Cardiac syndrome X: Current concepts

Cardiac syndrome X is a heterogeneous entity, both clinically and pathophysiologically, encompassing a variety of pathogenic mechanisms. Management of this syndrome represents a major challenge to the treating physician. They often seek medical care because of recurring and disabling chest pain, which may imply repetitive and costly invasive and non-invasive investigations. A careful patient evaluation for underlying pathophysiologic mechanism and exclusion of other causes of chest pain along with attention to various psychological aspects is helpful in reducing the stress and suffering of these patients. This article reviews the available literature on the pathophysiology and current controversies surrounding the management of this difficult to treat condition. (C) 2009 Published by Elsevier Ireland Ltd.