Which are the causes of Cardiac syndrome X / Microvascular Angina?

Cardiac syndrome X, also known as microvascular angina, is a condition characterized by chest pain or angina-like symptoms in the absence of significant blockages in the major coronary arteries. It primarily affects women, especially those who are postmenopausal, but can also occur in men.

The exact causes of cardiac syndrome X are not fully understood, but several factors have been identified as potential contributors:

1. Microvascular dysfunction: The main underlying cause of cardiac syndrome X is believed to be dysfunction in the small blood vessels (microvasculature) that supply the heart. These vessels may not dilate properly in response to increased demand, leading to inadequate blood flow and oxygen supply to the heart muscle.



2. Endothelial dysfunction: The endothelium, which lines the blood vessels, plays a crucial role in regulating vascular tone and blood flow. Dysfunction of the endothelium, characterized by impaired production of nitric oxide and increased production of vasoconstrictor substances, can contribute to microvascular dysfunction and the development of cardiac syndrome X.



3. Coronary artery spasm: In some cases, coronary artery spasms or vasospasms may occur, causing temporary narrowing or constriction of the coronary arteries. These spasms can further reduce blood flow to the heart and trigger angina symptoms.



4. Metabolic factors: Certain metabolic abnormalities, such as insulin resistance and dyslipidemia (abnormal lipid levels), have been associated with an increased risk of developing cardiac syndrome X. These factors can contribute to endothelial dysfunction and impair the normal functioning of the microvasculature.



5. Psychological factors: Psychological stress, anxiety, and depression have been linked to the development and worsening of cardiac syndrome X. These factors can influence the perception of pain and may also contribute to endothelial dysfunction and microvascular abnormalities.

It is important to note that cardiac syndrome X is a diagnosis of exclusion, meaning that other potential causes of angina-like symptoms, such as significant coronary artery disease, must be ruled out before making the diagnosis. Diagnostic tests, including coronary angiography, may be performed to assess the coronary arteries and exclude other possible causes.

Treatment for cardiac syndrome X aims to relieve symptoms and improve quality of life. It typically involves a combination of medications to manage angina symptoms, such as nitroglycerin and calcium channel blockers, as well as lifestyle modifications, including regular exercise, stress reduction techniques, and a heart-healthy diet.

In conclusion, cardiac syndrome X or microvascular angina is a condition characterized by angina-like symptoms in the absence of significant coronary artery blockages. The causes of this condition are thought to involve microvascular dysfunction, endothelial dysfunction, coronary artery spasms, metabolic factors, and psychological factors. Further research is needed to fully understand the underlying mechanisms and develop targeted treatments for this condition.