What causes cardiac syndrome X and what can I do about it?

Cardiac syndrome X

Recently, I went to my GP after experiencing chest pains while exercising. I’m 48 and have always been fit and healthy. My GP referred me for tests and a cardiologist has now told me that I have something called cardiac syndrome X. Two years ago, I went through the menopause. Are the two things related and how can I adapt my lifestyle to minimise the symptoms?

Dr Mike Knapton says:

Chest pain associated with exercise is a typical symptom of angina, which is usually caused by narrowing of the main coronary arteries that supply the heart with blood – known as coronary heart disease (CHD). However, in some cases, usually with post-menopausal women, the main coronary arteries do not appear narrowed when an angiogram (type of X-ray) is carried out, which is good news. But, rather frustratingly for the patient, the symptoms of angina still persist. In these circumstances, cardiac syndrome X (also known as microvascular angina) may be diagnosed.

The good news is that cardiac syndrome X is not life threatening and is not associated with increased risk of heart attack or stroke

This is a poorly understood condition, but it is thought that the angina pain is caused by narrowing of the smallest blood vessels in the heart, which are too small to be seen on an angiogram.

There is some evidence to suggest an association between cardiac syndrome X and low levels of oestrogen, which could explain why you experienced symptoms just after your menopause.

Medication is usually prescribed to relieve the angina pain, including GTN spray, which widens the arteries and therefore increases the blood supply to the heart. It’s also important to reduce the risk of the main arteries becoming narrowed with age. A healthy lifestyle, which includes avoiding smoking, exercising regularly and eating healthily, is very important.

You should also talk to your doctor about having a health check to assess your risk of developing CHD. If your risk is high, you will be offered statins to help lower it.

While it can be very frustrating and worrying to have the angina pain, the good news is that cardiac syndrome X is not life threatening and is not associated with increased risk of heart attack or stroke.

Mike KnaptonMeet the expert

Dr Mike Knapton is Associate Medical Director (Prevention and Care) at the BHF, overseeing the strategic role in helping patients and the public reduce their risk of heart disease. He remains a GP and works one day a week at a practice in Cambridge.

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