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Musculoskeletal chest pain in patients with stable angina pectoris – diagnosis and treatment Ph.D. Thesis Henrik Wulff Christensen Faculty of Health Sciences University of Southern Denmark Department of Clinical Physiology and Nuclear Medicine, Odense University Hospital 2004 Page 2 Musculoskeletal chest pain in patients with stable angina pectoris – diagnosis and treatment Ph.D. Thesis Henrik Wulff Christensen Faculty of Health Sciences University of Southern Denmark Department of Clinical Physiology and Nuclear Medicine, Odense University Hospital 2004 Page 3 2 The thesis is based on the following 4 part projects: Part project I Christensen HW, Vach W, Vach K, Manniche C, Haghfelt T, Hartvigsen L, Høilund-Carlsen PF. Palpation of the upper thoracic spine: an observer reliability ...

Spinal Cord Stimulation for Chronic Intractable Angina Pectoris : A Unified Theory on Its Mechanism O SMAN A. L ATIF , M . D ., S RDJAN S. N EDELJKOVIC , M . D ., L YNNE W ARNER S TEVENSON , M . D . Department of Medicine, Cardiovascular Division and Department of Anesthesia, Perioperative, and Pain Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, USA Summary: The use of spinal cord stimulation (SCS) for chronic intractable anginal pain was first described in 1987. Numerous studies havedemonstrated its efficacy in improving exercise tolerance, decreasing frequency of anginal episodes, and prolonging time to electrocardiographic signs of ischemia. ...

angina pectoris Pathophysiology of Angina Pectoris Angina is the sign of myocardial ischemia. Main presentation is retrosternal chest pressure. Coronary flow reserve is the maximal increase in coronary blood flow from vasodilation above resting levels. Demand for coronary blood flow increases with heart rate , contractility (sympathetic activation), and myocardial wall tension (high afterload (HTN) or preload) . Large arteries offer little resistance to coronary blood flow. Coronary arterioles are highest resistance . Normally these coronary arterioles can dilate to meet oxygen demand, but in atherosclerosis they can’t. Myocardial blood flow = **Compressive forces of the heart are highest on the coronary arterioles of the subendocardium . Therefore, the LV subendocardium ...

Indexed in Chemical Abstracts EMBASE/Excerpta Medica J ournal of Clinical and Basic Cardiology An Independent International Scientific Journal Krause & Pachernegg GmbH · VERLAG für MEDIZIN und WIRTSCHAFT · A-3003 Gablitz/Austria Homepage: www.kup.at/jcbc Online Data Base Search for Authors and Keywords Journal of Clinical and Basic Cardiology 2000; 3 (Issue 2), 129-132 Talinolol in patients with stable angina pectoris and concomitant hypertension Chrustalev OA, Galimskaja LJ, Gerasimov VG, Konopljanik NV Moshejko ME, Patrunova OS, Rjabichin EA Page 2 J Clin Basic Cardiol 2000; 3: 129 ORIGINAL PAPERS, CLINICAL CARDIOLOGY Talinolol in Angina Pectoris and Hypertension Received April 28 th , 2000; accepted July 3 rd ...

Indexed in Chemical Abstracts EMBASE/Excerpta Medica J ournal of Clinical and Basic Cardiology An Independent International Scientific Journal Krause & Pachernegg GmbH · VERLAG für MEDIZIN und WIRTSCHAFT · A-3003 Gablitz/Austria Homepage: www.kup.at/jcbc Online Data Base Search for Authors and Keywords Journal of Clinical and Basic Cardiology 2000; 3 (Issue 1), 29-34 Efficacy of slow-release Nifedipine Talinolol and combination in Angina Pectoris (NITAAP) Kuleshova EV, Abezgauz IA, Antonova IS, Bieberstein D Borisenko LV, Gusarov GV, Kantsevitch IA, Kraul H Lokhovinina NL, Perepech NB, Tsay NV Page 2 J Clin Basic Cardiol 2000; 3: 29 The NITAAP Study ORIGINAL PAPERS, CLINICAL Received December 1 st , 1999; accepted December ...

