There is evidence that angina-like chest pain associated with normal coronary angiography (syndrome X) may appear in adult patients. We have reviewed the clinical documentation of all the patient aged 65 or more admitted to our hospital because of recent onset typical or atypical angina, who underwent an exercise tolerance test and coronary angiography. Exclusion criteria were ischaemic or valvular heart disease and significant arterial hypertension. The selection lead to a series of 11 patients (6 females, 5 males) aged 65-72 years (mean 69). The bicycle ergometric test was positive in 7 and negative or not diagnostic in 2 patients each. Thallium-201 scintigraphy (performed in 6 patients) revealed reversible perfusion defects in 4 and was equivocal in 2 patients. At coronary angiography 6 patients showed non obstructive lesions (range: 20-40%) and only 5 had normal findings: 2 of these patients showed gastro-intestinal disease which could be considered as possible trigger of chest pain. Thus only 3 patients fulfilled the criteria for a diagnosis of syndrome X. These were 2 females and 1 male and were followed-up for a minimum of 2 years. All were in good condition, with normal left ventricular function free of major cardiac events, although occasional chest pain was still present. We conclude that syndrome X may appear also in the elderly with the same clinical features already described in younger patients. The overall prognosis is good and symptoms are partially insensitive to standard therapy. The low incidence in the older age may be explained, in our series, also by the restricted criteria adapted to select the study population.