Options for the Treatment of Intractable Angina

Anginal pain can occur by one of the following mechanisms:

• Reduced coronary arterial pressure distal to an occlusion, activating arterial pressureceptors
• Ischemia, stimulating the myocardial pressureceptors
• Release of chemical substances formed by tissue breakdown or platelet disintegration
• Myocardial ischemia stimulating visceral pain receptors.
• Distention of the myocardium

Traditional treatments of angina have included medication management, surgery and angioplasty. In some patients, despite maximum medical therapy angina and the severe disability continues. This often has a profound effect on the quality of life. For acute episodes, epidural analgesia can provide comfort to patients with intractable pain while other therapies are considered and implemented.

Another therapy has become recognized for its potential treating intractable angina on a long-term basis, Spinal cord stimulation (SCS). Through mechanisms not completely understood SCS is able to reduce substantially attacks of angina, without blocking the pain of an impending heart attack. Studies investigating SCS for angina have shown both improvement in quality of life of the patient and increase in life expectancy.

Procedure Overview

The SCS electrode is placed in the patient's epidural space at the dermatomal level of the patient's referred pain. A trial is performed prior to implantation to prove efficacy. The implantation of SCS can be easily done under local anesthesia. For more information, please see the section on interventional therapies.