Cardiac syndrome X  DRHC Dubai Cardiology Clinic

Cardiac syndrome X - Dubai Cardiology Clinic

It is called Microvascular angina also. Simple definition is a chest pain that looks like angina in middle aged woman (more in women than men) which lasts few minutes. It can occur at rest or during exercise relieved by sub lingual nitroglycerin in 50% of patients only.


  • Microvascular disease, which fail to dilate or constrict in response to various stressors such as exercise, the cold or emotional stress.
  • Enhanced pain perception.

Risk factors include:

  • Central abdominal obesity
  • Dyslipidemia
  • High blood pressure
  • Insulin resistance or glucose intolerance
  • Proinflammatory state
  • Genetic mutations
  • Lack of estrogen in woman
  • Family history of heart disease.


  • Chest pain (angina), but it last longer than traditional angina and no wall motion abnormality by echocardiogram.
  • Stress cardiac test usually abnormal with ST depression.
  • Myocardial perfusion imaging is abnormal in 30% of patient.
  • Coronary angiogram normal with non-significant lesions.
  • Rule out other causes of chest pain such as:
    • Prinz metal’s angina
    • Esophageal spasm.


Usually by exclusion which necessitate appropriate stress testing and coronary angiogram.


First of all, lifestyle modification such as diet with healthy food, and regular exercise 20 – 30 minutes a day or 150 minutes a week is needed. then the medications can be

  • Calcium blockers: amlodipine – diltiazem can be effective.
  • Betablocker: metoprolol, bisoprolol also work, but may make coronary spasm worse.
  • Ranolazine shown to improve myocardial ischemia and help to control chest pain.

Very important part of the treatment is regularly visiting the cardiologist and repeating the tests to make sure the condition was taken care of in full because there is some risk of heart attack and other cardiac events such as heart failure.

Dubai Cardiology Clinic - Treatment of various cardiovascular diseases such as HypertensionIschemic heart disease, Holter monitoring, Heart failure, Stress test, chest pain and echocardiography  are now available in DRHC.


Dr. M. Adib Nanaa

Specialist Cardiologist