Brief introduction of syndrome x

Directory 1 Pinyin 2 English Reference 3 Overview 4 Disease Name 5 English Name 6 X Syndrome Alias 7 Classification 8 ICD No.9 Epidemiology 10 Etiology1Pathogenesis 6543 Clinical Manifestation 8+02 X Syndrome 13 Laboratory Examination13./ Kloc-0/3.2 blood sugar 14 auxiliary examination 143 exercise radionuclide myocardial perfusion scan 14.4 coronary angiography (CAG) 15 diagnosis 16 differential diagnosis 1 6./Kloc-0. 6.3 biliary colic 16.4 neurological, muscular and skeletal causes 16.5 functional or mental chest pain 16 19 X syndrome prevention 20 related drugs 2 1 related examination accessories: 1 acupoints for treating x syndrome/kloc.

2 English reference X syndrome

3 Summary X syndrome refers to the symptoms of angina pectoris or angina pectoris-like discomfort. Exercise treadmill ECG exercise test has evidence of myocardial ischemia such as st segment depression, while CAG shows a group of clinical syndromes with normal coronary artery or without obstructive lesions. Likoff was first reported in 1967, and Kenpl called it syndrome X in 1973. Recently, Cannon et al. proposed microvascular angina pectoris. It should be noted that this disease should be distinguished from metabolic X syndrome, which includes insulin resistance, compensatory hyperinsulinemia, impaired glucose tolerance, dyslipidemia, hypertension and centripetal obesity, but these syndromes can cause cardiac X syndrome because they will damage vascular endothelial function and promote the progress of atherosclerosis. The disease accounts for about 15% of the registered cases of CASS, and it is more common in women, especially menopausal women. The mid-term prognosis of syndrome X is good and can be treated with drugs.

4 disease name X syndrome

5 English name X syndrome

Microvascular angina pectoris, another name for 6 X syndrome

7 Classification Cardiovascular Medicine > Coronary Atherosclerotic Heart Disease >: Angina Pectoris and Coronary Heart Disease

8 ICD number I20.8

9 Epidemiology In recent years, with the popularization of CAG technology, it is not uncommon to find syndrome X. It is reported that the disease accounts for about 15% of the registered cases of CASS, and it is more common in women, especially menopausal women.

10 Etiology The cause of X syndrome is not completely clear, and the following three hypotheses are most commonly put forward: the decrease of NO production leads to the impairment of endothelium-dependent coronary artery dilatation, the increase of sympathetic nerve sensitivity and exercise-mediated coronary artery contraction. However, there is increasing evidence that these patients have increased pain sensitivity and abnormal pain.

Pathogenesis 1 1 Possible pathogenesis:

1. Coronary microcirculation dysfunction or insufficient vasodilation reserve function? Many factors, such as old age, hypertension, diabetes, dyslipidemia and so on, cause pathological changes such as intimal hyperplasia and endothelial cell degeneration of coronary arterioles, and cause dysfunction of microvascular endothelial cells, thus reducing the production of endothelial NO, blood flow-mediated microvascular dilation and its relaxation reserve, thus causing myocardial ischemia. The evidence is as follows: ① When chest pain is induced by exercise or pacing, myocardial lactic acid is increased, and ECG has ischemic changes. UCG shows segmental wall motion and abnormal myocardial perfusion, LVEF is decreased, left ventricular end diastolic pressure is increased, coronary artery resistance is decreased, and the ability to increase blood flow is decreased; ② The contraction response of small coronary artery in patients was enhanced, but the vasodilation effect of papaverine injected into coronary artery was weakened.

2. Increased sensitivity to sympathetic nerves? Sympathetic fans whose sympathetic nerves are dominant are out of balance, which can cause syndrome X. For example, when doing cardiac catheterization, some patients with syndrome X are usually very sensitive to the operation of intracardiac instruments, and injecting normal saline directly into the left atrium will cause typical chest pain.

3.hyperalgesia? Some patients with syndrome X have no evidence of myocardial ischemia, and their discomfort may be hyperalgesia. The feeling of chest pain is caused by changes in arterial stretch, heart rate, heart rhythm or cardiac contractility. When the pain threshold is lowered, it can cause so-called allergic heart symptoms.

