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Management of Pain

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Chest Pain with Normal Coronary Arteries

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Abstract

Management of patients with persistent angina and no obstructive coronary artery disease continues to be a challenging area. Currently, pharmacotherapy used in patients with microvascular coronary dysfunction (MCD) is targeted at their underlying mechanism for pain. Therapies used in patients with coronary artery disease such as nitrates, β-blockers, calcium channel blockers, and statins have also been found to be beneficial in those with MCD. Other agents found to have promising effects on anginal symptoms includes ranolazine and angiotensin converting enzyme inhibitors. Hormone therapy in women with MCD improves quality of life, although improvement in myocardial ischemia remains to be determined. In patients with cardiac syndrome X, small trials have been performed showing either beneficial or indeterminate results with the use of other pharmacologic agents such as tricyclic medications, L-arginine, xanthine derivatives, n-3 polyunsaturated fatty acids, nicorandil, and trimetazidine. Non-pharmacologic therapies in the management of chronic angina also play an important role. Lifestyle modification, exercise, and cognitive behavioral therapy have shown to improve angina and exercise capacity in those with MCD. The use of neurostimulation, including transcutaneous electrical nerve stimulation and spinal cord stimulation, can also improve symptoms in those with chronic angina. Incorporating both pharmacologic and non-pharmacological therapies can lead to the effective management of chronic angina in patients with MCD.

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Acknowledgment

This work was supported by contracts from the National Heart, Lung and Blood Institutes, nos. N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164, grants U0164829, U01 HL649141, U01 HL649241, 1 R01 HL090957-01A1, T32HL69751, 1R03AG032631 from the National Institute on Aging, GCRC grant MO1-RR00425 from the National Center for Research Resources and grants from the Gustavus and Louis Pfeiffer Research Foundation, Danville, NJ, The Women’s Guild of Cedars-Sinai Medical Center, Los Angeles, CA, The Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, PA, and QMED, Inc., Laurence Harbor, NJ, the Edythe L. Broad Women’s Heart Research Fellowship, Cedars-Sinai Medical Center, Los Angeles, California, and the Barbra Streisand Women’s Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles.

Disclosures There are no relevant conflicts of interest of any of the authors to disclose.

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Authors and Affiliations

  1. Division of Cardiology, Cedars-Sinai Heart Institute, 8700 Beverly Blvd 5536-B, Los Angeles, CA, 90048, USA

    Anita Phan MD

  2. Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, 444 S. San Vicente Blvd Suite 600, Los Angeles, CA, 90048, USA

    Puja K. Mehta MD & C. Noel Bairey Merz MD, FACC, FAHA

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  1. Anita Phan MD
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  2. Puja K. Mehta MD
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  3. C. Noel Bairey Merz MD, FACC, FAHA
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Correspondence to C. Noel Bairey Merz MD, FACC, FAHA .

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Editors and Affiliations

  1. Medical School, Coronary Artery Disease, Research Group, St George's Hospital, Cranmer Terrace, London, SW17 0RE, United Kingdom

    Juan Carlos Kaski

  2. University of Sydney, Discipline of Surgery, The Whiteley-Martin Research Centre, Parker Street, Sydney, 2747, New South Wales, Australia

    Guy D. Eslick

  3. , Women's Heart Center, Cedars-Sinai Heart Institute, S. San Vicente Blvd 444, Los Angeles, 90048, USA

    C. Noel Bairey Merz

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Phan, A., Mehta, P.K., Bairey Merz, C.N. (2013). Management of Pain. In: Kaski, J., Eslick, G., Bairey Merz, C. (eds) Chest Pain with Normal Coronary Arteries. Springer, London. https://doi.org/10.1007/978-1-4471-4838-8_31

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  • DOI: https://doi.org/10.1007/978-1-4471-4838-8_31

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