Syndrome X and Microvascular Coronary Dysfunction

Abstract

Case presentation: A 44-year-old woman is referred for worsening chest pain since 2007, with abnormal stress testing in May 2008, followed by coronary angiography in June 2008. She had several prior hospitalizations to evaluate possible myocardial infarction, and 1 with an elevated troponin level in 2001. She has a history of breast cancer in 2007. She currently reports daily exertional substernal chest pain that radiates to her left arm and hand that is relieved with rest. She works as an undercover police officer, frequently has to chase suspects, and is concerned about being able to do her job. A review of cardiac risk factors is negative. She takes tamoxifen with vitamins, and her physical examination and resting ECG are normal. Review of the prior coronary angiography confirms absence of obstructive coronary artery disease and normal left ventricular function.