Cardiac Syndrome X: Management Algorithms
The management of cardiac syndrome X (CSX) often represents a challenging task for the managing physician. The syndrome encompasses heterogeneous patient categories with different pathophysiological and etiological backgrounds. Each of these patient subgr
- PDF / 895,060 Bytes
- 13 Pages / 595.28 x 790.87 pts Page_size
- 59 Downloads / 192 Views
27
Gaetano Antonio Lanza and Juan Carlos Kaski
Abstract
The management of cardiac syndrome X (CSX) often represents a challenging task for the managing physician. The syndrome encompasses heterogeneous patient categories with different pathophysiological and etiological backgrounds. Each of these patient subgroups may require different therapeutic approaches, depending on the prevailing pathogenic mechanism. In addition, within groups, some patients but not others may respond favourably to different forms of treatment. Coronary microvascular dysfunction is one of the prevailing pathogenic mechanisms and can result in impaired coronary vasodilation, excessive coronary vasoconstriction or both. Identifying the prevailing pathogenic mechanisms should result in the implementation of effective treatment strategies. This chapter focuses on the practical management of patients with CSX. Keywords
Treatment • Management algorithms • Pharmacotherapy
Introduction The management of cardiac syndrome X (CSX) often represents a difficult task for the managing physician, as the syndrome encompasses heterogeneous patients with different pathophysiological and etiological backgrounds. Each of these patient subgroups may require different therapeutic approaches, depending on the prevailing pathogenic mechanism. In addition, within groups, some patients may respond poorly to various forms of medical therapy. G.A. Lanza, MD Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, L.go Vito 1, Roma 00168, Italy e-mail: [email protected] J.C. Kaski, MD, DM (Hons), DSc, FRCP, FESC, FACC, FAHA (*) Division of Clinical Sciences, Cardiovascular Sciences Research Centre, St George’s University of London, Cranmer Terrace, London SW17 0RE, UK e-mail: [email protected] J.C. Kaski et al. (eds.), Chest Pain with Normal Coronary Arteries, DOI 10.1007/978-1-4471-4838-8_27, © Springer-Verlag London 2013
Symptoms, including exertional angina and chest pain at rest, fatigue, dyspnoea, tiredness, etc., may be a reflection of different mechanisms operating in different patients. It is now apparent that most of the patients presenting with typical symptoms of angina pectoris despite normal coronary angiograms or non-obstructive coronary artery disease, have microvascular angina (MVA), i.e. angina caused by coronary microvascular dysfunction (CMVD) [1–3], and this entity is discussed in detail in other chapters of this book. In clinical practice, however, the diagnosis of MVA is often questioned or assumed on an “exclusion criterion” only, based on the absence of coronary artery stenosis. In several patients with chest pain and normal coronary arteries, however, symptoms may be non-cardiac in origin, such as gastro-oesophageal or musculo-skeletal chest wall disorders. In these latter cases, therapy directed to CMVD will most likely fail in preventing or controlling symptoms. Thus, documentation of the presence or absence of CMVD should be desirable to identify a suitable therapeutic strategy. Likewise, the identification of
Data Loading...
