Report of a case with cardiac X syndrome diagnosed by echocardiography
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Keywords

coronary flow reserve
coronary microvascular disease
cardiac syndrome X
stress echocardiogram

How to Cite

KARAM, E., Khodeir, P., & Abou Nader , G. (2019). Report of a case with cardiac X syndrome diagnosed by echocardiography. Mediterranean Journal of Emergency Medicine, (27), 25-29. Retrieved from http://ojs.mjemonline.com/index.php/mjem/article/view/109

Abstract

Cardiac syndrome X is a term that describes the association of typical oppressive chest pain, ST segment depression during exercise, and normal coronaries on angiography. It’s attributed in most cases to change in coronary microvasculature.

As it is currently known that normal coronaries on angiography are required to diagnose cardiac syndrome X. In the following article, the first cardiac syndrome X to be diagnosed by stress echocardiogram is reported. A coronary angiography done few days later, confirmed the diagnosis.

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References

Alfonso CR, Vega Fleites LF, Valladares Carvajala FJ, Navarro Lópeza JJ, García Cuestaa DA. Report of a case with cardiac syndrome X or microvascular angina. CorSalud 2013; 5:207-21.

Schindler TH, Hornig B, Buser PT, Olschewski M, Magosaki N, Pfisterer M, et al. Prognostic value of abnormal vasoreactivity of epicardial coronary arteries to sympathetic stimulation in patients with normal coronary angiograms. Arterioscler Thromb Vasc Biol 2003; 23:495-501.

Hasdai D, Holmes DR Jr, Higano ST, Burnett JC Jr, Lerman A. Prevalence of coronary blood flow reserve abnormalities among patients with non obstructive coronary artery disease and chest pain. Mayo Clin Proc 1998; 73:1133-40.

Sara JD, Widmer RJ, Matsuzawa Y, Lennon RJ, Lerman LO, Lerman A. Prevalence of coronary microvascular dysfunction among patients with chest pain and non obstructive coronary artery disease. JACC Cardiovasc Interv 2015; 8:1445-53.

Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med 2010; 362:886-95.

Bugiardini R, Bairey Merz CN. Angina with “normal” coronary arteries: A changing philosophy. JAMA 2005; 293:477-84.

Kavanagh-Gray D. Syndrome X: case report. CMA 1977; 116:385-6.

Chen Ch, Wei J, AlBadri A, Zarrini P, Bairey Merz N. Coronary microvascular dysfunction – epidemiology, pathogenesis, prognosis, diagnosis, risk factors and therapy. Circ J 2017; 81:3-11.

Murthy VL, Naya M, Foster CR, Gaber M, Hainer J, Klein J, et al. Association between coronary vascular dysfunction and cardiac mortality in patients with and without diabetes mellitus. Circulation 2012; 126:1858-68.

Löffler AI, Bourque JM. Coronary microvascular dysfunction, microvascular angina, and management. Curr Cardiol Rep 2016; 18:1.

Dimitrow PP. Transthoracic doppler echocardiography: Noninvasive diagnostic window for coronary flow reserve assessment. Cardiovasc Ultrasound 2003; 1:4.

Cullen JH, Horsfield MA, Reek CR, Cherryman GR, Barnett DB, Samani NJ. A myocardial perfusion reserve index in humans using first-pass contrast- enhanced magnetic resonance imaging. J Am Coll Cardiol 1999; 33:1386-94.

Panting JR, Gatehouse PD, Yang GZ, Grothues F, Firmin DN, Collins P, et al. Abnormal subendocardial perfusion in cardiac syndrome X detected by cardiovascular magnetic resonance imaging. N Engl J Med 2002; 346:1948-53.

Prior JO, Allenbach G, Valenta I, Kosinski M, Burger C, Verdun FR, et al. Quantification of myocardial blood flow with 82Rb positron emission tomography: Clinical validation with 150-water. Eur J Nucl Med Mol Imaging 2012; 39:1037-47.

Marroquin OC, Holubkov R, Edmundowicz D, Rickens C, Pohost G, Buchthal S, et al. Heterogeneity of microvascular dysfunction in women with chest pain not attributable to coronary artery disease: Implications for clinical practice. Am Heart J 2003; 145:628-35.

Lerman A, Zeiher AM. Endothelial function: Cardiac events. Circulation 2005; 111:363-8.

Pellikka PA, Nagueh SF, Elhendy AA, Kuehl CA, Sawada SG. American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr. 2007; 20:1021-41.

Qamruddin S. False-Positive Stress Echocardiograms: A Continuing Challenge. Ochsner J 2016; 16:277-9.

Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 2005; 352:539-48.

Parodi G, Del Pace S, Carrabba N, Salvadori C, Memisha G, Simonetti I, et al. Incidence, clinical findings, and outcome of women with left ventricular apical ballooning syndrome. Am J Cardiol 2007; 99:182-5.

Mejía-Rentería HD, Iván J Núñez-Gil IJ. Takotsubo syndrome: Advances in the understanding and management of an enigmatic stress cardiomyopathy. World J Cardiol 2016; 8:413-24.

Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, et al. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med 2015; 373:929-38.