Syndrome X

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WikiDoc Resources for Syndrome X
Articles
Most recent articles on Syndrome X Most cited articles on Syndrome X Review articles on Syndrome X Articles on Syndrome X in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Syndrome X Images of Syndrome X Photos of Syndrome X Podcasts & MP3s on Syndrome X Videos on Syndrome X
Evidence Based Medicine
Cochrane Collaboration on Syndrome X Bandolier on Syndrome X TRIP on Syndrome X
Clinical Trials
Ongoing Trials on Syndrome X at Clinical Trials.gov Trial results on Syndrome X Clinical Trials on Syndrome X at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Syndrome X NICE Guidance on Syndrome X NHS PRODIGY Guidance FDA on Syndrome X CDC on Syndrome X
Books
Books on Syndrome X
News
Syndrome X in the news Be alerted to news on Syndrome X News trends on Syndrome X
Commentary
Blogs on Syndrome X
Definitions
Definitions of Syndrome X
Patient Resources / Community
Patient resources on Syndrome X Discussion groups on Syndrome X Patient Handouts on Syndrome X Directions to Hospitals Treating Syndrome X Risk calculators and risk factors for Syndrome X
Healthcare Provider Resources
Symptoms of Syndrome X Causes & Risk Factors for Syndrome X Diagnostic studies for Syndrome X Treatment of Syndrome X
Continuing Medical Education (CME)
CME Programs on Syndrome X
International
Syndrome X en Espanol Syndrome X en Francais
Businness
Syndrome X in the Marketplace Patents on Syndrome X
Experimental / Informatics
List of terms related to Syndrome X

Cardiology Network
Discuss Syndrome X further in the WikiDoc Cardiology Network
Adult Congenital
Biomarkers
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Congestive Heart Failure
CT Angiography
Echocardiography
Electrophysiology
Cardiology General
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Health Economics
Hypertension
Interventional Cardiology
MRI
Nuclear Cardiology
Peripheral Arterial Disease
Prevention
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Pulmonary Embolism
Stable Angina
Valvular Heart Disease
Vascular Medicine

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The terms Syndrome X or Metabolic syndrome X may also be referring to metabolic syndrome.

(Cardiac) syndrome X is angina (chest pain) with signs associated with decreased blood flow to heart tissue but with normal coronary arteries. It occurs more often in young women. Some studies have found increased risk of other vasospastic disorders in syndrome X patients, such as migraine and Raynaud's phenomenon. It is treated with calcium channel blockers, such as nifedipine, and usually carries a favorable prognosis.

This is a distinct diagnosis from Prinzmetal's angina.

Cardiac syndrome X is sometimes referred to as microvascular angina when there are findings of microvascular dysfunction.

Features

While there is no formal definition for Syndrome X, the general consensus is that it entails all of the following:

• Angina: This usually does not cause dysfunction on echocardiogram and can last longer than that of heart disease.
• Abnormal Cardiac stress test: ST changes are typically similar to those of coronary artery disease and opposite of those with Prinzmetal's angina. Myocardial perfusion imaging can be abnormal in 30% of patients.
• Coronary angiogram: Normal

• Other causes of chest pain must be ruled out, including:
  • Prinzmetal's angina
  • Esophageal spasm

Diagnosis

Syndrome X is a diagnosis of exclusion. Typically this will necessitate both a clinical diagnosis, appropriate stress testing, and a coronary angiogram that meet the above criteria.

Pathophysiology

In a large percentage of patients, there is a finding of systemic microvascular abnormalities, causing reduced blood flow in the microvasculature of the cardiac muscles.

While numerous physiological mechanisms have been proposed, none have been proven.

Treatment

• nitrates - can reduce chest pain
• calcium channel blockers - specifically nifedipine and diltiazem can be effective.
• beta blockers - also work.
• aminophylline - may work by inhibiting adenosine receptors.
• estrogen - may work in women.

