Cardiac X syndrome: the overview of the literature and the local experience in Southern Switzerland.

Abstract

Summary In recent years, a particular emphasis from the European authorities was put on women’s health. Different publications emerged in international journals dedicated to this topic. Several studies described the difficulties and the differences in diagnosis and treatment of heart diseases in women emphasising how even common cardiac conditions are often undertreated and misdiagnosed. The Swiss Society of Cardiology annual congress this year was also dedicated to the topic “Women and the Heart”, underlying the nationwide relevance of the problem. These data demonstrate the need for more specific attention and research on female aspects of cardiovascular care. Besides the typical manifestations of heart disease, such as acute coronary syndromes, angina or hypertension which have a similar prevalence in both genders, there is a syndrome mostly affecting perimenopausal women. It is defined as Cardiac syndrome X (CSX), and is a clinical condition usually characterised by anginal pain, positive exercise stress testing and negative coronary angiography. Although the prognosis according to previous studies was thought to be good, it is now appreciated that these women face significantly greater morbidity than once believed, with an uncertain treatment course and a substantial cost burden to the health care system. Thus, this particular syndrome deserves special attention from health care professionals. Different pathophysiological mechanisms have been proposed to explain the nature of this syndrome. In this article we will review the literature data on CSX with a special focus on symptoms, pathophysiologic mechanisms, difficulties in management and prognosis in this particular group of patients, sharing the authors’ experience in this field as well.