Angine réfractaire et coronarographie presque blanche : Le syndrome X cardiaque

Résumé

Résumé

Objectif : Le syndrome X cardiaque se caracterise par la presence de signes et de symptomes d’ischemie en l’absence de maladie coronarienne obstructive. Encore meconnu par plusieurs, ce syndrome laisse les patients qui peuvent en etre atteints quitter l’hopital sans diagnostic franc et sans ajustement adequat de leur medication. Le present article expose une pathologie d’actualite pour laquelle l’arsenal therapeutique n’est encore qu’a l’etat embryonnaire.

Résumé du cas : Une dame de 41 ans se presente a nouveau a l’hopital pour des douleurs retrosternales recidivantes a l’effort comme au repos. La coronarographie est normale de meme que les investigations gastro-intestinales. La patiente subit des investigations cardiaques quasi annuelles, et aucune explication n’est donnee a cette angine qui altere grandement sa qualite de vie. Lors de son hospitalisation, le diagnostic de maladie microvasculaire est pose pour la premiere fois.

Discussion : L’hypothese actuelle relative au syndrome X cardiaque postule une mauvaise reponse des microvaisseaux et une hypersensibilite aux stimuli douloureux, d’ou egalement l’utilisation du terme ≪ syndrome du coeur sensible ≫. Cette pathologie ne repond pas a tous les antiangineux. Le traitement actuel propose consiste a rassurer le patient qui en est atteint, a introduire un betabloquant et de la nitroglycerine au besoin. Pour traiter en deuxieme ligne la perception inadequate de la douleur, on pourrait envisager l’imipramine. Le suivi clinique est souvent important. Les nombreux examens engendres n’apportent pas toujours les reponses escomptees et provoquent chez le patient un sentiment de decouragement ou d’anxiete.

Conclusion : Une bonne comprehension de la physiopathologie de ce syndrome participe a la prise en charge de cette maladie. Les professionnels de la sante doivent etre presents et rassurer le patient victime de cette maladie eprouvante psychologiquement.

Abstract

Objectives: Cardiac syndrome X is characterized by signs and symptoms of ischemia in the absence of obstructive coronary artery disease. As this syndrome is still poorly understood by many, potentially affected patients may leave the hospital without a clear diagnosis and without their medication having been properly adjusted. This article discusses a disease of current concern for which the therapeutic arsenal is still in its infancy.

Case summary: A 41-year-old woman presented to the hospital again because of recurrent retrosternal pain that occurs on both exertion and at rest. Coronary angiogram and gastrointestinal investigations were normal. The patient underwent cardiac investigations nearly every year, and no explanation was provided for this angina, which significantly affected her quality of life. During her hospital stay, she was diagnosed with microvascular disease for the first time.

Discussion: Current hypothesis regarding cardiac syndrome X is a poor microvascular response and hypersensitivity to pain stimuli, the reason for which it is also called “sensitive heart syndrome”. This disease does not respond to all antianginals. Proposed treatment consists in reassuring the patient and initiating a beta-blocker and nitroglycerine, to be taken as needed. Physician may consider prescribing imipramine to treat the abnormal pain perception. Clinical followup is often extensive; however, tests and examinations do not always provide answers, which causes patients to have anxiety.

Conclusion: A good understanding of the pathophysiology of this syndrome contributes to its management. Health professionals should be attentive and reassure the patient with this psychologically challenging disease.

Keywords: Cardiac syndrome X, endothelial dysfunction, microvascular disease normal coronary angiogram, sensitive heart syndrome.