Recent studies have supported the notion that women with Cardiac Syndrome X(angina and "normal" coronary arteries) actually do have coronary artery pathology involving "microvessels" - the small branches of the coronary arteries that are not visualized by cardiac catheterization.
Most angina (chest discomfort due to insufficient blood flow to the heart muscle) is associated with partial blockages in the large coronary arteries. Patients with angina often have heart catheterizations, in which dye is injected into the coronary arteries so that the blockages can be visualized. Once the blockages are located, they are often treated by angioplasty, stenting, or bypass surgery.
In women with Cardiac Syndrome X, despite the fact that they describe symptoms typical of angina and often have ECG changes suggesting coronary artery blockages, are found to have "normal" appearing coronary arteries on catheterization. These women are often told they are normal, and that their symptoms are due to anxiety, so go away and leave the cardiologist alone.
However, evidence has recently accumulated suggesting that many of these women have pathology in the small coronary arteries. Now evidence has been presented from the Women's Ischemia Syndrome
Evaluation study showing that many women with Cardiac Syndrome X have objective findings on a test called magnetic resonance spectroscopy (MRS,) that demonstrate that they have true ischemia - oxygen starvation in the cardiac muscle - despite having "normal" large coronary arteries. Further, women who have abnormal MRS scans had a 50 - 60% probability of having to be admitted to the hospital for unstable angina over the next few years. This is the same risk as for women who had classic, large vessel coronary artery disease. Despite the high risk of hospitalization for true angina, however, women with positive MRS scans had a favorable overall prognosis.
What this means
This study gives powerful corroborative evidence that women with Cardiac Syndrome X are not merely anxious, flighty, or hypochondriacs. They appear to have true (though poorly characterized) small vessel coronary artery disease that produces true cardiac ischemia and real angina. The bad news is that we still don't know the nature of this small vessel disease, or how to treat it. The good news is that - really for the first time - serious research is finally taking place to identify the nature of the problem and to devise effective treatments for it. And furthermore, these women no longer have to tolerate the notion that they are nuts. Indeed, encountering the attitude that they are nuts can now be used as a valuable indication that their doctors are inadequate, and that it's time to go elsewhere for their medical care.
The MRS test, by the way, is still experimental, and is available in only a few research centers.
