title: Women, cardiac syndrome X, and microvascular heart disease.
abstract: New data suggest that persistent chest pain, despite normal coronary angiography, is less benign than previously thought. It has long been recognized that cardiac syndrome X (CSX) is associated with significant suffering, disability, and health care costs, but the biggest shift in thinking comes in terms of long-term risk. It is now recognized that the prognosis is not benign and that a significant proportion of patients are at increased cardiovascular disease risk. Of major debate is the question of whether the mechanisms that explain this chest pain are cardiac vs noncardiac. The most current definition of CSX is the triad of angina, ischemia, and normal coronary arteries, which is associated with an increased cardiovascular risk. This paper provides a review of CSX, epidemiology of the problem, proposed explanatory mechanisms, and important next steps in research. Central to this review is the proposition that new insights into CSX will be fostered by both clinical and scientific collaboration between cardiovascular and pain scientists.
authors.affiliation: Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. arthurh@mcmaster.ca
authors.forename: Heather M
authors.initials: HM
authors.lastname: Arthur
authors.forename: Pat
authors.initials: P
authors.lastname: Campbell
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Harvey
authors.forename: Michael
authors.initials: M
authors.lastname: McGillion
authors.forename: Paul
authors.initials: P
authors.lastname: Oh
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Woodburn
authors.forename: Corinne
authors.initials: C
authors.lastname: Hodgson
mesh_terms: D002170:Canada / Q000453:epidemiology; D002637:Chest Pain / Q000378:metabolism / Q000503:physiopathology; D017023:Coronary Angiography / Q000379:methods; D003331:Coronary Vessels / Q000378:metabolism / Q000503:physiopathology; D017281:Cost of Illness; D019468:Disease Management; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D017566:Microvascular Angina / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D055806:Microvessels / Q000378:metabolism / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D017698:Postmenopause / Q000378:metabolism*; D011379:Prognosis; D012106:Research; D012307:Risk Factors; D013315:Stress, Psychological / Q000209:etiology; D013995:Time