Role of Inflammation and Endothelial Dysfunction in the Pathogenesis of Cardiac Syndrome X

Abstract

Chest pain with normal coronary arteriograms represents a major diagnostic and therapeutic challenge to contemporary cardiology. Cardiac syndrome X (CSX), defined as typical angina-like chest pain, a positive response to exercise stress testing and normal coronary arteriograms, encompasses patients with a variety of pathogenic mechanisms. Cardiac ischemia has been documented in approximately 25% of CSX patients and is associated with endothelial dysfunction and microvascular vasodilator abnormalities. Increased endothelin-1, a powerful vasoconstrictor, has been suggested to play a pathogenic role. There is a high prevalence of postmenopausal women with CSX and thus estrogen deficiency has also been proposed to represent a possible pathogenic mechanism. Inflammatory mechanisms and endothelial dysfunction at the coronary microvascular level appear to be important in the pathogenesis of CSX. Treatment with agents that have protective effects on the vasculature and also anti-inflammatory properties, such as statins and angiotensin-converting enzyme inhibitors have been effective in improving both symptoms and electrocardiographic signs of myocardial ischemia in patients with CSX. This review discusses the roles for endothelial dysfunction and inflammation in the pathogenesis of CSX, as well as the potential therapeutic implications of these mechanisms.

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“…In many cases blood inflammatory markers like C-reactive protein are also elevated. A preponderance of those affected are post-menopausal women [133][134][135][136].…”

Efficacy of Chamomile-Lemon Balm Syrup in Patients With Conventional Drug-Resistant Cardiac Syndrome X: A Single-Arm Clinical Trial

“…The other mechanisms proposed for CSX include inflammation and oxidative stress. Inflammation has been involved in the pathogenesis of microvascular dysfunction in CSX (8). In evidence, a significantly higher level of C-reactive protein as an inflammatory marker had been found in the patients with CSX when compared with controls (9).…”

“…Disturbance of endotheliumdependent vasodilation due to decreased nitric oxidereleasing and increased microvascular constriction following cardiac autonomic imbalanced or coronary hyperreactivity to constrictor stimuli are commonly proposed mechanisms of microvascular dysfunction attributed to CSX. These mechanisms are related to the raised genesis of reactive oxygen species (3)(4)(5)(6)(7)(8). Anxiety and other psychological stresses can provoke chest pain in patients with CSX by altering the regulation of the cardiac autonomic system to sympathetic dominance.…”

Papel de la microcirculación coronaria en las enfermedades cardiacas

“…Serán necesarios consejos sobre el estilo de vida; tratamiento de los factores de riesgo cardiovascular (en particular el descenso importante de lípidos con estatinas), así como un abordaje multidisciplinar que incluya: intervención psicológica, entrenamiento físico y terapia farmacológica. La terapia farmacológica abarca an gésicos, antianginosos, betabloqueantes y calcioantagonis (en pacientes en los que se ha documentado isquemia) y ni tos (efectivos en el 50% de los pacientes) 11 . Otros fárma también parecen ser efectivos, pero la evidencia es aún esca nicorandil, alfabloqueantes, trimetazidina e inhibidores d ECA 10 .…”