This book is timely and challenging. Within its pages are commentaries and opinions on the scientific background and explanatory ideas for a complex of symptoms and investigations known as syndrome X. The commonest cause by far of angina pectoris is coronary artery obstruction due to atheromatous lesions both within the wall of the artery and intruding into the lumen; in such patients it is expected that there maybe ST segment depression on atrial pacing or on an exercise test indicating myocardial ischemia. Syndrome X was a term first used in an editorial written by Kemp in 1973. He was referring to patients in group X in a paper from Arbogast and Bourassa. Patients in group X had three features, namely angina as judged on a clinical history, alterations of the ST segment on the electrocardiogram during atrial pacing and smooth unobstructed coronary arteries (presumed normal) as assessed by the technique of coronary angiography. The changes on the electrocardiogram, conventionally indicative of myocardial ischemia, could not be explained on the basis of any abnormality of the coronary arteries and Kemp named the complex of fmdings syndrome X because of this seeming paradox and the lack of a single explanation. In the last thirty-one years there has been substantial scientific interest in this syndrome giving rise to a large number of publications. The name syndrome X has led to considerable confusion. Physicians are familiar with the X chromosome and with X linked congenital disorders.

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List of Contributors. Foreword. Preface. 1. Cardiac syndrome X and microvascular angina; J.C. Kaski. 2. Chest pain with normal coronary arteries: psychological aspects; S.G. Potts, C. Bass. 3. Esophageal chest pain; J.S. de Caestecker. 4. Esophageal abnormalities and `Linked - Angina' in syndrome X; A. Chauhan. 5. Abnormal pain processing in syndrome X; O. Frøbert, et al. 6. Insights into the pathophysiology of syndrome X obtained using positron emission tomography (PET); S.D. Rosen, P.G. Camici. 7. Myocardial metabolism in cardiac syndrome X; J.P. Bagger. 8. Endothelial dysfunction in cardiac syndrome X (microvascular angina); K. Egashira, et al. 9. Endothelin: an important mediator in the pathophysiology of syndrome X; I.D. Cox, J.C. Kaski. 10. Estrogen deficiency and syndrome X; P. Collins. 11. Alternative mechanisms for myocardial ischemia in syndrome X - New diagnostic markers; F. Crea, et al. 12. Increased plasma membrane ion-leakage: A new hypothesis for chest pain and normal coronary arteriograms; A. Waldenström, G. Ronquist. 13. A possible cell membrane defect in chronic fatigue syndrome and syndrome X; W.S. Watson, et al. 14. The changing concept of syndrome X; A. Maseri, et al. 15. Assessment of coronary blood flow reserve - Techniques and limitations; A. L'Abbate. 16. The role of echocardiography in diagnosis and management of cardiac syndrome X; P. Nihoyannopoulos. 17. Imaging in microvascular angina - what's new? A. Tweddel. 18. Assessment ofquality of life in patients with syndrome X; F. Atienza, J.A. de Velasco. 19. Treatment of patients with angina and normal coronary arteriograms; G.M.C. Rosano, et al. 20. Management strategies for chest pain in patients with normal coronary angiograms; R.O. Cannon III. 21. Abnormal autonomic nervous control of the cardiovascular system; G.M.C. Rosano, et al. 22. The metabolic syndrome; F. Leyva, J.C. Stevenson. 23. Two syndromes X; A. Henderson. 24. Hyperlipidemia and endothelial vasodilator dysfunction: The pathogenetic link to myocardial ischemia; A.M. Zeiher. 25. Microvascular dysfunction in patients with systemic hypertension without left ventricular hypertrophy: The role of nitric oxide; J.A. Panza. 26. Microvascular angina and hypertensive left ventricular hypertrophy; W. Motz, S. Scheler. 27. Myocardial ischemia in hypertrophic cardiomyopathy: Clinical assessment and role in natural history; P.M. Elliott. 28. Microvascular endothelial dysfunction after heart transplantation; G. Vassalli, A. Gallino. Index.