Causes of Chest Pain

Cardiac Syndrome X

Cause of pain:

Angina is caused by ischemia (oxygen starvation) of the cardiac muscle. In Syndrome X, there are signs of ischemia on stress testing, but the coronary arteries are normal on cardiac catheterization. The cause of Syndrome X is unclear, but most authorities believe that patients with this syndrome have some sort of vascular abnormality involving the small branches of the coronary arteries - branches that are not visualized on cardiac catheterization. Fortunately, the prognosis of patients with Syndrome X appears to be quite good.

Characteristics of pain:

Angina can be quite variable, but classically is described as a pressure-like, squeezing, crushing, or tight pain. Some patients with angina deny pain at all, but agree when the term "discomfort" is described to them. The discomfort often radiates to the jaw, shoulders or arms. It can be accompanied by nausea, sweating, shortness of breath, dizziness, weakness, or fatigue.

Evaluation:

The evaluation of angina includes a careful medical history and physical examination, which often point to the diagnosis. Testing always includes an ECG, and often a stress test or a cardiac catheterization. In Syndrome X, the characteristics of the pain and the ECG are strongly suggestive of angina, but the coronary arteries are normal on catheterization. Further, classic coronary artery spasm cannot be provoked.

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