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Cardiac Syndrome X

cardiac syndrome x

Cardiac syndrome X (CSX) is thought to be a type of angina. Angina is a pain that comes from the heart. The common type of angina is usually caused by narrowing of the coronary (heart) arteries. This causes a reduced blood supply to a part, or parts, of your heart muscle. The blood supply may be good enough when you are resting. When your heart works harder (when you walk fast or climb stairs and your heart rate increases) your heart muscle needs more blood and oxygen. If the extra blood that your heart needs cannot get past the narrowed coronary arteries, the heart responds with pain.
In CSX you feel chest pain when your heart works harder, but the heart arteries appear to be normal. Unlike the more common type of angina, CSX is more common in women than men, and tends to affect younger people .

What causes CSX ?

 There have been many different theories, but the following are currently thought to explain why it might occur:
The larger blood vessels in the heart that show up in angiography are normal. However, much smaller vessels  is thought to be where there is narrowing. It is also thought that the lining of the heart's blood vessels does not work as well.
The heart muscle more sensitive to pain in people who  have this condition.

Who can have cardiac syndrome X?

Certain factors make CSX more likely to develop. For example:

  • High cholesterol level
  • Smoking
  • Being overweight and unfit
  • High blood pressure
  • Diabetes

What are the symptoms?

The common symptom is a pain, ache, discomfort or tightness that you feel across the front of the chest when you exert yourself - for example, when you climb stairs,walk up a hill or against a strong, cold wind. You may also, or just, feel the pain in your arms, jaw, neck or stomach.

An angina pain will usually ease within 10 minutes when you rest. Angina pain may also be triggered by other causes of a faster heart rate. For example, when you have a vivid dream or an argument. The pains also tend to develop more easily after meals.

How do doctors diagnose CSX?

When you see your doctor, they will want to know all about the pain and when it happens. Angina-type pains have a pattern. They will also use this information to rule out other causes of pain, such as pain from the gullet or from your muscles and joints. They will usually also ask you about your lifestyle your diet and if you exercise. They may also take a blood pressure reading. They may ask you to have a blood test to check your cholesterol level.

If they think angina is likely, they may prescribe you a glyceryl trinitrate (GTN) tablets. You take a dose under your tongue when your angina pain develops, it should ease the pain within a few minutes A dose of GTN may cause a headache and/or flushing for a short while. If this medicine does not relieve the pain quickly, tell your doctor. Further tests may be needed.
A heart tracing called an electrocardiograph (ECG) is often done, but this is usually normal when you are not exerting yourself. When you have an ECG whilst exercising (sometimes called a stress test) the doctor may be able to see a typical pattern .

Typical angina can be confirmed by an angiogram test. This is when special dye is injected into the arteries or the heart (coronary arteries to see the location and severity of any narrowing. This test is normal in people with CSX.

What treatments are available?

CSX can be tricky to treat. Treatments that usually work for the common type of angina don't seem to work as well for CSX.

The first treatment usually tried is a beta-blocker medicine. This has the best chance of improving symptoms, but it can vary. Treatments that help to modify the pain and how it is felt, can also be tried. These include imipramine or a piece of equipment called a transcutaneous electrical nerve stimulation (TENS) machine .Sometimes other medicines may also be advised, if you have high blood pressure or a high cholesterol level.

A lot of medicines have been tried over the years, without success. More research is needed to work out the most effective treatment.

What can I do to help myself?

Briefly, risk factors that can be modified and may help to prevent angina from getting worse include:

  • Stop smoking.
  • Blood pressure control.
  • If you are overweight, losing some weight is advised. Losing weight will reduce the amount of workload on your heart and also help to lower your blood pressure.
  • High cholesterol should be treated if it is high.
  • If possible, you should aim to do some moderate physical activity like brisk walking, swimming, cycling, d gardening, most days of the week for at least 30 minutes. Ask your doctor to confirm that you can undertake regular physical activity.
  • Diet. You should aim to eat a healthy diet. A healthy diet means:
  • At least five portions of a variety of fruit and vegetables per day.
  • Avoid food such as fatty meats, cheeses, full-cream milk, fried food, butter, etc.
  • Avoid red meat rather eat chicken and fish.
  • If you do fry, choose a vegetable oil such as sunflower, rapeseed or olive.
  • Try not to extra salt to food, and limit foods which are salty.
  • Alcohol. Drinking a small or moderate amount of alcohol is probably beneficial to the heart. That is, 1-2 units per day - which is up to 14 units per week.

What is the outlook (prognosis)?

In about 1 out of 3 people with CSX, symptoms improve over time. Unfortunately, in about 1 out of 5 people, their symptoms become worse. The pain can become difficult to relieve and this affects the quality of life for people with CSX.
At the moment, CSX on its own does not appear to affect life expectancy. If there are also other problems, such as high blood pressure and cholesterol, life expectancy may be lower if they are not treated effectively.


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