Clinical manifestations of 12 X syndrome 1 What are the main symptoms? The main clinical manifestation of syndrome X is paroxysmal chest pain, which can be characterized by typical fatigue angina, atypical chest pain, stable angina, unstable angina and persistent resting chest pain. Taking nitroglycerin is ineffective, and the duration of chest pain can be as long as 1 ~ 2 hours. A considerable number of patients have unstable thresholds for inducing physical activity, and they can wake up in the early morning, and some patients show persistent dull pain.

2. Other symptoms? Some patients with mild or no coronary artery disease are too concerned about personal health because of chest pain, and may have mental symptoms such as panic, anxiety and depression, accounting for 2/3 of patients with syndrome X.

13 laboratory examination any laboratory examination results have little diagnostic value for the diagnosis of syndrome x, but you can find the risk factors of coronary heart disease and the secondary factors that cause angina pectoris.

13. 1 blood lipids There is sufficient evidence to prove that dyslipidemia is closely related to the onset of coronary heart disease, so all patients suspected of coronary heart disease should be tested for blood lipids. The typical blood lipid characteristics of arteriosclerosis are: total cholesterol, low density lipoprotein and triacylglycerol increase, while high density lipoprotein decreases.

13.2 impaired glucose tolerance and diabetes are risk factors for coronary heart disease, so patients suspected of coronary heart disease should check their fasting blood sugar to find out whether hyperinsulinemia exists.

14 auxiliary examination of objective evidence of myocardial ischemia;

14. 1 ECG is mostly in the normal range when there is no chest pain attack: a few patients may have mild STT changes. Ischemic STT changes can appear in ECG during chest pain attack, and the treadmill exercise test is positive, and sometimes Hoher monitoring can also find myocardial ischemic STT changes. However, some patients failed to find ischemic changes in ECG during typical chest pain attacks.

14.2 UCG examination is generally normal at rest, and left ventricular segmental motor dysfunction can be seen when angina pectoris is induced by pressure. However, the pressure UCG of dipyridamole can not find the signs of global or segmental left ventricular dysfunction, but it can induce segmental wall motion abnormality when epicardial coronary artery disease occurs, which can be used as one of the differential clues of syndrome X.

14.3 exercise radionuclide myocardial perfusion scan when exercise-induced angina pectoris, this examination can find signs of segmental myocardial perfusion reduction or defect and redistribution. Radionuclide ventriculography can show the abnormal motion function of left ventricular segment during exercise, and EF does not increase or decrease.

14.4 patients with coronary angiography (CAG) X syndrome had normal CAG or no obvious stenosis, and ergonovine provocation test was negative. There is no abnormality in left ventricular angiography, no signs of cardiac enlargement or myocardial hypertrophy, and the left ventricular end diastolic pressure is generally normal.

15 diagnostic criteria: typical angina pectoris, myocardial ischemia or atypical chest pain in ECG at the time of attack, positive exercise test, normal coronary artery function and CAG in ventricle, and negative ergonovine provocation test. When there are the above items, it can be clinically confirmed as syndrome X.

The differential diagnosis of 16 X syndrome should be differentiated from other diseases that cause chest discomfort.

16. 1 Esophageal diseases (1) Reflux esophagitis: due to the relaxation of the lower esophageal sphincter and the reflux of acidic gastric juice, esophageal inflammation and spasm are caused, which is manifested as burning pain behind the sternum or in the upper middle abdomen, and sometimes radiated to the back, which is suspected of angina pectoris. However, this disease often occurs when lying flat after meals, and taking antacids can alleviate it.

(2) Esophageal hiatal hernia: It is often accompanied by gastric acid reflux, and its symptoms are similar to esophagitis, which mostly occurs when bending or lying down after a full meal. Gastroenterography can make a definite diagnosis.

(3) Diffuse esophageal spasm: Reflux esophagitis may also be accompanied, and chest pain caused by it has various manifestations. Taking nitroglycerin is effective, ergonovine can induce it, so it is easy to be suspected as angina pectoris, which is a common cause of atypical angina pectoris and chest pain. According to the patient's history of gastric acid reflux and anorexia, symptoms often occur when eating cold drinks or after meals, which has nothing to do with fatigue. Dysphagia during the attack can be distinguished from angina pectoris. Esophagoscopy and esophageal manometry can make a definite diagnosis.

Clinically, angina pectoris and esophageal diseases often coexist. Esophageal reflux can lower the threshold of angina pectoris, and esophageal spasm can be induced by ergonovine and relieved by nitroglycerin, so it is often difficult to distinguish the two. Chest pain is characterized by heartburn, which is related to changes in food intake and dysphagia. Esophageal pain radiates to the back more often than angina pectoris. Accurate diagnosis requires not only careful medical history and physical examination, but also laboratory examination.

