Cardiac Syndrome X Clinical Presentation

Updated: Dec 24, 2020
  • Author: Subodh R Devabhaktuni, MD; Chief Editor: Richard A Lange, MD, MBA  more...
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Presentation

History and Physical Examination

Individuals with cardiac syndrome X (CSX) are typically younger than those with angina due to obstructive coronary artery disease. [38]

Approximately half of patients with cardiac syndrome X have recurrent angina-like chest pain epsidoes, whereas the remainder have atypical chest pain. The duration of anginal-type chest pain is often prolonged, [38]  and it often does not respond to sublingual nitroglycerin.

Some patients present with acute coronary syndrome (ACS). There is no significant blockage on coronary angiogram in around 15-20% of patients with non-ST-elevation myocardial infarction (MI). [39]  However, there are no data on presence of microvascular dysfunction in this patient population.

Rheumatologic disorders such as fibromyalgia and costochondritis and noncardiac causes of chest pain, such as esophageal dysfunction, have occasionally been reported in patients suspected to have cardiac syndrome X. [40]  Thus, a significant proportion of patients in whom cardiac syndrome X is diagnosed may have a noncardiac etiology for their chest discomfort.

Physical examination

Abnormal physical findings that reflect ischemia, such as gallop sound and the murmur of mitral regurgitation, are uncommon in cardiac syndrome X.

Exaggerated morning blood pressure surge may be an independent predictor for arterial stiffness (increased carotid-intima-media thickness) and diastolic dysfunction in patients with cardiac syndrome X. [41]  

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Physical Examination

Abnormal physical findings that reflect ischemia, such as gallop sound and the murmur of mitral regurgitation, are uncommon in cardiac syndrome X.

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