# Typical Exertional Angina With No Angiographic Coronary Artery Disease

## TL;DR

A young, healthy male presented with chest pain and no coronary artery disease, highlighting the atypical presentation of Cardiac Syndrome X.

## Contribution

This case report presents an uncommon male presentation of Cardiac Syndrome X, typically seen in women.

## Key findings

- The patient experienced exertional chest pain with no evidence of coronary artery disease on angiograms.
- ECG showed nonspecific ST changes and AV block, but troponin levels were normal.
- The case emphasizes the need for awareness of Cardiac Syndrome X in atypical populations.

## Abstract

Cardiac syndrome X (CSX) is a cardiac condition that is a diagnosis of exclusion. Patients usually present with terrible chest pains suggestive of myocardial infarction, but angiogram imaging shows no occlusion in the coronary vessels that would be suggestive of coronary artery disease. CSX is more commonly seen in women, but this case report demonstrates a different clinical presentation of CSX in a young, otherwise healthy male patient. The 38-year-old male patient presented to the emergency room with chest discomfort radiating to the left arm and to the left jaw. The chest pain started after the patient went for a jog, with the pain lasting for a couple of hours. The electrocardiogram (ECG) was abnormal, showing nonspecific ST changes and unremarkable troponin levels. The patient underwent a coronary angiogram, which was unremarkable. Three years later, the patient presented once more with chest heaviness that occurred again after going for a run. The patient's troponins were unremarkable, and an ECG test showed a new onset of AV block. Due to the ongoing chest pain, the patient received another coronary angiogram. This showed that the coronary vessels had no indications of occlusion. The patient was discharged and scheduled to follow up with their cardiologist for an extensive discussion about medications for their condition. This case report should bring awareness of the classical presentation of this disease in an uncommon population group and a way to identify this syndrome once exclusions have been made on previous hospitalizations.