See also

• Takotsubo cardiomyopathy

References

• Botker HE, Sonne HS, Sorensen KE (1996). "Frequency of systemic microvascular dysfunction in syndrome X and in variant angina". Am J Cardiol 78 (2): 182-6. PMID 8712140.
• Cardiac Syndrome X: An Overview
• Cardiac Syndrome X
• Texas Heart Institute
• New England Journal of Medicine Editorials

v • d • e Electrocardiography
Overview	History of the EKG • EKG interpretation basics • Normal sinus rhythm
EKG Complexes	P wave • QRS complex • ST Segment • T wave • U wave Osborn wave • H wave • K wave • Delta wave NSSTW changes
EKG Intervals	PR Interval • QRS Interval • ST Interval • QT Interval
Conduction System & Bradycardia	Cardiac pacemaker • SA node • AV node• Bundle of His • Purkinje fibers • Sinus bradycardia • First Degree AV Block • Second Degree AV Block • Complete or Third-Degree AV Block • Concealed conduction • AV Junctional Rhythms • LBBB • LAHB • LPHB • RBBB • Trifascicular block
Atrial Arrhythmias	Sinus tachycardia • Premature Atrial Contractions (PACs) • Ectopic Atrial Rhythm • Paroxysmal Atrial Tachycardia (PAT) • Paroxysmal Atrial Tachycardia (PAT) with Block • Multifocal Atrial Tachycardia (MAT) • Atrial Flutter • Atrial Fibrillation • Wandering atrial pacemaker
Ventricular Arrhythmias	Differential Diagnosis of Tachycardia with a Wide QRS Complex • Accelerated Idioventricular Rhythm • Ventricular Parasystole • Premature Ventricular Contractions (PVCs) • Ventricular tachycardia • Ventricular Fibrillation • Sudden cardiac death
EKG Abnormalities in Disease States	Hypertrophy & Dilatation • Right atrial enlargement • Left atrial enlargement • Biatrial enlargement • Left Ventricular Hypertrophy • Right Ventricular Hypertrophy • Biventricular Hypertrophy • Acute myocardial infarction • NSTEMI • STEMI • Right ventricular myocardial infarction • Atrial infarction Pre-excitation Syndromes • Wolff-Parkinson-White Syndrome • Lown Ganong Levine Syndrome • Mahaim Type Preexcitation Cardiomyopathies • Arrhythmogenic Right Ventricular Dysplasia • Dilated Cardiomyopathy • Hypertrophic Cardiomyopathy Drug Effects on the EKG • Adenosine • β-blockers • Digitalis • Quinidine • Procainamide • Disopyramide • Lidocaine • Tocainide and Mexiletine • Phenytoin • Encainide, Flecainide and Propafenone • Amiodarone • Bretylium • Ca Channel Blockers • Phenothiazines • Tricyclic Antidepressants • Lithium Congenital Heart Disease • Dextrocardia • Atrial Septal Defect • Ventricular Septal Defect • Tetralogy of Fallot • Conjoined Twins or Siamese Twins Electrolyte Disturbances • Hyperkalemia • Hypokalemia • Hypercalcemia • Hypocalcemia • Nonspecific Changes Other Heart Diseases • Pericarditis • Myocarditis • Tamponade • Heart Transplantation • Sick Sinus Syndrome • Long QT Syndrome Inherited Disease • Brugada Syndrome Systemic Diseases • CNS Disease • Cardiac Tumors Heart Transplantation • EKG Changes in patient with Heart Transplantation Exogenous Effects • Hypothermia • Chest Trauma • Insect Bites • Electric Injuries
Technical Issues and Potential Errors in Interpretation	Artifacts • Lead Placement Errors • The EKG in a Patient with a Pacemaker

