The aim of this work was to define the notion of cardiac syndrome X based on latest research, determine its connection with mental disturbances and present the current therapeutic directions. Cardiac syndrome X was distinguished in 1973 to describe a group of patients with coronary syndrome symptoms despite normalcoronary vessels in coronarography. Many years have passed since then, but the syndrome definition and the diagnostic criteria still arouse controversy. It is estimated that 10 to 20% of persons who undergo coronarography suffer from cardiac syndrome X, a vast majority of them being perimenopausal women. That patient population suffers from anxiety disorders, depressive symptoms and sleep disturbances much more frequently than does general population. Treatment includes a range of medicines with various mechanisms of action, but their effectiveness is limited; non-pharmacological actions are a significant part of the therapy. The patient group with cardiac syndrome X requires periodic follow-ups because prospective observation has shown that it is a risk group concerning development of atherosclerosis and acute coronary syndrome.