What Are the Most Common Syndrome X Symptoms?

Syndrome X, also known as microvascular angina, refers to symptoms of exertional angina or angina-like discomfort. Active plate electrocardiogram exercise tests have evidence of myocardial ischemia such as ST segment depression. Coronary angiography shows normal or non-obstructive coronary A group of clinical syndromes.

Basic Information

nickname

Microvascular angina pectoris

Visiting department

Cardiology

Common locations

heart

Common causes

Not completely clear

Common symptoms

Paroxysmal chest pain

Contagious

no

Causes of x syndrome

The cause of this disease is not completely clear. The most commonly proposed hypotheses are: impaired endothelial-dependent coronary dilation due to reduced NO production, increased sensitivity to sympathetic nerve stimulation, and exercise-mediated coronary contraction.

Clinical manifestations of x syndrome

Main symptoms

The main clinical manifestations of Syndrome X are paroxysmal chest pain, which can be manifested as typical labor angina pectoris or atypical chest pain, both as stable angina pectoris and unstable angina pectoris, lasting resting type Chest pain. It is not effective for taking nitroglycerin. The duration of chest pain can be as long as 1-2 hours. Quite a few patients have a threshold of inducing physical activity.

2. Other symptoms

Some patients with mild or no coronary disease, who care too much about their personal health due to chest pain, may experience panic, anxiety, and depression, and account for 2/3 of patients with syndrome X.

x syndrome test

The results of any laboratory test have little diagnostic value for the diagnosis of syndrome X, but can find the risk factors of coronary heart disease and the secondary factors that cause angina pectoris.

Blood lipid

There is sufficient evidence that blood lipid disorders are closely related to the onset of coronary heart disease, so all patients with suspected coronary heart disease should be measured for lipids. The typical blood lipids of arteriosclerosis are: total cholesterol, low-density lipoprotein cholesterol, and triglycerides increase while high-density lipoprotein cholesterol decreases.

Blood glucose

Impaired glucose tolerance and diabetes are risk factors for coronary heart disease, so patients with suspected coronary heart disease should check fasting blood glucose for hyperinsulinemia.

3. Objective evidence of myocardial ischemia

(1) ECG is usually in the normal range when there is no chest pain: a few patients may have mild ST-T changes. ECG may show ischemic ST-T changes during chest pain attacks. Positive treadmill exercise tests are positive. Sometimes holter monitoring may also reveal ST-T changes with myocardial ischemia. However, some patients fail to detect ECG ischemic changes during typical chest pain episodes.

(2) UCG examination is usually normal at the time of echocardiography (UCG) rest. Left ventricular segmental motor dysfunction can be seen when stress-induced angina pectoris, but dipyridamole-loaded UCG cannot find the whole or segmental left ventricular function impaired Signs, and in the epicardial coronary lesions, it can induce segmental wall motion abnormalities, which can be used as one of the clues for the identification of syndrome X.

(3) Exercise nuclide myocardial perfusion scan When exercise-induced angina pectoris, this examination can find signs of segmental myocardial perfusion reduction or defect and redistribution. Radionuclide ventriculography can show that the left ventricular segmental motor function is abnormal during exercise, and EF does not increase or decrease.

(4) In patients with coronary angiography (CAG) X syndrome, CAG is normal or no significant stenosis is found, and the ergometrine challenge test is negative. Left ventricular angiography showed no abnormalities, no signs of cardiac enlargement or myocardial hypertrophy, and left ventricular end-diastolic pressure was generally normal.

x syndrome diagnosis

Have typical exertional angina pectoris, ECG has myocardial ischemia or atypical chest pain during seizures, exercise tests are positive, ventricular function and CAG show normal coronary arteries, and ergometrine challenge tests are negative. When all of the above, clinical Can be confirmed as X syndrome.

Differential diagnosis of x syndrome

Syndrome X should be distinguished from other diseases that cause chest discomfort.

Esophageal disease

(1) Reflux esophagitis due to lax sphincter relaxation at the lower end of the esophagus , acidic gastric juice reflux, causing esophageal inflammation and cramps, manifested as burning pain behind the sternum or mid-upper abdomen, and may be radiated to the back and suspected of angina. However, the disease often occurs when supine after a meal, which can be relieved by taking antacids.

