A 50-year-old woman feels pain behind her breastbone when she walks or cleans house. The pain is pressing, “like someone squeezing her chest.” When she stops, the pain goes away. Sometimes the relation to exertion is variable. The woman may notice that even if she goes on exercising the pain goes away. At other times it may appear at rest. She consults a physician who tells her the pain sounds like angina pectoris and orders further tests. The resting electrocardiogram shows some nonspecific abnormalities of the ST-T complex. A treadmill test is strongly positive; the patient feels pain and the ST segment goes down 1.5 mm at a moderate level of exercise. All this looks dangerous, so the physician orders coronary arteriography.

Surprise! The coronary arteriography is completely normal. The left ventricle pumps normally. There’s nothing wrong with the heart. If the physician isn’t well informed, he will be baffled. If he knows as much as he should, he’ll realize the patient is very lucky. She has a syndrome called Likoff-X in honor of Dr. William Likoff, who did many of the early studies on it. It’s a medical curiosity, but it’s not a disease.

Nobody has any idea why menopausal and postmenopausal women have this pseudoangina syndrome. A great deal of research has failed to reveal the cause. Some studies have suggested that there is some abnormality in the circulation through the small vessels or capillaries of the heart muscle, but there’s no agreement on what it is or even if it exists.

One thing is absolutely clear, however—it’s harmless. The woman with syndrome X can take up mountain climbing or weight lifting or singles tennis or whatever suits her fancy. In spite of the abnormal ECG and stress test, the woman has a normal life expectancy and has no reason to fear heart trouble. Syndrome X does not produce any bad effects and there is no risk of disease or death. It’s not a disease by any reasonable definition. It’s an oddity; no more serious than having one blue eye and one brown one. The intelligent physician explains all this to the woman and gives her something like aspirin for the pain in her chest.

Physicians sometimes prescribe cardiac medications in an unthinking reflex response to the pain in the chest and the abnormal ECG. This is a bad idea for several
reasons. In the first place, the cardiac medications don’t do any good because there’s nothing to treat. In the second place, the mere act of taking cardiac medications often makes the patient a “cardiac cripple.” She becomes convinced that there must be something the matter with her heart when, in fact, there isn’t. Furthermore, medications are often toxic.