Features of Diagnosis and Treatment of Coronary Syndrome X

It is known that now in 10-20% of patients, who are undergoing diagnostic coronary angiography, coronary arteries are intact, but clinically, they have appropriate complaints and need medical help. There are also difficulties in selecting the optimal antianginal drugs for such patients because the majority cases they are ineffective. So, the purpose of the study was to consider the issue of diagnosis and treatment of coronary syndrome X. Material and methods. We used the following methods for the diagnosis of microvascular angina: - The method of introduction of adenosine in coronary arteries allowed us to determine the rate of bleeding when connecting an ultrasound sensor. This diagnostic method detected changes in the blood flow with high probability. - MRT of heart helped determine the adequacy of blood flow precisely in the subendocardial region. - Single-photon emission computer tomography was performed together with bicycle ergometry or pharmacological tests. When the heart reached the rate with signs of ischemia, the radioisotope substance was introduced. After an hour, a computer tomography was performed to assess violations of perfusion. - Magnetic resonance spectroscopy showed the ratio of ATP and phosphocreatine. Results and discussion. In the treatment, we suggested gradually picking up medicines, starting with nitrates. But they do not often have any positive effect. In literature, their effectiveness is described only in 50% of patients. So, if there is no effect, beta-blockers are used, which in most cases are drugs of choice. Calcium antagonists and prolonged nitrates did not justify confidence in monotherapy, but in combination with beta-blockers, their effectiveness increased several times. If there is no effect again, ACE inhibitors are used. The literature describes the data of long-term (within 6-12 months) treatment of patients with coronary syndrome X with perindopril in a dose of 4-8 mg per day, which leads to a decrease in the frequency of angina attacks in 55% of patients, an increase in threshold load power – by 22.2%, its time – at 32.4% with the disappearance of signs of ischemia during a load test in 30% of patients. Conclusions. Considering the positive effect of perindopril in clinical manifestations, exercise tolerance, endothelial function and autonomic heart function in patients with coronary syndrome X, it is advisable to recommend inclusion of this drug in the treatment of such patients as a means of pathogenetic therapy. According to a large number of studies, ACE inhibitors improve endothelial dysfunction and can positively affect the manifestation of coronary syndrome X. In a double-controlled placebo trial, it was demonstrated that using perindopril for eight weeks not only significantly improved the performance of samples with physical activity, but also the reserve of coronary blood flow and the level of endothelial nitric oxide in patients with coronary syndrome X. Positive effects of the use of ACE inhibitors are associated with the restoration of levels of endothelial nitric oxide and a decrease in the ratio of L-arginine and dimethylarginine. At the same time, the use of calcium channel blockers as monotherapy is controversial.