Chest pain with no answers
Imagine going to bed as a healthy, active person who does martial arts three times a week. Then you wake up and experience sudden, rapid heartbeat and chest pain just climbing a flight of stairs. And the symptoms don’t go away.
This has been Linda Black’s life since 2008. “Something drastic had changed overnight that just didn’t make sense,” says Linda (a pseudonym – she did not want her real name used).
After dozens of tests and visits to doctors, she has no understanding of what is causing her pain. No one has been able to pinpoint an exact cause or offer effective treatment.
She was 60 when her symptoms started and was unable to continue working as a nurse. Since then, financial hardship has been an added stress. She worries about what may happen in the future as she has an extensive family history of heart disease.
Unfortunately, Linda is not alone.
Tests show normal arteries
Every year in Ontario, 45,000 new patients with chest pain undergo an angiography to look at the blood vessels of the heart and check for blockages. An estimated 10 to 30 per cent of them will show no evidence of obstruction in the large coronary arteries. The majority of such patients are women, mainly post-menopausal women.
Cardiac syndrome X (CSX) is a term used to describe these patients who have coronary arteries that appear normal on imaging tests, along with ongoing complaints of chest pain and unclear explanations for the problem. A significant proportion of them may be at increased risk of heart attack and stroke.
Treating these patients requires time and patience. Since the cause is unclear, finding a treatment that helps them takes trial and error.
Cardiologist Dr. Paula Harvey, director of cardiovascular research at Women’s College Hospital in Toronto, sees a large caseload of CSX patients in her practice – virtually all of them women. Dr. Harvey estimates that nothing really works for about half of these patients.
But she takes care to emphasize to her patients that what they’re going through is real.
Dr. Harvey does refer many of her patients to cardiac rehabilitation programs. Cardiac rehab helped Linda Black resume some physical activity, including walking and tai chi, even though her symptoms persist.
Slow progress in research
Researchers are looking at the potential causes of CSX, but progress is slow, even though it’s been more than 40 years since the syndrome was first described. The current focus is on the smaller blood vessels in the heart. Researchers are investigating whether abnormal function of the layer of cells on the walls of these arteries may be the source of CSX.
For now, both patients and healthcare professionals feel frustrated as they search for explanations and treatments for CSX.
“An awful lot of patients are left with persistent symptoms that really impact on their lives,” says Dr. Harvey. “They get very frustrated. They can get depressed.”
Nevertheless, Dr. Harvey holds out some hope for the future: “Our whole understanding of vascular function has exploded over the last few decades and I would hope that will lead to further understanding of this syndrome. I do think we are getting better at this, but we have a long way to go.”