Ischemia and No Obstructive Coronary Artery disease (INOCA) is also known as Syndrome X. Unfortunately, X does not mark the spot in this case.
Fairly commonly, a woman will enter a doctor’s office or an emergency room complaining of chest pain, shortness of breath, or centrally located abdominal pain. The doctor orders an EKG which comes back normal or nonspecifically abnormal. She is sent home and told there is nothing to worry about most likely. When it happens again the woman is placed on a treadmill, and next a cardiac catheterization resulting in no visible obstructive lesions.
The next time the woman is seen is often after a heart attack or sudden death. This is Syndrome X.
Approximately three to four million women in America have stable INOCA. Treatment is available, and once the diagnosis is known will eliminate unneeded testing that have their own complications and negative effects.
There are two common causes of INOCA: Coronary microvascular dysfunction and vasospasm of the epicardial arteries. Many with INOCA show no signs of cardiac lesions. More often than not a coronary angiogram comes up clean.
Coronary function testing (CFT,) PET scanning, cardiac magnetic resonance, and Doppler echocardiography may all be employed to diagnose the condition.
When it comes to life insurance underwriters want as much information as possible before issuing coverage to those with Syndrome X. They want to see all cardiac testing, nature of treatment, and frequency of symptoms. When there is a clear diagnosis and the time between medical events is greater than six months many insurers will issue coverage at standard rates. If the patient rarely schedules cardiac follow-up visits or does little to nothing about certain risk factors the insurer will likely apply a higher premium or deny.