Editorial Advances in understanding the mechanisms of angina pectoris in cardiac syndrome X

This editorial refers to ‘Abnormal cortical pain processing in patients with cardiac syndrome X’ † by M. Valeriani et al., on page 975 Angina pectoris was initially described by Heberden in 1772 and is considered to be the hallmark of ischaemic heart disease. However, with the advent of selective coronary angiography, clinicians were confronted with a conundrum as some patients with ‘unmistakable’ angina had angiographically normal epicardial coronary arteries. This apparent disparity between the clinical symptoms and the angiographic findings appeared to be resolved when it was demonstrated that affected patients had electrocardiographic and metabolic evidence of ischaemia. Thus, it was hypothesized that the angina experienced by these patients was due t