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Paediatric Cardiology

Despite major advancements in coronary revascularization therapy, including percutaneous coronary intervention and coronary artery bypass grafting, many patients are ineligible for interventional therapy or remain symptomatic despite optimal treatment. For this group of patients, pain often significantly limits physical activity and contributes to a poor quality of life. Spinal cord stimulation (SCS) has been described as a potential safe and effective treatment modality for this select group of patients. The majority of patients suffering from ischemic heart disease can be adequately treated with revascularization procedures and anti-anginal medications. As the interventional techniques and medical management of CAD improves mortality for this group of patients, the number of people living with chest pain despite medical treatment continues to increase. According to some estimates there may be approximately 1 million people living with intractable angina in the United States with approximately 50,000 new cases diagnosed each year. Despite optimal therapy, however, this particular patient continued to remain symptomatic, experiencing daily retrosternal chest pain, jaw pain, shoulder pain, and dyspnea. Neuromodulation via SCS to the lower cervical and upper thoracic nerve roots was able to significantly improve the anginal symptoms and exercise tolerance of this patient. Moreover, several recent investigations have shown objective data suggesting improved coronary and myocardial perfusion in patients treated with spinal cord stimulation. It is thought that the anti-anginal effects of spinal cord stimulation are multifactorial and are due to reduced pain perception, decreased sympathetic tone, and improved coronary microcirculatory blood flow. Electrical SCS should be considered a safe and effective therapeutic option for the treatment of patients with refractory angina. Talal W. Khan, Neurostimulation for intractable angina
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Last date updated on June, 2014

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