Patients with Refractory Angina are often told that they have run out of treatment options. Actually there are a number of treatment options available for patients with Refractory Angina. It is important to realise however that not every treatment option is suitable or indicated for every patient. One also has to weigh up the risk of the treatment against the benefit it may offer you. Response to treatment is also highly individualised and what works for one person may not work for another.
Click on the link below to explore the treatments available through the Bradford Angina Service
Renew ECP Therapy is an established non-invasive treatment for patients with angina. It is delivered by leg cuffs that sequentially inflate and deflate very rapidly. By doing so it alters flow and pressure of blood within the heart. Its exact mechanism of action is not yet fully understood but it has been shown to improve blood vessel formation within the heart muscle (collateralisation). It is delivered for one hour a day, 5 days a week for a total of 7 weeks (ie 35 sessions in all). Many patients receiving the full treatment have shown an increased vitality, a reduction in their angina pain and consequently a lower medication dosage. For more information visit Renew ECP, watch a short ECP: How it works video or hear feedback from patients who have received the treatment. As with all therapies, there is no guarantee that it will work in every patient and results may vary.
TENS (transcutaneous electrical nerve stimulation) is a simple and safe treatment for patients with refractory angina. It works by delivering a small electrical current to the chest wall. This electrical current has two effects. The first is to interfere with the pain signal being sent from the heart to the brain. If you were to imagine that the heart had a “volume” control knob then TENS effectively turns the volume down so that less pain is felt. The second is to improve the microcirculation within the heart so that more blood is delivered to the heart muscle. The TENS machine can be worn during all of your normal daily activities.
Patients with pacemakers however are unable to use TENS as it may interfere with their pacemaker’s function. Please click on the link to see a video of a TENS machine in use (click here).
In all probability by now you have tried every type of cardiac medication. However, there is one new tablet that has been introduced for patients with angina called Ranolazine (Ranexa). Ranolazine acts through a complex pathway to improve blood supply to the heart muscle. The main advantage of Ranolazine is that it does not drop blood pressure (so patients do not feel dizzy and tired) or tend to cause headaches, side effects commonly experienced by patients on other anti-anginal medication. If you have not already tried Ranolazine it is highly likely that we will prescribe it for you. If it is effective we will ask your GP to continue prescribing it for you. If it proves ineffective (like all therapies there is no guarantee that it will help) we will stop it as patients do not like to take more tablets than is necessary.
The Stellate Ganglion is a junction box in the neck that pain signals from the heart (angina) have to travel through to get to the brain. By injecting a chemical into this junction box (using local anaesthetic and xray guidance) pain signals from the heart can be effectively blocked. Stellate Ganglion Block therefore can be an effective way of reducing angina. However its effect is only temporary (6-12 weeks) but the procedure can be repeated many times. Like all therapies Stellate Ganglion Block is not guaranteed to work in every patient.
The Coronary Sinus Reducer is a new therapy for angina. It is a waisted stent that is placed in the main outflow vein of the heart and not in a coronary artery. The simplest way to explain how it works is to think of a sink. The taps represent the arteries bringing blood into the heart, the bowl represents the heart muscle and the plug hole represents the main outflow vein of the heart. Everyone knows what happens when a sink gets blocked, water stays in the bowl and drains away slowly. By placing a Coronary Sinus Reducer in the main outflow vein of the heart it slows drainage of blood away from the heart muscle. As the blood remains in the heart muscle for longer it can take more oxygen from it and so improve angina. One of our patients has called this the “plug hole effect”. The advantage of the Coronary Sinus Reducer over conventional stenting is that it can be inserted into almost anybody’s heart as the drainage vein is large and never gets atheroma i.e. the disease that leads to narrowing of the coronary arteries. However it is suitable only for patients whose angina is caused by the left coronary system. As with all therapies there is no guarantee that it will work in every patient. Click the link to see the Coronary Sinus Reducer.
Angioplasty is a common treatment for patients with angina. It involves stretching the narrowed coronary artery with balloon and then placing a stent across the narrowing to keep it open. Many patients with refractory angina have had several angioplasties. Others have been told that angioplasty is not possible. Just because a patient has been told that angioplasty is not feasible in them at this time does not mean to say that angioplasty can’t be carried out at a future date. If we feel that angioplasty is
feasible and likely to be helpful we will consider it.
It is worth remembering that whilst angioplasty is often very effective at improving a patients angina it does not reduce the risk of heart attack or death. It is purely designed to improve symptoms. Patients therefore who have not had an angioplasty have not