels is disturbed due to vascular spasm.

First of all, you should consult a doctor to clarify the diagnosis. Cardiac syndrome requires an electrocardiogram, ultrasound of the heart, and sometimes angiography. General and biochemical blood tests with determination of glucose and cholesterol levels are shown.

Researchers do not have an exact answer to this question. Perhaps vascular spasm develops due to an imbalance of factors responsible for vasoconstriction (vasoconstrictors) and substances responsible for their expansion (vasodilators).

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