**Question:** All are true about Syndrome X, EXCEPT:

A. Increased risk of developing type 2 diabetes mellitus
B. Presence of a positive family history
C. Unilateral renal artery stenosis
D. Normal coronary angiography findings

**Core Concept:**
Syndrome X, also known as ischemic heart disease with negative angiography, is characterized by angina pectoris or chest pain in the absence of obstructive coronary artery disease on coronary angiography. It is often associated with microvascular dysfunction in the heart (i.e., reduced blood flow in the coronary microvasculature), which can lead to ischemia and chest pain. Syndrome X is a clinical entity and not solely based on angiographic findings.

**Why the Correct Answer is Right:**
The correct answer (D) highlights that Syndrome X is characterized by angina pectoris, not a normal coronary angiography finding. In contrast to normal coronary angiography, Syndrome X patients typically experience chest pain that is not relieved by nitrates and is often associated with ST-segment depression on electrocardiography (ECG). The other options are often seen in the clinical presentation and pathophysiology of Syndrome X:

**Why Option A is Right:**
Increased risk of developing type 2 diabetes mellitus is not specifically related to Syndrome X. While Syndrome X patients may have a higher risk of developing type 2 diabetes due to their shared risk factors (e.g., obesity, hypertension, dyslipidemia), it is not a defining feature of Syndrome X itself.

**Why Option B is Right:**
Presence of a positive family history is not unique to Syndrome X. Syndrome X patients often have a positive family history of cardiovascular disease due to shared genetic and lifestyle risk factors. Syndrome X is a clinical entity and not solely based on family history.

**Why Option C is Right:**
Unilateral renal artery stenosis is not a defining feature of Syndrome X. Syndrome X is characterized by the absence of significant coronary artery stenosis on angiography, while unilateral renal artery stenosis is a condition involving narrowing of the renal arteries leading to kidney dysfunction, not specifically related to Syndrome X.

**Why Option D is Right:**
Normal coronary angiography findings in Syndrome X patients are a result of microvascular dysfunction and not coronary artery stenosis. Syndrome X patients often exhibit reduced coronary flow reserve and impaired vasodilation, contributing to chest pain and myocardial ischemia. Angiography results are typically normal in these patients due to microvascular dysfunction rather than the absence of coronary artery stenosis.

**Why Option E is Wrong:**
Although angina is a common feature of Syndrome X, this option is not specific to Syndrome X. Angina can occur due to various causes, including coronary artery stenosis, vasospasm, or microvascular dysfunction.

**Why Option F is Wrong:**
The presence of hypertension is not specific to Syndrome X. Hypertension is a common risk factor for cardiovascular disease and can be present in various cardiac conditions, including coronary artery stenosis, vasospasm, and microvascular dysfunction.

**Why Option G is Wrong:**