v • d • e Circulatory system pathology (I, 390-459)
Hypertension	Hypertensive heart disease - Hypertensive nephropathy - Secondary hypertension (Renovascular hypertension)
Ischaemic heart disease	Angina pectoris (Prinzmetal's angina) - Myocardial infarction (heart attack) - Dressler's syndrome
Pulmonary circulation	Pulmonary embolism - Cor pulmonale
Pericardium	Pericarditis - Pericardial effusion - Cardiac tamponade
Endocardium/heart valves	Endocarditis - mitral valve (regurgitation, prolapse, stenosis) - aortic valve (stenosis, insufficiency) - pulmonary valve (stenosis, insufficiency) - tricuspid valve (stenosis, insufficiency)
Myocardium	Myocarditis - Cardiomyopathy (Dilated cardiomyopathy, Hypertrophic cardiomyopathy, Loeffler endocarditis, Restrictive cardiomyopathy) - Arrhythmogenic right ventricular dysplasia
Electrical conduction system of the heart	Heart block: AV block (First degree, Second degree, Third degree) - Bundle branch block (Left, Right) - Bifascicular block - Trifascicular block Pre-excitation syndrome (Wolff-Parkinson-White, Lown-Ganong-Levine) - Long QT syndrome - Adams-Stokes syndrome - Cardiac arrest - Sudden cardiac death Arrhythmia: Paroxysmal tachycardia (Supraventricular, AV nodal reentrant, Ventricular) - Atrial flutter - Atrial fibrillation (Familial) - Ventricular fibrillation - Premature contraction (Atrial, Ventricular) - Ectopic pacemaker - Sick sinus syndrome
Other heart conditions	Heart failure - Cardiovascular disease - Cardiomegaly - Ventricular hypertrophy (Left, Right)
Cerebrovascular diseases	Stroke - Transient ischemic attack - Intracranial hemorrhage/cerebral hemorrhage: Extra-axial hemorrhage (Epidural hemorrhage, Subdural hemorrhage, Subarachnoid hemorrhage) Intra-axial hematoma (Intraventricular hemorrhages, Intraparenchymal hemorrhage) - Anterior spinal artery syndrome - Binswanger's disease - Moyamoya disease
Arteries, arterioles and capillaries	Atherosclerosis (Renal artery stenosis) - Aortic dissection/Aortic aneurysm (Abdominal aortic aneurysm) - Aneurysm - Raynaud's phenomenon/Raynaud's disease - Buerger's disease - Vasculitis/Arteritis (Aortitis) - Intermittent claudication - Arteriovenous fistula - Hereditary hemorrhagic telangiectasia - Spider angioma - Dissection (Carotid artery, Vertebral artery)
Veins, lymphatic vessels and lymph nodes	Thrombosis/Phlebitis/Thrombophlebitis (Deep vein thrombosis, May-Thurner syndrome, Portal vein thrombosis, Venous thrombosis, Budd-Chiari syndrome, Renal vein thrombosis, Paget-Schroetter disease) - Varicose veins / Portacaval anastomosis (Hemorrhoid, Esophageal varices, Varicocele, Gastric varices, Caput medusae) - Superior vena cava syndrome - Lymph (Lymphadenitis, Lymphedema, Lymphangitis)
Other	Hypotension (Orthostatic hypotension) - Rheumatic fever
See also congenital (Q20-Q28, 745-747)

v • d • e WikiDoc Research Resources for Syndrome X (Click show to right to view)
Articles on Syndrome X	Most recent articles on Syndrome X • Most cited articles on Syndrome X • Review articles on Syndrome X • Articles on Syndrome X in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Syndrome X	Powerpoint slides on Syndrome X • Images of Syndrome X • Photos of Syndrome X • Podcasts & MP3s on Syndrome X • Videos on Syndrome X
Evidence Based Medicine Regarding Syndrome X	Cochrane Collaboration on Syndrome X • Bandolier on Syndrome X • TRIP on Syndrome X
Cost Effectiveness of Syndrome X	Cost Effectiveness of Syndrome X
Clinical Trials Involving Syndrome X	Ongoing Trials on Syndrome X at Clinical Trials.gov • Trial results on Syndrome X • Clinical Trials on Syndrome X at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Syndrome X	US National Guidelines Clearinghouse on Syndrome X • NICE Guidance on Syndrome X • NHS PRODIGY Guidance • FDA on Syndrome X • CDC on Syndrome X
Textbook Information on Syndrome X	Books and Textbook Information on Syndrome X
Pharmacology Resources on Syndrome X	Dosing of Syndrome X • Drug interactions with Syndrome X • Side effects of Syndrome X • Allergic reactions to Syndrome X • Overdose information on Syndrome X • Carcinogenicity information on Syndrome X • Syndrome X in pregnancy • Pharmacokinetics of Syndrome X •
Genetics, Pharmacogenomics, and Proteinomics of Syndrome X	Genetics of Syndrome X • Pharmacogenomics of Syndrome X • Proteomics of Syndrome X
Newstories on Syndrome X	Syndrome X in the news • Be alerted to news on Syndrome X • News trends on Syndrome X
Commentary on Syndrome X	Blogs on Syndrome X
Patient Resources on Syndrome X	Patient resources on Syndrome X • Discussion groups on Syndrome X • Patient Handouts on Syndrome X • Directions to Hospitals Treating Syndrome X • Risk calculators and risk factors for Syndrome X
Healthcare Provider Resources on Syndrome X	Symptoms of Syndrome X • Causes & Risk Factors for Syndrome X • Diagnostic studies for Syndrome X • Treatment of Syndrome X
Continuing Medical Education (CME) Programs on Syndrome X	CME Programs on Syndrome X
International Resources on Syndrome X	Syndrome X en Espanol • Syndrome X en Francais
Business Resources on Syndrome X	Syndrome X in the Marketplace • Patents on Syndrome X
Informatics Resources on Syndrome X	List of terms related to Syndrome X

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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .