Managing Refractory Angina Pectoris


Refractory angina pectoris is termed as a class III or class IV angina according to the Canadian Cardiovascular Society. The disease is characterized by the limitation of routine physical activities.

In some cases, individuals might not be able to perform the ordinary physical tasks without feeling any discomfort. The disease is also marked by the persistence of various symptoms as well as objective evidence of myocardial ischemia.

Revascularization therapies, changes in the lifestyle and optimal medical therapy showed no changes in the symptoms. People diagnosed with refractory angina pectoris might have small coronary arteries or numerous distal coronary stenosis. They might also be a victim of coronary artery disease.

What causes refractory angina pectoris?

Refractory angina pectoris has increasingly become such a common clinical issue that clinicians often face during their routine clinical practice. The patients of the disease undergo chronic symptoms which fall in the context of chronic artery disease.

The disease is basically characterized by an angina-type uncontrolled pain which cannot be medically addressed using interventional, surgical, or pharmacological therapy.

In simple terms, it occurs due to a coronary insufficiency in a person who is suffering from coronary artery disease and can’t be controlled using a combination of various methods like angioplasty, coronary bypass surgery, and medical therapy.

What treatment options are available?

Apart from the traditional medical therapies, research also discusses the pharmacological treatment options for treating refractory angina pectoris. Research also extensively reviews the recent therapeutic options that are available for the individuals.

One option among the various non-invasive and pharmacological therapeutic options for those diagnosed with refractory angina pain is ranolazine. This is a new drug which is to be used together with nitrates, beta-blockers, or amlodipine for treating chronic angina.

Enhanced external counterpulsation, another treatment option, significantly improves the symptoms of the disease. Moreover, it also improves the long-term ventricular function in the patients of RAP.

Randomized trials have shown that neuro-stimulation was also effective in reducing the symptoms of RAP. In the previous two decades, trans-myocardial laser revascularization has also been used as an invasive treatment option for RAP.

A few treatment options such as gene therapy for the treatment of refractory angina pectoris are still being investigated.

For the last twenty years, spinal cord stimulation has been commonly used for treating RAP. Numerous studies have shown to improve angina symptoms as well as the quality of life of the individual. However, research continues to find a more efficient treatment option.

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