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Cardiac X syndrome

Updated on November 19, 2012

Cardiac X syndrome is disease where the patient has the pain of angina but doesn’t have coronary artery disease (CAD). The patients with cardiac X syndrome have symptoms of CAD but the coronary arteries are not blocked. Cardiac X syndrome is more common in women especially after menopause. The condition is not life threatening and doesn’t increase the risk of CAD. The following are some risk factors for the disease –

· Abdominal obesity

· Atherogenic dyslipidemia – a blood fat disorder

· High blood pressure

· Insulin resistance or intolerance to glucose

· Prothrombotic or pro-inflammatory state

· Older people more prone

· Women more prone since the constant changing of estrogen level may be one of the contributing reasons

· History of heart disease in the family

· Genetics

In some women with CXS (cardiac X syndrome), there is an abnormality of autonomic nervous system (dysautonomia). In dysautonomia, the autonomic nervous system loses its balance and at various times, the parasympathetic or sympathetic system may inappropriately predominate.

Symptoms and signs-

The patient has angina pain starting in the centre of the chest but the pain may spread to the left arm, neck, back, throat or jaw. There may be feeling of numbness or loss of feeling in arms, shoulders or wrists. Normally, the patients with cardiac X syndrome have chest pain after exercise.

The patients with cardiac X syndrome show symptoms and signs of CAD with an exercise stress test but when coronary angiography is performed, the coronary arteries show no blockage.

Consequences of cardiac X syndrome-

Normally, cardiac X syndrome is not life-threatening but, however, there are two possible exceptions to this. First, the persons with CXS may be prone to develop stress cardio-myopathy and second, some women with CXS are known to develop acute coronary syndrome (ACS), which is a serious medical condition.


The diagnosis is made primarily by excluding all other causes of chest pain. The following will differentiate CXS from coronary artery disease.

  • Stress test- Also called exercise ECG, it will show how the heart responds to increasing exercise. In case of CXS, it will show changes of coronary artery blockage in the recordings due to lack of oxygen.
  • Echocardiography- It uses sound waves to produce an image of the heart to see how it is working.
  • Exercise radioisotope test- Also called nuclear stress test, it uses a radioactive substance, which is injected into the blood, to show how the blood flows through the arteries.
  • Coronary angiography- In this a dye is injected into the bloodstream to give X-ray movie of the action of the heart and blood flow through valves and arteries, called an angiogram. It will show the number and seriousness of blockages in the coronary arteries.


It is treated by medicines which relieve symptoms of angina. The common medicines used for it are as follows. A number of these medicines are to be tried to find what works best for one.

  • Nitroglycerine- It dilates the coronary arteries and improves the blood flow to the heart. They can be used as skin patch, tablets, spray or ointment.
  • Beta-blocker- They block the chemical and hormonal changes sent to the heart. When under physical and emotional stress, the body sends signals to the heart to work harder. A beta-blocker blocks the effects of the signals and reduces the amount of oxygen demanded by the heart.
  • Calcium channel blocker- By relaxing the smooth muscles of the arteries, it keeps the coronary arteries open and reduces blood pressure.


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