variant angina - Angina Message Board

georgi3 · 01-16-2005, 12:03 PM

thanks to those who got back to me.....
angiogram came back fine so we are looking at arterial muscle spasms. have put him on tablets but no effect yet... still ischaemic and has chest pain.stress test tomorrow.....thanks so much for your replies.xxxx

NineLives · 01-16-2005, 12:20 PM

Possibly cardiac syndrome X? During a angiogram the physician cannot view the smaller capillaries of the heart. Have they prescribed calcium channel blockers?

LongJohnSilver · 09-09-2006, 03:48 AM

FINALLY someone who knows about the existence of cardiac syndrome x! My wife was diagnosed with it yesterday after an angiogram. The cardiologist had fully expected significant blockage (failed stress test, and the elimination of chest pains when we'd do our daily walks esp. on inclines - using a nitroglycerine spray.

BUT, her coronary arteries were "totally clear", and her left ventricle test showed no anomalies.

Diagnosis: "Cardiac Syndrome X" - which might better be called "faux angina", but I'm a theologian Dr. not a medical one. :O)

Here's part of a brief description, the web link to it, and some very detailed links to the Mayo Clinic take on it -- the latter of which DEBUNKS the idea that its cause is
microvascular dysfunction (which is commonly assumed as the cause)!

Johnny Long - London

[url]http://www.bbc.co.uk/health/conditions/cardiacsyndromex1.shtml[/url]

What is it?
The term cardiac syndrome X was first used in 1973 to describe a condition that to this day remains a bit of a mystery.

Patients with the syndrome suffer the same chest pain as those with angina

For example, patients with the syndrome suffer the same chest pain as those with angina. In angina, this pain is often triggered by exercise and is caused by a narrowing of the arteries allowing insufficient blood to the heart. In cardiac syndrome X, the pain may also be triggered by exercise. When a treadmill or stress ECG test is performed to investigate the cause of the pain, the result is positive. However, when an angiogram - an x-ray dye test of the coronary arteries - is performed, no narrowing or hardening is found.

There's still no agreed definition of cardiac syndrome X. However, it's generally thought that to make a diagnosis the following criteria need to be fulfilled:

angina chest pain
positive stress test
completely normal coronary angiogram
(article continued on the web page).

For the MAYO CLINIC take on the subject, see:
[url]http://www.mayoclinicproceedings.com/inside.asp?AID=1263&UID=[/url] and:
[url]http://www.mayoclinicproceedings.com/inside.asp?AID=3098&UID=[/url]
which virtually rules our microvascular dysfunction which is commonly assumed
to be the cause.

Lenin · 09-09-2006, 06:52 AM

I would think the way to determine microvascular ischemia (cardiac syndrome X) is with a nuclear stress scan. Thus even if the large vesssels relmain open as they do in angiography the tiny vessels will interfere with the blood flow to certain parts of the heart and thus be clearly visible.

THe upside is that CSX isn't life threatening.

Variant angina, or the unexplainable clamping down of vessels, sometimes major, ones usually at rest, can be a killer.

I would think that agressive lipid lowering treatment might be very wise in cases of CSX in order to clear as much of the microvascualture as possibe, as is hard exercise to force the formation of additional tiny blood pathways.

(I hope Georgi's husband is doing well.)

Beefsteak · 09-12-2006, 10:02 PM

Lenin,
Is there evidence that "hard" exercise forces the formation of secondary blood pathways? I mean as distinct from minimal exercise which is a lot easier, and, for some like me, a lot less painful too.

The concept is attractive, but I wonder whether an enlarged heart is more likely.

My GP mentioned other pathways and scrutinised my angiograms (for minor blood vessels) but did not mention exercise as contributing. When asked, my cardioligist said exercise did not help the problem specifically.

The other point is that if hard exercise helps by creating and maintaining vascular pressure then it seems possible that vascodilators like nitrates and difedipine might negate the effect by making blood flow easier.

I would appreciate your comments on this.
Beefsteak