16.2 Pulmonary embolism caused by lung and mediastinal diseases (1): The pain occurs suddenly, which occurs at rest and is seen in patients with high risk factors of this disease (such as heart failure, venous diseases, postoperative, etc.). ), often accompanied by hemoptysis and shortness of breath The nature of its pain is usually described as chest tightness accompanied by or followed by pleurisy chest pain, that is, severe pain on this side of the chest, which is aggravated by breathing or coughing. X-ray chest film, pulmonary angiography and lung radionuclide scanning can make a definite diagnosis.

(2) Spontaneous pneumothorax and mediastinal emphysema: Both of them have sudden chest pain. The former is located on the side of the chest and the latter is located in the center of the chest, both of which are accompanied by acute dyspnea. X-ray chest film can make a definite diagnosis.

16.3 Gallbladder colic often occurs suddenly, the pain is severe and often fixed, lasting for 2 ~ 4 hours, and then it can disappear by itself without any symptoms between attacks. Generally, the right upper abdomen is the heaviest, but it can also be located in the upper abdomen or precordial area. This discomfort often radiates to the scapula, along the costal margin to the back and occasionally to the shoulder, suggesting that the diaphragm is affected by * * *. Nausea and vomiting are common, but the relationship between pain and eating is uncertain. The disease often has a history of indigestion, flatulence and intolerance to greasy food. But these symptoms are also common in the general population, and their specificity is not strong. Ultrasonic imaging can accurately diagnose gallstones, and can know the size of gallbladder, the thickness of gallbladder wall and whether there is bile duct dilatation. Oral cholecystography failed to show gallbladder filling, suggesting that gallbladder has no function.

16.4 causes of nerves, muscles and bones (1) cervical radiculitis: it can manifest as permanent pain and sometimes lead to sensory disturbance. Pain may be related to neck activity, just like bursitis caused by shoulder joint activity. Finger pressing along back, skin allergic area, suspicious, thoracic radiculitis. Sometimes the compression of brachial plexus by cervical rib can produce pain similar to angina pectoris. Physical examination can also find shoulder inflammation and/or shoulder ligament calcification, cervical spondylosis, musculoskeletal diseases like angina pectoris, subacromial bursitis and costal chondritis.

(2) Thoracorib syndrome: also known as Tietze syndrome. The pain is limited to swelling and tenderness of costal cartilage and costal sternal joint. Tietze syndrome with typical clinical manifestations is not common, but tenderness (no swelling) at the junction of ribs and costal cartilage caused by costal chondritis is more common. Tenderness at the costal cartilage junction is a common clinical sign during examination. The treatment of costal chondritis usually uses anti-inflammatory drugs to solve doubts.

(3) Herpes zoster: chest pain may appear at the initial stage of its eruption, even similar to myocardial infarction in severe cases. The diagnosis of this disease can be made according to the persistence of pain, the distribution of sensory nerve fibers in the skin, the extreme sensitivity of the skin to touch and the appearance of specific herpes.

(4) Unexplained chest wall pain and tenderness: Palpation and chest activities (such as bending over, turning around or swinging your arms while walking) can cause chest pain. Contrary to angina pectoris, the pain can last for seconds or hours, and nitroglycerin can't relieve it immediately. Generally, no treatment is needed, and salicylate is used occasionally.

16.5 functional or mental chest pain, which is a manifestation of neurasthenia and anxiety. Pain can be located at the apex of the heart, and it is a dull pain that lasts for several hours. It often aggravates or turns into a sharp stabbing pain under the chest, and the time limit is 1 ~ 2s, which mostly occurs in emotional tension and fatigue, and has little to do with exercise, and may be accompanied by tenderness in the precordial area. The attack may be accompanied by palpitation, hyperventilation, numbness and tingling in limbs, sighing, dizziness, dyspnea, general weakness and emotional instability or depression. Drugs other than analgesics cannot be relieved, but they can be relieved through various forms of intervention, such as rest, childbirth, antipsychotics, placebos, etc. Contrary to myocardial ischemic pain, functional pain is more likely to show different responses to different intervention methods. Because functional pain often occurs after hyperventilation, which can cause increased muscle tension and diffuse chest tightness. Some so-called functional chest pain may actually have the basis of organic diseases. This is common in chest pain in patients with mitral valve prolapse. The nature of chest pain varies greatly among patients, which can be similar to typical angina pectoris or the aforementioned neurasthenia chest pain.

