Medical Care

Cardiac syndrome X (CSX) is treated with lifestyle modification,^[1]including diet, exercise, smoking cessation, and weight reduction. A cardiac-prudent diet is advised.

Pharmacotherapy may involve the use of anti-anginal agents like beta blockers (first line of therapy), calcium channel blockers, and nitrates.^[1]Cattaneo and colleagues recently reviewed evidence suggesting that the drug ranolazine is useful in the management of primary microvascular angina.^[44]

Spinal cord stimulation: Spinal cord stimulation led to a signiﬁcant reduction in chest pain and improved quality of life in about 50% of patients resistant to all other treatment.^[45]

Psychological therapy

Cognitive behavioral therapy and group therapy have shown promising results in reducing episodes of chest discomfort over a period of 3-6 months.^{[46, 47]}They are more effective if started early. Tricyclic antidepressants and xanthine derivatives can be used in treating the hyperalgesia.

Physical training

A physical training program may improve exercise capacity and reduce the frequency of chest pain episodes.^[48] Adding a 4-week course of cardiac rehabilitation to usual care may increase the Duke Treadmill Score and exercise test duration as well as improve the resting oxygen pulse, peak oxygen, and first-minute recovery heart rate.^[49]

Enhanced external counter pulsation (EECP)

EECP may reduce symptoms through an improvement in endothelial function, promotion of collateralization, ventricular function enhancement, and peripheral effects resembling those seen with regular physical exercise.^[50]Bonetti et al reported successful treatment of CSX with severely symptomatic coronary endothelial dysfunction in the absence of obstructive coronary artery disease with standard 35-hour course of EECP therapy.^[51]

Other

Neurostimulation and stellate ganglionectomy may be alternative treatment options.^[1]

Medication

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Media Gallery

Cardiac Syndrome X. Coronary blood ﬂow in response to nitroglycerine (NTG) and acetylcholine (ACH) infusion.
Cardiac Syndrome X. Cardiac magnetic resonance image.

of 2

Author

Subodh R Devabhaktuni, MD Assistant Professor of Medicine (Clinical Cardiac Electrophysiology), University of Arkansas for Medical Sciences College of Medicine; Cardiologist, UAMS Health

Subodh R Devabhaktuni, MD is a member of the following medical societies: American College of Cardiology, Heart Rhythm Society

Disclosure: Nothing to disclose.

Coauthor(s)

Kartika Shetty, MD, FACP Program Director, Internal Medicine Residency Program, Sunrise GME; Facility Medical Director, TEAMHealth, Mountain View Hospital

Kartika Shetty, MD, FACP is a member of the following medical societies: American College of Physicians, Association of Program Directors in Internal Medicine, Medical Council of India

Disclosure: Nothing to disclose.

Chowdhury H Ahsan, MD, PhD, MRCP, FSCAI Clinical Professor of Medicine, Director of Cardiac Catheterization and Intervention, Marlon Cardiac Catheterization Laboratory, Director of Cardiovascular Research, University Medical Center, University of Nevada School of Medicine

Chowdhury H Ahsan, MD, PhD, MRCP, FSCAI is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, Society for Cardiovascular Angiography and Interventions, American Stroke Association

Disclosure: Received consulting fee from sanofi for consulting; Received honoraria from astra zeneca for speaking and teaching; Received honoraria from BI for speaking and teaching.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Richard A Lange, MD, MBA President, Texas Tech University Health Sciences Center, Dean, Paul L Foster School of Medicine

Richard A Lange, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, Association of Subspecialty Professors

Disclosure: Nothing to disclose.

Additional Contributors

Nirmal Sunkara, MD Chief Resident, Department of Internal Medicine, University of Nevada School of Medicine

Nirmal Sunkara, MD is a member of the following medical societies: American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Kasaiah Makam, MD Resident Physician, Department of Internal Medicine, University of Nevada School of Medicine

Kasaiah Makam, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.