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Angina with clear arteries- cardiac syndrome X. My 55 year old friend has been diagnosed with this and she suffers angina daily on exertion.

She also has episodes of racing palpitations and tiredness. She was given calcium channel blockers, aspirin, statins, PPI's and nitrate spray but refuses to take any of these due to side effects. She is normal weight, has normal BP and cholesterol under 5, but her mother had a heart attack followed with bypass when she was 60 years old. She had a CT angiogram but cardiologist lost interest when coronary arteries appeared normal.The diagnosis was cardiac syndrome X or microvascular angina. Her angina is worsening and I feel she is in denial. Should she be taking medication and should she be concerned?

8 Replies

Hi Dandelion,

Please accept that this answer is not from a practising health professional! I am only a fellow blogger who tries to be informed, although, because of my background I understand medical terminology. All I've done is look up a couple of websites, one aimed at patients and one aimed at health professionals.

Your friend might find the following helpful


The good news seems to be that your friend doesn't seem to be at increased risk and the aim of management is to improve the symptoms. One third of people get better by themselves. It seems to be one of those vague syndromes that there isn't much evidence about treatment. The nitrate spray would relieve the pain when she gets it. The syndrome was only named in 1967...try different websites, there is a lot of information and it doesn't seem to be a life threatening condition.



Would it be possible for you to explain this:cardiac syndrome X, it this to do with cholesterol or other form of blood issues?



Hello Bala,

No it doesn't seem to be cholesterol related.

The problem is in the lining and muscles of the very tiny arteries supplying the heart, not the major ones which block in a heart attack (this is probably why the cardiologist lost interest in the question above!).

The fact that 70% of sufferers are post menopausal women suggests a hormonal influence maybe related to earlier pregnancy problems such as high blood pressure.

Remember, I have only got this information from (reliable) web sites and I had never heard of this condition until Dandelion asked.



Thanks for yuor explanation.


I've had a similar diagnosis. I too did not want to take drugs, but I do carry a nitro spray with me. I was diagnosed a year ago and my symptoms have improved with an exercise routine that has steadily improved my fitness to the point where I only get symptoms walking up steep hills and then not all the time. I also take various supplements including coQ10, magnesium, carnitine, folic acid and krill oil. I've also learned to meditate to keep my stress levels low. I think all of this has helped me and I don't feel frightened any more. I don't know if any of this would help you, but there is plenty of information out there about supporting heart conditions with other methods other than drugs and I think this syndrome might be one which could. I really wish you well. But also if your symptoms are getting worse, please go and see another consultant and get a second opinion. Keep us posted.


dandelion, I hope this meets with your approval


Angina pectoris (chest pain) is a phrase which comes from Latin and translates as

"tight chest". People with Angina experience pain in the centre of the chest. The chest can

feel constricted and tight, but the pain can also be oppressive, as if something is crushing your chest.

Pain starts in the centre of the chest behind the 'breast bone' "sternum" or the left side of the front of the chest. It can spread out to other parts of your body like your arms and stomach.

Angina is brought on by:

* physical exercise, especially if the exercise occurs after a heavy meal, or in the extreme cold.

* emotional stress, though usually only when the underlying problem is severe.

Once exercise ceases, the pain fades away very quickly, usually within one or two minutes.

The relationship between exercise and bringing on symptoms and rest relieving them is the single most important factor your doctor can use in making the diagnose.

While it certainly is possible Angina occurs at rest, this is relatively rare, and usually only in the first month or two after symptoms start.

Almost all long-standing symptoms that are due to Angina will be brought on by exercise and relieved by rest.


In most cases, the cause of Angina is coronary (atherosclerosis) the thickening of arteries that supply blood, oxygen and nutrients to the heart.is happens when fatty deposits, called plaque or atheroma, narrow the arteries over time and reduce blood flow to the heart.

Symptoms may only appear at times when your heart needs more blood supply such as when you are emotionally stressed, exercising such as climbing stairs.

As your heart tries to pump faster to meet your body's increased demands, the narrowed arteries struggle to keep up. The heart then receives too little oxygen which causes pain in the heart that is felt as chest pain. In severe cases this can also happen when the heart is at rest.

What can be done to prevent Angina?

* Many of the risk factors can be tackled by lifestyle changes.

* Eat a varied and healthy diet with plenty of leafy vegetables. Avoid sugary foods and saturated fat found in meat and full-fat dairy products.

* Stop smoking. Your doctor or pharmacist will be able to provide advice about stop-smoking

programmes and medicines that can help you quit.

* Lose weight if you are over weight

* Exercise more: aim for a half-hour walk each day.


Is that syndrome-x related to insulin resistance, elevated triglycerides, high blood pressure, elevated blood glucose, and low HDL? This can be improved by controlling carbohydrate intake to between 10 and 14,10g portions per day (ideally = 3 meals x 40g carbohydrate). Favour low GI carbohydrates; natural foods as opposed to refined.


No, cardiac syndrome X is different from metabolic syndrome X. The websites I looked at say a better name is microvascular angina to avoid this confusion.


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