Cardiac Syndrome X: The Sensitive Heart of a Young Adult Man

Cardiac syndrome X (CSX), now well known as microvascular angina, is a mysterious cardiac condition in medical science. While the symptoms suggest obstructive coronary disease, the actual angiography turns out to be negative or nonsignificantly obstructive. Despite being a benign condition, its presence increases the risk of adverse cardiovascular events and leads to poor quality of life in the patients. The prevalence of cardiac syndrome X is higher in women, mostly in postmenopausal states. This case report sets a different clinical picture of cardiac syndrome X, where a young male patient is found to have this syndrome. A 38-year-old male went to the hospital with a chief complaint of substernal chest pain for one hour. An electrocardiogram (EKG) showed nonspecific ST-T wave changes, and the cardiac troponin results were nonsignificant. On the contrary, the myocardial perfusion scan came back positive for significant ischemia in various parts of the heart. The patient underwent a coronary angiogram, which showed normal coronary arteries. In view of similar chest pain episodes in the past and the presence of risk factors, he was discharged with extensive counseling on lifestyle modification and medical management. This case report raises awareness about this syndrome's classic clinical scenario and chronology of events in a rare class of the population. Through this case report, clinicians can learn the art of diagnosing this syndrome and provide appropriate patient care in near-miss situations.