Syndrome X

This label has been applied since 1981 to a group of patients (often middle-aged women) who have typical angina pectoris, positive exercise tests, no evidence of coronary spasm and angiographically normal coronary arteries. These patients probably represent a heterogeneous group and the cause of their angi na is unknown. Their angina may be ischemic and related to abnormal perfusion reserve due to inappropriate dilatation of small resistive vessels. Symptomatic benefit can usually be achieved from sublingual glyceryl trinitrate and from therapeutic trials of calcium antagonists and nitrovasodilators. Reassurance that the condition seems largely benign and carries no risk of acute infarction is obviously appropriate but symptoms can remain disturbing.