(2) Esophageal hiatal hernia is often associated with gastric acid reflux, and its symptoms are similar to esophagitis. It often occurs when you bend down or lie supine after a full meal. Gastrointestinal radiography can clearly diagnose.

(3) Diffuse esophageal spasm can be associated with reflux esophagitis, and its chest pain caused by a variety of manifestations, taking nitroglycerin is effective, ergometrine can be induced, so it is easy to suspect an angina pectoris attack, it is atypical angina pectoris chest pain A common cause. According to the patient's history of acid reflux and anorexia, symptoms often occur when eating especially cold drinks or after meals, have nothing to do with exertion, and have difficulty swallowing during an episode can be distinguished from angina. Esophagoscopy and esophageal manometry can confirm the diagnosis.

Clinically, angina pectoris and esophageal disease often coexist. Esophageal reflux can lower the threshold of angina pectoris. Esophageal spasm can be induced by ergometrine and relieved by nitroglycerin. Therefore, the identification of the two is often difficult. Chest pain is manifested as "heartburn" and is related to changes in body position and eating, and is accompanied by dysphagia is a characteristic of esophageal pain; esophageal pain is more often radiated to the back than angina. Accurate diagnosis requires not only a careful history and physical examination, but sometimes also a laboratory test.

2. Lung and mediastinal diseases

(1) The pain of pulmonary embolism occurs suddenly and occurs at rest. It is seen in patients with high-risk factors of the disease (such as heart failure, venous disease, post-surgery, etc.), often accompanied by hemoptysis and shortness of breath. Its painful properties are typically described as chest tightness with or subsequent pleural inflammatory chest pain, that is, sharp pain on that side of the chest, exacerbated by breathing or coughing. X-ray chest radiography, pulmonary angiography, and lung nuclide scanning can confirm the diagnosis.

(2) Both chest pain of spontaneous pneumothorax and mediastinal emphysema occur suddenly. The former chest pain is located on the side of the chest, and the latter is located in the center of the chest. Both are accompanied by acute dyspnea. X-ray chest radiographs can confirm the diagnosis.

3. Bile colic

The disease usually develops suddenly, and the pain is intense and often fixed. It lasts for 2 to 4 hours, and then disappears on its own without any symptoms between episodes. It is usually the heaviest in the right upper abdomen, but it can also be located in the upper abdomen or anterior cardiac area. This discomfort usually radiates to the scapula, and can radiate to the back along the costal margin, and occasionally to the shoulder, indicating that the diaphragm is irritated. There is often nausea and vomiting, but the relationship between pain and meals is uncertain; the disease often has a history of indigestion, flatulence, and intolerance of fatty foods, but these symptoms are also common in the general population and not very specific. Ultrasound imaging is accurate for the diagnosis of gallstones, and can understand the size of the gallbladder, the thickness of the gallbladder wall, and whether there is bile duct dilatation. Oral cholecystography failed to show gallbladder filling, suggesting no function of the gallbladder.

4. Nerve, muscle and bone causes

(1) Cervical spinal radiculitis can manifest as permanent pain, sometimes leading to sensory disturbances. Pain may be related to neck movements, just like the painful episodes of bursitis caused by shoulder movements. Fingers are pressurized along the back, there are skin allergies, suspicious and thoracic spinal radiculitis. Sometimes, cervical rib compression of the arm and shoulder plexus can produce pain similar to angina pectoris. During physical examination, shoulder arthritis and / or calcification of shoulder ligament, cervical spondylosis, musculoskeletal disease resembling angina pectoris, bursitis under the acromion, and costal chondritis can also be found through activities.

(2) Thoracic rib syndrome is also called Tietze syndrome. The pain is limited to the swelling of the costal cartilage and costal sternal joints, and there is tenderness. The clinical manifestations of Tietze syndrome are uncommon, and rib chondritis causes tenderness (without swelling) at the junction of ribs and costal cartilage. During the examination, tenderness at the costal cartilage junction is a common clinical sign. Costal chondritis is usually treated with anti-doubt and anti-inflammatory drugs.

(3) Herpes zoster can cause chest pain in the early stage of rash, and in severe cases can even resemble myocardial infarction. The diagnosis of this disease can be made based on the persistence of pain, the limitation of the skin sensory nerve fiber distribution area, the extreme sensitivity of the skin to touch, and the appearance of specific herpes.