Indexed in Chemical Abstracts EMBASE/Excerpta Medica J ournal of Clinical and Basic Cardiology An Independent International Scientific Journal Krause & Pachernegg GmbH · VERLAG für MEDIZIN und WIRTSCHAFT · A-3003 Gablitz/Austria Homepage: www.kup.at/jcbc Online Data Base Search for Authors and Keywords Journal of Clinical and Basic Cardiology 2000; 3 (Issue 2), 99-101 Long-term results of coronary balloon angioplasty in unstable angina pectoris Halon DA, Flugelman MY, Lewis BS, Merdler A, Rennert H Shahla J Page 2 J Clin Basic Cardiol 2000; 3: 99 FOCUS ON CORONARY SYNDROMES Long-Term Results of Coronary Balloon Angioplasty T he clinical syndrome of unstable angina pectoris is char- acterized by new recurrent episodes of ischaemic pain ...

24 ( Angina pectoris ) Page 2 25 (wood) (Alcoholic cardiomyopathy) (Glyceride) (Triglycerides) (Cholestrol) (Thrombus) (Necrosis) (High Density Lipoproteins) (HDL) disease) (Ischemic heart contration couping) (Excitation (Contractile proteins) (Acetaldehyde) (depressant effect) (Stroke volume) Page 3 26 (Cardiac output) reflexes) (Cardiovascular (Stress) (E. C. G,) (Dysrrhythmias) The Holiday) (Heart Syndrome (Paroxysmal Atrial Tachycardia) Beats) (Atrial & Ventricular Ectopic (Tachycardia Sinus) (Ventricular Tachycardia) (Atrial Fibrllation) (Conductive system) (Alcoholic Cardiomyopathy) Page 4 27 (Beer drinker's cardiomyopathy) shine) (Moon failure) ...

Diagnosis and Management of Angina Pectoris Dr. Lo Ying-Sui, Archie MD(Chicago), FRCPC, FACP Fellow, American Heart Association Council on Clinical Cardiology Introduction Coronary artery disease is the leading cause of cardiovascular mortality in Hong Kong, and physicians in our community frequently encounter patients with cardiac problems at all different levels of practice. The last 20-30 years have seen tremendous advances in the field of cardiology. Results of voluminous research are being published each month in the cardiological literature. The advent of coronary artery bypass graft surgery 1-6 and percutaneous transluminal coronary angioplasty 7-10 hasrevolutionised the therapeutic armamentarium in the treatment of coronary artery disease. Despite these technological breakthroughs, however, there remains one part of the treatment ...

A BASIC INFORMATION DESCRIPTION Chest pain arising from the heart, usually under the ster- num (breastbone), due to a lack of oxygen to the heart muscle. It can be brought on by exercise, emotional upset or heavy meals in a person who has a heart disor- der. Normally the arteries that supply blood to the heart can cope with an increased demand, but if coronary artery disease is present or high blood pressure, the flow is restricted. It affects men over age 35 and post- menopausal women. FREQUENT SIGNS AND SYMPTOMS • Tightness, squeezing, pressure or ache in the chest. • Sudden breathing difficulty (sometimes). • Chest pain similar to indigestion. • A choking feeling in the throat. • Chest pain that radiates to the jaw, teeth or earlobes. • Heaviness, numbness, tingling or ache in the chest, arm, shoulder, elbow or hand usually on the left side. • Pain between the ...

DRG 140 - ANGINA PECTORIS ICD-9-CM CODING GUIDELINES The below listed angina guidelines are not inclusive. The coder should refer to the applicable Coding Clinic guidelines for additional information. The Centers for Medicare & Medicaid Services considers Coding Clinic , published by the American Hospital Association, to be the official source for coding guidelines. Hospitals should follow the Coding Clinic guidelines to assure accuracy in ICD-9-CM coding and DRG assignment. Definition of Principal Diagnosis The principal diagnosis is that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care. Two or more diagnoses may equally meet the definition for principal diagnosis. This is in terms of the circumstances of admission, diagnostic work-up and/or therapy provided. Be aware that there is a difference between admitting ...

This material was produced by TMF Health Quality Institute, the Medicare Quality Improvement Organization for Texas, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 8SOW-TX-HPPE-06-06 Rev. 3/06 1 of 3 DRG 140 ( Angina Pectoris ) Review Worksheet Instructions Purpose This review worksheet can be used to evaluate simple coding errors as well as complex errors that impact the DRG assignment. It can be used to identify problems in coding or DRG assignment, to monitor improvement in coding or DRG assignment and/or to identify problems related to the medical necessity of admission. The worksheet can be used in either postpayment or prepayment review. Preparation Review the related coding conventions and guidelines, and be aware of ...

Spinal cord stimulation for refractory angina pectoris : a retrospective analysis of efficacy and cost-benefit W. Yu, F. Maru, M. Edner, K. Hellström, T. Kahan, and H. Persson Section of Cardiology, Division of Internal Medicine, Karolinska Institutet Danderyd Hospital, S-182 88 Stockholm, Sweden Background Patients with refractory angina pectoris have severe symptoms despite of optimal medications, but are not suitable for revascularizations. Spinal cord stimulation (SCS) has been used for treating refractory angina pectoris since 1985. The efficacy of SCS has been proven by randomized controlled trials and follow-up studies have shown that SCS is a safe treatment. The objective of the current study was to retrospectively analyse the clinical outcomes and cost- benefit of SCS in patients with refractory angina pectoris . Methods Under local anaesthesia, an electrode was introduced ...

Peripheral Percutaneous Stimulation for Refractory Angina Pectoris . S Kothari, T. Goroszeniuk. Pain management Centre, St. Thomas’ Hospital. London SE1 7EH. UK. Introduction: A proportion of patients suffering with typical chest pain are at increased surgical risk, gain no prognostic benefit from re-vascularisation and are refractory to pharmaceutical manipulations. Literature has shown that in this cohort of patients Spinal Cord Stimulation (SCS) offers demonstrable pain relief1. However SCS is an invasive procedure with its own inherent risks and limitations. Anticoagulant therapy may contraindicate implantation of SCS in some patients. Peripheral Percutaneous Neuromodulation (PPN) is minimally invasive, technically easier and with fewer complications when compared to SCS and offers comparable pain relief in selected cases2. We report on our successful use of peripheral percutaneous neuromodulation ...

SUSTAINED BENEFITS OF NEUROSTIMULATION IN PATIENTS WITH ANGINA PECTORIS AND NORMAL CORONARY ARTERIES J de Vries, MJL DeJongste, MJM Durenkamp, F Zijlstra, MJ Staal. University Medical Centre Groningen. NL Jessica.de.vries@thorax.umcg.nl Introduction: In patients with angina pectoris and normal coronary arteries, conventional medical therapy often fails, leaving these patients with unbearable chest pain and functional limitations. Neurostimulation has been reported to produce beneficial outcomes in terms of efficacy and safety in these patients, though none of the studies have focused on long-term efficacy. Objectives: To evaluate the influence of long-term neurostimulation on quality of life, i.e. the effect on use of medication, occurrence of angina pectoris , exercise capacity, and treatment satisfaction. Methods: Patients with typical angina pectoris in the presence of normal ...

PERSONALITY: PREDICTOR OF NEUROSTIMULATION OUTCOMES IN PATIENTS WITH ANGINA PECTORIS AND NORMAL CORONARY ARTERIES J de Vries, MJL DeJongste, GJ Versteegen, MJM Durenkamp, MJ Staal. University Medical Centre Groningen. NL Jessica.de.vries@thorax.umcg.nl Abstract Introduction: In patients with typical angina pectoris and normal coronary arteries an adequate therapy is lacking, leaving these patients with unbearable chest pain and functional limitations. Neurostimulation has been reported to relieve symptoms of angina pectoris and improve exercise tolerance. However, neurostimulation is not effective in all of these patients. Since psychological features as a high degree of anxiety have been reported in these patients with angina pectoris and normal coronary arteries, we thought to study patients’ personality. Objectives: To study baseline characteristics and personality, seeking ...

ELECTRODE DISPLACEMENT IN SPINAL CORD STIMULATION (SCS) FOR ANGINA PECTORIS : CORRESPONDENCE BETWEEN PARAESTHESIA AREA AND PAIN REGION CAN BE RE-ESTABLISHED BY IMPLANTING A SECOND LEAD WITHOUT USING A DUAL CHANNEL PULSE GENERATOR C Scherer, T Enggaard, C Andersen ESES-Unit, Dep. of Anaesthesiology and Intensive Care, Odense University Hospital, Denmark Introduction: Covering the pain region with electrically provoked paraesthesia using TENS (Transcutaneous Electrical Neurostimulation) or SCS has been proofed to be efficient treatment options in otherwise intractable angina pectoris , which is CCS class III – IV angina despite maximum treatment with at least 2 drugs out of beta-blockers, Ca++-antagonists or long acting nitrates and the lack of (further) invasive treatment possibilities. Effectiveness can be assessed by a decreasing consumption of short acting nitrates and/or opioids, a decrease ...

Interim Analysis of the German Registry for Neurostimulation in Refractory Angina Pectoris Eddicks, Stephan1, Eckert, Siegfried2, Maier, Christoph3, Baberg, Henning3, Arnold, Hans4, Böker, Dagmar4, Harmann, Beate5, Theres, Heinz1, Deutschland Register für SCS bei refraktärer Angina [German Registry for SCS in Refractory Angina ] (MCP Abbreviation for the Program: RAP Registry) 1 Cardiology, Angiology and Pulmonology, Charité Campus Mitte, Berlin, 2 NRW Heart Center, Bad Oeynhausen, 3 BG Clinics Bergmannsheil, Ruhr University, Bochum, 4 Schleswig-Holstein University Hospital, Lübeck, 5 Medtronic GmbH, Düsseldorf Introduction: Spinal cord stimulation (SCS) as a symptom-orientated procedure is gaining increasing acceptance in the treatment of refractory angina pectoris (RAP) in end stage coronary heart disease when no other conventional therapeutic options are available. The exact mechanism ...

OPTISTIM-Study: spinal cord stimulation in patients with refractory angina pectoris Stephan Eddicks, *Michael Schenk, ²Klaus Maier-Hauff, Gert Baumann, Heinz Theres Cardiology, Angiology and Pulmonology, Charité CCM, Berlin, Germany *Anaesthesiology, Charitè CCM, Berlin, Germany ²Neurosurgery, Army hospital Berlin, Germany Introduction: spinal cord stimulation (SCS) is becoming more and more attractive as an alternative treatment-option for patients suffering from refractory angina (RAP). The efficacy and safety of SCS is well described but there is still a lack of placebo-controlled randomized trials. OPTISTIM was designed as a prospective, monocentre, double-blind and placebo-controlled randomized pilot- trial. It is the first placebo-controlled clinical trial for the investigation of SCS in RAP. Methods: Patients (n=12) had to be implanted with an SCS-Device for at least 3 months and ...

External Counterpulsation for Angina Pectoris PURPOSE OF THE POLICY To provide coverage information for specific medical conditions and procedures. STATEMENT OF THE POLICY This medical policy is proprietary information and should not be distributed outside of Health Alliance unless authorized by the Medical Management Department. BENEFITS External Counterpulsation for Angina Pectoris is a provisionally covered medical benefit. DESCRIPTION External Counterpulsation for Angina Pectoris involves the sequential compression of cuffs wrapped around the patients calves and thighs, which increases the diastolic aortic pressure and coronary perfusion pressure. The treatment is administered one to two hours daily, 4-5 days per week for an average total of 35 sessions. INTERPRETATION External Counterpulsation for Angina Pectoris is a covered ...

Technology Evaluation Center BlueCross BlueShield Association ® ® An Association of Independent Blue Cross and Blue Shield Plans ©2005 Blue Cross and Blue Shield Association. Reproduction without prior authorization is prohibited. 1 NOTICE OF PURPOSE: TEC Assessments are scientific opinions, provided solely for informational purposes. TEC Assessments should not be construed to suggest that the Blue Cross Blue Shield Association, Kaiser Permanente Medical Care Program or the TEC Program recommends, advocates, requires, encourages, or discourages any particular treatment, procedure, or service; any particular course of treatment, procedure, or service; or the payment or non-payment of the technology or technologies evaluated. Assessment Program Volume 20, No. 12 December 2005 Executive Summary Background External counterpulsation ...

External Counterpulsation Therapy Improves Endothelial Function in Patients With Refractory Angina Pectoris Michael Shechter, MD, MA, FACC, Shlomi Matetzky, MD, Micha S. Feinberg, MD, Pierre Chouraqui, MD, FACC, Zeev Rotstein, MD, Hanoch Hod, MD, FACC Tel Aviv, Israel OBJECTIVES The goal of this study was to investigate the influence of short-term external counterpulsation (ECP) therapy on flow-mediated dilation (FMD) in patients with coronary artery disease (CAD). BACKGROUND In patients with CAD, the vascular endothelium is usually impaired and modification or reversal of endothelial dysfunction may significantly enhance treatment. Although ECP therapy reduces angina and improves exercise tolerance in patients with CAD, its short-term effects on FMD in patients with refractory angina pectoris have not yet been described. METHODS We prospectively assessed endothelial function in 20 ...

1 Drug Therapy of Angina Pectoris Dr. Qingping Feng • BETA-ADRENERGIC BLICKING AGENTS • CALCIUM CHANNEL BLOCKING AGENTS • ANGINA PECTORIS : PATHOPHYSIOLOGY AND THERAPEUTIC STRATEGY Determinants of Cardiac Oxygen Demand and Oxygen Supply Classic Angina Pectoris (Exertional Angina ) Variant Angina Pectoris (Prinzmetal’s Angina , Vasospastic Angina ) • ORGANIC NITRATES Nitroglycerin Other Organic Nitrates Amyl Nitrite Definition of Angina Pectoris • Angina Pectoris is defined as sudden pain beneath the sternum, often radiating to the left shoulder and arm. • Anginal pain is precipitated when the oxygen supply to the heart is insufficient to meet oxygen demand. • Most often, anginal pain occurs secondary to atherosclerosis of the coronary arteries. Effect of exertion on the balance between oxygen ...

1 Drug Therapy of Angina Pectoris Dr. Qingping Feng WHAT IS ANGINA PECTORIS ? Angina pectoris is defined as sudden pain beneath the sternum, often radiating to the left shoulder and arm. Anginal pain is precipitated when the oxygen supply to the heart is insufficient to meet oxygen demand. Most often, anginal pain occurs secondary to atherosclerosis of the coronary arteries. Hence, angina should be seen as a symptom of disease and not as a disease in its own right. Three drug families are used to treat angina . These are the organic nitrate (e.g., nitroglycerin), the beta blockers (metoprolol, propranolol), and the calcium channel blockers (e.g., verapamil). ANGINA PECTORIS : PATHOPHYSIOLOGY AND TREATMENT STRATEGY Angina pectoris has two major forms: (1) classic angina (exertional or effort-induced angina ) and (2) variant angina (Prinzmetal’s or vasospastic ...

1 Angina Dr Jasmine Henderson, Pharmacology, University of Sydney What you should know • What is angina ? • How is it treated? • Side effects of treatment What is angina pectoris ? • Ischaemic pain (warning sign) • Imbalance in supply & demand O2 • Coronary artery narrowed/spasm • Silent vs stable vs unstable vs variant angina • Location: chest, arms and neck • Risks: obesity & age Factors affecting supply/demand • Intramyocardial tension - main O2 user • Aerobic metabolism (venous blood desaturated) • HR • Amount of arterial block (normally =5x dilation) • Collateral vessels • When total block arteries- acute myocardial infarct (AMI), irreversible damage (3 mins) Treatment of angina • Nitrates/nitrites • B-blockers • Ca Channel blockers • K channel ...

DRUGS FOR THE TREATMENT OF ANGINA PECTORIS (ISCHEMIC HEART DISEASE) Angina pectoris literally means “chest pain” and this usually occurs upon exertion. When the patient exerts him/herself, the oxygen demand of the heart goes up (as does HR). Coronary arteries that are occluded by fatty plaques or that undergo vasospasm cannot deliver sufficient oxygenated blood to the myocardium. As a result, local ischemia sets in, and mediators released during this ischemia cause chest pain which may radiate into the left arm or jaw. Exertional angina (or stable angina ) is one type of the disease; unstable angina (which indicates progression of the blockage to the heart) and variant (also called Prinzmetal’s or vasospastic) angina are other forms. In all cases, the goal is to increase oxygen delivery to the heart, OR to decrease cardiac work. These goals may be met using vasodilators (nitrates or calcium ...

Angina Pectoris What is angina pectoris ? Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease. Angina is a symptom of a condition called myocardial ischemia. It occurs when the heart muscle (myocardium) doesn't get as much blood (hence as much oxygen) as it needs. This usually happens because one or more of the heart's arteries (blood vessels that supply blood to the heart muscle) is narrowed or blocked. Insufficient blood supply is called ischemia. Angina als...

Angiogenic Gene Therapy (AGENT) Trial in Patients With Stable Angina Pectoris Cindy L. Grines, MD; Matthew W. Watkins, MD; Greg Helmer, MD; William Penny, MD; Jeffrey Brinker, MD; Jonathan D. Marmur, MD; Andrew West, MD; Jeffery J. Rade, MD; Pran Marrott, MRCP, MSc; H. Kirk Hammond, MD; Robert L. Engler, MD Background —The angiogenic response to myocardial ischemia can be augmented in animal models by gene transfer with the use of a replication defective adenovirus (Ad) containing a human fibroblast growth factor (FGF) gene. Methods and Results —The objectives of the Angiogenic GENe Therapy (AGENT) trial were to evaluate the safety and anti-ischemic effects of 5 ascending doses of Ad5-FGF4 in patients with angina and to select potentially safe and effective doses for subsequent study. Seventy-nine patients with chronic stable angina Canadian Cardiovascular Society class 2 or 3 underwent double-blind ...

The Eighteenth-Century Origins of Angina Pectoris : Predisposing Causes, Recognition and Aftermath Leon Michaels London: The Wellcome Trust Center for the History of Medicine at UCL. 2001. xvii + 219 p. US$50 William Hebredon’s concise and remarkably accurate description of angina pec- toris was presented at the Royal College of Physicians in London in 1768. Leon Michael proposes that this symptom complex was indicative of a new disease rather than an old one that had not previously been recognized; that it occurred in England before it was observed in continental Europe; and that it was caused by changing social and dietary habits in the 18th century. Among the many changes in that era, those that he felt were most likely related to the etiology of the new disease occurred in agriculture. Medical reports from ancient Greece on revealed only 10 examples of symp- toms similar to those described by ...

Clinical Effectiveness – Primary Care (PRICCE) STANDARDS FOR THE TREATMENT OF STABLE ANGINA PECTORIS Information on Angina 9.1 Angina pectoris is primarily a clinical diagnosis. Typical history of retrosternal chest pain, relieved by rest, exacerbated by exertion (physical or emotional), cold weather and post-prandially. 9.2 Prevalence and Incidence Crude Incidence Rate of Angina Age 31 - 70 / year/ 1000 patients Men 1.13 Women 0.53 All 0.83 Table 1 Overall Prevalence of Angina Age > 30 years 2.6% Overall 1.5% Average GP with list of 2000 will have 30-40 angina patients Table 2 9.3 Any pain above the diaphragm brought on by exertion and relieved by rest should suggest angina . The pain is classically restrosternal, but may be on either side of the chest or even ...

East Kent Health Authority – Clinical Effectiveness – Primary Care (PRICCE) Guidelines 38 15 April 2003 STANDARDS FOR THE TREATMENT OF STABLE ANGINA PECTORIS Information on Angina 9.1 Angina pectoris is primarily a clinical diagnosis. Typical history of retrosternal chest pain, relieved by rest, exacerbated by exertion (physical or emotional), cold weather and post-prandially. 9.2 Prevalence and Incidence Crude Incidence Rate of Angina Age 31 - 70 / year/ 1000 patients Men 1.13 Women 0.53 All 0.83 Table 1 Overall Prevalence of Angina Age > 30 years 2.6% Overall 1.5% Average GP with list of 2000 will have 30-40 angina patients Table 2 9.3 Any pain above the diaphragm brought on by exertion and relieved by rest should suggest angina . The pain is classically ...