Cardiac Syndrome X Treatment & Management

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


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