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Abstract Cardiac syndrome X is the triad of angina pectoris, a positive exercise test for myocardial ischaemia and angiographically smooth coronary arteries [1]. No single underlying mechanism has been identified for the angina like chest pain with normal coronary angiographic findings, Small vessel coronary artery disease, abnormal coronary vascular resistance, and subendocardial ischemia have been invoked as possible mechanisms, although none of these factors is universally accepted. Several studies have found abnormalities consistent with myocardial perfusion in patients with CSX using positron emission tomography, scintigraphic myocardial perfusion imaging[93],and nuclear magnetic resonance imaging[94]. Echocardiography is a flexible imaging modality for the management of patients with chest pain and assessment of left ventricular systolic function, diastolic function, and even myocardial and coronary |