In the case report of a female patient with a diagnosis of cardiological syndrome X, we demonstrate an appropriate algorithm of examinations in patients with negative selective coronarography. It just happens that physicians in such patients frequently discontinue all medication and consider the patient to be „in full health“. At the same time the pain and complaints of a patient down with syndrome Xmay be worse than in patients with demonstrable ischemic heart disease. In our patient upon negative coronarography, with the aid of the hyperventilation echocardiographic test there has been ruled out vasospastic angina pectoris, and confirmed latent tetany and a disorder in myocardial perfusion on SPECT examination. This disorder at the level of coronary microcirculation was most probably due to endothelial dysfunction. Diagnostic conclusion: cardiological syndrome X, latent tetany. The patient received treatment combining nitrate, calcium antagonist, acetylosalicylic acid, antidepresant, magnesium lactate. The patient remains without complaints under this therapy.

        Key words: cardiological syndrome X - negative selective coronarography - treatment of syndrome X