16.6 non-coronary atherosclerotic heart and vascular diseases (1) acute pericarditis: young onset, often preceded by a history of viral upper respiratory tract infection. The pain caused by inflammation is sudden and more severe than angina pectoris. It is located on the left side of the chest rather than in the middle, and often radiates to the neck. Pain is persistent and has nothing to do with fatigue. Breathing, swallowing and twisting can aggravate it, and the pain will be relieved when the patient sits up and leans forward. There is pericardial fricative sound in auscultation. With the help of ECG, the diagnosis can be made.

(2) Aortic disease: When patients with hypertension suddenly have persistent severe pain and radiate to the back and waist, it suggests the possibility of aortic dissection separation; The continuous expansion of thoracic aortic aneurysm can erode the vertebral body and cause localized and severe drilling pain, especially at night. Severe aortic stenosis can be distinguished by echocardiography of angina pectoris, systolic murmur in aortic valve area and coronary insufficiency.

(3) Severe right ventricular hypertension: Mitral stenosis, primary pulmonary hypertension and cor pulmonale can all cause pain. This kind of pain may also occur when the pulmonary artery is compressed, such as severe pulmonary valve stenosis with right ventricular hypertension. At present, it is believed that this kind of pain is caused by limited cardiac output, decreased coronary blood flow in systolic period and increased oxygen consumption in right ventricle, which leads to poor myocardial perfusion. Therefore, chest discomfort can be caused by cardiac ischemia. Because this kind of pain can relieve itself for several minutes, the reaction to nitroglycerin is difficult to evaluate. If the pain is caused by exercise, nitroglycerin can be used to prevent it, which is probably caused by coronary heart disease. Many patients with pulmonary hypertension have ST segment deviation in ECG during or after exercise.

(4) Chest pain with normal coronary angiography: Angina pectoris with normal coronary angiography or chest pain similar to angina pectoris is often called syndrome X, which should be distinguished from typical ischemic heart disease caused by coronary heart disease. The cause is not clear, and some patients do have myocardial ischemia, which is characterized by increased lactic acid production during exercise or rapid pacing.

Studies have proved that many patients with syndrome X have microvascular and/or endothelial dysfunction, and their chest pain can coexist with myocardial ischemia in clinic. But some patients can't find any evidence of myocardial ischemia in clinic. These patients often have behavioral, mental or esophageal dysfunction (such as pain recurrence caused by injecting hydrochloric acid into their esophagus), which indicates that chest pain symptoms can be completely non-cardiogenic. At present, it is considered that chest pain in patients with normal coronary angiography can be caused by many abnormal conditions: ischemic chest pain caused by microvascular dysfunction is called microvascular angina pectoris; Chest discomfort without ischemia is hyperalgesia; The feeling of chest pain is caused by arterial stretching, changes in heart rate and rhythm or changes in cardiac contractility. Sympathetic fans with dominant sympathetic nerves are out of balance, which can cause syndrome X. During cardiac catheterization, some patients with syndrome X are usually very sensitive to the operation of intracardiac instruments, and direct injection of normal saline into the right atrium can cause typical chest pain. Some patients may have microvascular dysfunction and hyperalgesia simultaneously. The pathological changes of coronary vessels in patients with syndrome X are inconsistent: some patients have thickened intima of coronary arterioles or atherosclerotic plaques, while others have completely normal coronary arteries.

Patients with chest pain and normal coronary angiography are more common in premenopausal women. The symptoms of chest pain are mostly atypical. Fatigue can induce chest pain, but the pain threshold changes greatly, and sometimes the pain is very severe. This disease will affect the quality of work and life of patients. Some patients may have clinical manifestations such as panic, anxiety or mental abnormality. Some patients have insulin resistance and hyperinsulinemia. No abnormalities were found in clinical physical examination. Some patients with chest pain may have abnormal non-specific STT waves on ECG. Nearly 20% of patients are positive in exercise test. Exercise radionuclide myocardial imaging can find that some patients have abnormal myocardial perfusion, but it has no consistent correlation with defect range, positive degree of exercise test and exercise tolerance.

Compared with patients with angina pectoris caused by coronary atherosclerosis, the prognosis of syndrome X is usually very good, and there is no significant difference from the normal population.

