Refractory Angina

What is refractory angina?

Refractory angina (RA) is a chronic heart pain due to heart diseases, such as coronary heart disease (CHD) and myocardial ischemia. In some cases, angina may be a symptom when a patient is suffering from coronary artery disease. It's hard to control the pain with common treatments, such as angioplasty, medical therapy, and coronary artery bypass surgery.

How does the pain occur?

Typically, angina is a recurring pain that occurs when part of the heart does not receive adequate blood. This happens when plaque develops in the arteries, resulting in a slow supply of blood. This leaves the heart muscle deprived of the much-needed oxygenated blood.

The result of this deprival is angina or chest pain. People with angina usually describe the pain as heaviness, squeezing, tightness or pressure in the chest.

What are the symptoms of refractory angina?

In addition to pain, there are other medical symptoms that patients may experience, such as sweating, nausea, shortness of breath, dizziness, and fatigue. In some cases, you can also experience pain in the arm, neck, jaw, back or shoulder. These symptoms tend to be hard to manage with both conventional and modern treatment options.

If you notice any of these symptoms, it helps to talk to your doctor or get a medical test to determine the underlying cause.

Is angina common?

Angina is not a disease, and it's usually a symptom of an underlying condition. There are many types of angina, such as unstable angina, variant angina, microvascular angina, Prinzmetal's angina, and stable angina. Each one of these is caused by ischemia, the narrowing and blockage of one or more coronary arteries.

Angina is also a symptom of another heart problem known as coronary microvascular disease. This condition affects the smallest arteries in the heart and women are more susceptible to it than men.

Therefore, angina is a common symptom, and it affects patients differently depending on the cause.

Risk factors

Refractory chest pain affects both men and women, but it's more common in men, especially when they are 70 years old and above. There are particular risk factors that heighten the chances of experiencing the pain. Ideally, if you're at risk of coronary MVD or any other heart disease, you are likely to get the pain.

The major factors include smoking, diabetes, hypertension, unhealthy cholesterol levels, inactivity, poor diet, aging, family history of heart disease, metabolic syndrome, and obesity.

If you have any of these risk factors, consulting a doctor helps to reduce the possibility of getting a heart disease.

How is refractory angina diagnosed?

All cases of angina need to be checked out by a doctor. If you experience chest pain, the doctor will determine if it's angina and whether it's stable or unstable.

Unstable cases will need an emergency medical treatment to prevent the patient from getting a heart attack. A physical exam is also important during the doctor visit.

If you have a coronary blockage, you'll undergo an angiography to determine the location of the blockage in the artery.

Treatment of refractory angina

As you already know, it's hard to treat this chest pain, and the goal of treatment is usually to help to minimize the pain. Doctors may use different therapies and lifestyle changes to help patients with refractory angina.

Lifestyle changes may include: losing weight, quitting smoking, and avoiding activities that put a strain on the heart.

The doctor may recommend Enhanced External Counter Pulsation (EECP), which involves placing cuffs on the upper and lower legs to encourage the flow of blood to the heart. The cuffs are designed to inflate over time with the pulse of your heart. You will need 35 hours to complete the treatment.

Another treatment is Spinal Cord Stimulation (SCS), and it involves applying an electrical current to the spinal chord. The doctor inserts electrodes into the back, causing numbness on both sides of your chest. The electrodes are then connected to an energy source, which connects to a portable control device.

Patients may also undergo Chronic Angina Self-Management Training (SMT), which equips them with the knowledge to manage the day-to-day problems, such as stress, anxiety, fatigue, and poor mobility. SMT is typically a training program for refractory angina patients that gives them self-management techniques such as safe exercises, pacing, energy conservation, and sleep quality enhancement.

You may also be prescribed medications, such as nicorandil and trimetazidine. These are both specialized medications for the pain. Nicorandil works by widening the blood vessels to reduce chest pain while Trimetazidine increases blood flow to the heart to reduce pain.

If you have heart disease, seek medical help before the symptoms worsen. Following medical guidelines for management of the pain is essential. Most importantly, limit the activities that may weigh on your heart, such as intense exercises and lifting heavy loads.

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Last Reviewed:
June 14, 2017
Last Updated:
October 10, 2017