Tag Archives: angina pectoris

Introduction Coronary artery spasm (CAS), or Prinzmetal angina, is an increasingly recognised cause of myocardial ischaemia in non-obstructed coronary arteries. It typically presents with anginal chest pain.1 It is rarely associated with myocardial infarction and symptomatic arrythmias.2 It occurs primarily at rest, most commonly in the morning,1,3 and is mostly observed in 40–70-year-old males.4 Prevalence varies by ethnicity, with Japanese ethnicity most strongly linked.5 Atherosclerotic coronary stenosis is an independent risk factor for CAS; more diseased vessels have a higher tendency to spasm in ergonovine provocation testing.6 We des

Introduction Papworth Hospital NHS Trust, Cambridge Spinal cord stimulation (SCS) therapy has been used for more than four decades in a variety of chronic pain conditions. The introduction of neurostimulation was a logical consequence of the ‘gate-control’ theory published in 1965.1 According to this model, the activation of large afferent nerve fibres inhibits pain input mediated by small fibres into the dorsal horn of the spinal cord. The goal of SCS is to attenuate discomfort by provoking paraesthesia in the same area. The European Society of Cardiology defines refractory angina as a chronic condition characterised by the presence of a

Introduction Chronic refractory angina is defined as coronary insufficiency in the presence of coronary artery disease with clinically established reversible myocardial ischaemia that cannot be controlled by a combination of medical therapy, angioplasty and coronary bypass surgery (CABG).1 Symptom duration should exceed three months. It carries a small increased risk of mortality,2 a significant risk of morbidity3 and accounts for more than 1% of the UK’s total health service budget.4 Triggers for angina include behavioural factors, such as activity and stress. Common misconceptions (e.g. that angina may precipitate myocardial infarction) m

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