Patients with clinical evidence of ischemia can be treated with nitrates and beta blockers, but the actual treatment effect is often not ideal. Nitrate can not improve the exercise tolerance of patients with syndrome X, and even reduce the exercise tolerance of some patients. Calcium antagonists can reduce the frequency and severity of chest pain attacks in some patients and improve their exercise tolerance. Try to find the non-cardiac causes of chest pain during the treatment. For patients with gastroesophageal reflux and esophageal dysfunction, treating these diseases can effectively relieve symptoms. For patients who have no evidence of ischemia and/or have no response to anti-ischemic therapy, besides providing general support treatment, it is also an important part of treatment to patiently explain the good prognosis of the disease and reassure the patients.

/treatment of kloc-0/7 x syndrome 17. 1 the purpose of treatment is to dispel patients' doubts first, and then to relieve symptoms quickly. It is common for symptoms to persist, so many patients can't return to work, and CAG can reassure patients by itself. In one study, patients learned that the coronary artery was normal, which not only reduced the number of hospitalizations, but also shortened the days of hospitalization for heart reasons.

17.2 there is no special treatment for syndrome x. Commonly used anti-angina drugs such as nitrates, calcium antagonists, beta blockers, etc. can be used to treat this disease, but the curative effect is not constant. For some patients, symptoms can be alleviated or alleviated, but for others, the curative effect may not be significant. Both beta blockers and calcium antagonists can effectively reduce the number of chest discomfort, while the beneficial effect of nitrate is only found in half of patients. The sublingual administration of nitrate drugs in patients with syndrome X can not improve the exercise tolerance, and some patients may reduce the exercise tolerance. Calcium antagonists can reduce the frequency and severity of angina pectoris in some patients and improve exercise tolerance. The effect of β -blockers is not as significant as angina pectoris caused by coronary heart disease, suggesting that reducing myocardial oxygen demand is not an effective measure to prevent or compensate abnormal vascular movement.

In addition, the use of α -adrenergic receptor blockers seems to be a reasonable treatment, but the results of small-scale trials are still inconsistent; The antidepressant imipramine (50mg/d) can effectively reduce the frequency of chest pain by 50%. Hormone replacement therapy in postmenopausal women can weaken the effect of normal coronary artery on acetylcholine, increase coronary blood flow and improve endothelium-dependent coronary artery dilatation. A study has proved that this hormone can reduce the frequency of chest pain by 50%.

Therefore, first of all, it is necessary to explain to patients that the mid-term prognosis of this disease is quite good, eliminate their concerns, and then treat them with long-acting nitrate. If the patient still has symptoms, calcium antagonists or beta blockers should be started, and imipramine 50mg/d can be used finally. If the symptoms persist after the above drug treatment, other causes of chest pain, especially abnormal esophageal movement, should be ruled out.

18 Prognosis The mid-term prognosis of syndrome X is very good. CASS registration showed that the 7-year survival rate of patients with angina pectoris, normal coronary angiography and LVEF>0.50 was 96%, while the 7-year survival rate of patients with mild abnormal lumen stenosis < 50% was 92%. Even if these patients have a history of smoking or hypertension, myocardial ischemia caused by exercise will not increase the mortality rate, so the prognosis is good.

The long-term survival rate of patients with angina pectoris but normal CAG is very high, which is significantly higher than that of patients with coronary artery stenosis, and there is no difference between them and normal people of the same age. Nevertheless, long-term follow-up found that left ventricular function often remained normal, but many patients had been suffering from chest pain and needed medical treatment.

Prevention of 19 X syndrome Because patients often have anxiety and fear about chest pain, patiently explaining the condition to patients is helpful to relieve symptoms. Moderate physical activity and physical exercise is also an effective treatment.

Related drugs include papaverine, nitroglycerin, glycerol, glucose, dipyridamole, ergonovine, oxygen and imipramine.

2 1 correlation check insulin

Acupoint expansion in the treatment of syndrome X: Influence on cardiac function: The peak pulse value of patients is reduced in deformation, contraction and bending through observation of cardiogram, ECG vector oscilloscope and X-ray oscillograph. ...

The ghost heart tomb is under the corpse star. It is more reasonable to test the names of two stars, Daling and Jishi. Is it old or old? ...

In the study of acupoints, the acupoints are displayed by electrophoresis, and the X-ray microstructure of blood vessels at acupoints is observed. It is considered that there are points such as lack of basin, cloud gate, extreme spring and chongmen. ...

The matter of the heart tomb is under the corpse star. It is more reasonable to test the names of two stars, Daling and Jishi. Is it old or old? ...

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