(4) Chest wall pain and tenderness of unknown cause Palpation and chest movements (such as bending down, swinging arms while walking, etc.) can cause chest pain. In contrast to angina pectoris, which can last for seconds or hours, nitroglycerin does not relieve it immediately. Generally no treatment is needed, and salicylate is occasionally needed.

5. Functional or mental chest pain

It is a manifestation of the anxiety state of neurological weakness. Pain can be located in the apex of the heart. It is a dull pain that lasts for several hours. It is often aggravated or transformed into a sharp stab-like pain under the breast within 1 to 2 seconds. It usually occurs during emotional tension and fatigue, and has little to do with exercise. Accompanied by tenderness in the precardiac area. Seizures may be accompanied by signs of palpitations, hyperventilation, numbness and tingling in the limbs, sighing, dizziness, dyspnea, general weakness and emotional instability or depression. Drugs other than analgesics do not provide relief, but can be reduced by various forms of intervention, such as rest, labor, tranquillizers, and placebo. In contrast to myocardial ischemic pain, functional pain is more likely to show different responses to different interventions. Because functional pain often occurs after hyperventilation, the latter can cause increased muscle tone and produce diffuse chest tightness. Some so-called functional chest pains may actually have a basis for organic disease. This is common in chest pain in patients with mitral valve prolapse. The nature of its chest pain varies widely from patient to patient, which can be similar to typical angina pectoris or chest pain of the aforementioned neurocirculation weakness.

6. Non-coronary atherosclerotic heart and vascular disease

(1) The onset of acute pericarditis is young and often has a history of viral upper respiratory infections. The onset of pain caused by its inflammation is sudden and sharper than angina pectoris. It is located to the left rather than the center of the chest, and often radiates to the neck. The pain is persistent and has nothing to do with fatigue. It can be aggravated by breathing, swallowing, and twisting the body. The pain is reduced when the patient sits and leans forward. Auscultation has pericardial friction. The diagnosis can be confirmed with the help of an electrocardiogram.

(2) Aortic disease . Sudden and severe pain suddenly occurs in patients with hypertension, and the possibility of dissection of the aorta is revealed when it is radiated to the back and waist. The continuous expansion of the thoracic aortic aneurysm can erode the spine and cause localized and severe. Drilling-like pain, especially at night; severe aortic stenosis due to insufficient coronary blood supply, angina may occur, systolic murmurs and echocardiograms in the aortic valve area can be identified.

(3) Severe right ventricular hypertension mitral stenosis, primary pulmonary hypertension and pulmonary heart disease can cause pain. This pain can also occur when the pulmonary arterial pressure is low, such as severe pulmonary stenosis with right ventricular hypertension.

x syndrome treatment

There is no special treatment for Syndrome X. Commonly used anti-angina drugs such as nitrates, calcium antagonists and beta-blockers can be used for the treatment of this disease, but the effect is not constant. Symptoms may be reduced or relieved in some patients, but may not be significant in others.

In addition, the use of alpha adrenergic blockers seems to be a reasonable treatment, but the results of small-scale trials are still inconsistent; the antidepressant imipramine can effectively reduce the frequency of chest pain by 50%, and hormone replacement in postmenopausal women Therapy can reduce the effects of normal coronary arteries on acetylcholine, increase coronary blood flow, and improve endothelial-dependent coronary dilation. One study has shown that this hormone can reduce the frequency of chest pain by 50%.

Therefore, first explain to the patient that the mid-term prognosis of the disease is quite good, remove their concerns, and then treat with long-acting nitrate. If the patient still has symptoms, calcium antagonists or beta blockers should be started, and imipramine can be used last. If symptoms persist after treatment with the above drugs, other causes of chest pain should be ruled out, especially abnormal esophageal movement.

x syndrome prognosis

The intermediate-term prognosis for X syndrome is very good. The long-term survival rate of patients with angina pectoris but normal CAG is very high, which is significantly higher than that of patients with coronary stenosis, and there is no difference with the survival rate of the normal age group. Despite this, long-term follow-up visits have often shown that left ventricular function remains normal, but many patients have chest pain and require medication.

x syndrome prevention

Because patients often have anxiety and fear of chest pain, patiently explaining the condition to the patient can help relieve symptoms. Moderate physical activity and physical exercise are also an effective treatment.