Influence of Stellate Ganglion Block on Angina Pectoris and the Post-Exercise Electrocardiogram

Wiener, Lewis; Cox, J. W.

doi:10.1097/00132586-196706000-00049

Cited by 6 publications

(6 citation statements)

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“…When considering RAP, a diagnostic blockade of the lower cervical sympathetic structures or the upper thoracic sympathetic ganglia could be performed if there is a suspected contribution of the sympathetic (vegetative) nervous system in ischaemic myocardial pain 14 . The sympathetic nervous system is thought to play a significant role during myocardial ischaemia with both sympathetic activation pathways, humoral and neurogenic, being involved.…”

Section: Sympathetic Nerve Blocksmentioning

confidence: 99%

Interventional treatment of pain in refractory angina. A review

Dobias¹,

Michálek²,

Neužil³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Refractory angina is characterized by repeated attacks of chest pain in patients on maximal anti-anginal pharmacotherapy, with a professional conscensus that further surgical or radiological revascularization would be futile. Refractory angina is a serious but relatively uncommon health problem, with a reported incidence of approximately 30 patients per million people/year. In this condition simply treating the associated pain alone is important as this can improve exercise tolerance and quality of life.Methods. An extensive literature search using five different medical databases was performed and from this, eightythree papers were considered appropriate to include within this review. Results and Conclusion. Available literature highlights several methods of interventional pain treatment, including spinal cord stimulation and video-assisted upper thoracic sympathectomy which can provide good analgesia whilst improving physical activities and quality of life. The positive effect of spinal cord stimulation on the intensity of pain and quality of life has been confirmed in nine randomized controlled trials. Other potential treatment methods include stellate ganglion blocks, insertion of thoracic epidural or spinal catheters and transcutaneous electrical nerve stimulation. These approaches however appear more useful for diagnostic purposes and perhaps as short-term treatment measures.

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Section: Sympathetic Nerve Blocksmentioning

confidence: 99%

Interventional treatment of pain in refractory angina. A review

Dobias¹,

Michálek²,

Neužil³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Several adjunctive therapies are available to patients with refractory angina, including stellate ganglion blockade, 42 electrical neuromodulation devices such as transcutaneous electrical nerve stimulation (TENS) 43 and spinal cord stimulation (SCS), 44 enhanced external counter-pulsation(EECP) 45 and transmyocardial laser revascularisation (TMLR) 46 . However previous studies indicate such interventions fail to provide a universal impact on the chest pain and dyspnoea associated with refractory angina.…”

Section: Refractory Anginamentioning

confidence: 99%

The expanding role of lipoprotein apheresis in the treatment of raised lipoprotein(a) in ischaemic heart disease and refractory angina

Khan

Pottle

Pennell

et al. 2014

Global Cardiology Science and Practice

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It is increasingly recognised that lipoprotein(a) [Lp(a)], an inherited, genetically-determined form of LDL-cholesterol, is an independent cardiovascular risk factor and predictor of adverse cardiovascular outcomes. Lp(a) is felt to increase cardiovascular risk via its pro-thrombotic effect and by enhancing intimal lipoprotein deposition. Lipoprotein apheresis is currently the most effective treatment for raised Lp(a). There is a growing body of evidence suggesting that aggressively lowering raised Lp(a) may improve cardiovascular and clinical outcomes, although much more research is required in this field.Angina which is refractory to conventional medical therapy and revascularisation, is extremely challenging to manage. Treatment options for such patients remain very limited. We describe the case of a patient with refractory angina and raised lipoprotein(a) in whom aggressive reduction of Lp(a) with lipoprotein apheresis successfully ameliorated the progression of coronary stenosis and provided effective and durable relief of angina symptoms. In our centre, we are currently conducting a prospective, randomised controlled cross-over study of patients with refractory angina and raised Lp(a), randomised to undergoing lipoprotein apheresis or ‘sham’ apheresis with assessment of myocardial perfusion, carotid atherosclerosis, endothelial vascular function, thrombogenesis, oxidised phospholipids and their antibodies, exercise capacity, angina symptoms and quality of life at the beginning and end of treatment.

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“…Despite this concern, left stellate ganglionectomy (removal of cardiac afferent and efferent fibers) is effective for individuals with intractable angina (57). Studies in patients with angina documented that left stellate ganglionectomy prevented anginal attacks and improved exercise tolerance (9,34,57,74). Schwartz (57) suggested that the cardioprotective effect of left stellate ganglionectomy was the elimination of the excitatory cardio-cardiac sympathetic reflex which initiates angina.…”

Section: Limitationsmentioning

confidence: 99%

Cardiac spinal deafferentation reduces the susceptibility to sustained ventricular tachycardia in conscious rats

Lujan

Krishnan

DiCarlo

2011

American Journal of Physiology-Regulatory, Integrative and Comp

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Lujan HL, Krishnan S, DiCarlo SE. Cardiac spinal deafferentation reduces the susceptibility to sustained ventricular tachycardia in conscious rats. Am J Physiol Regul Integr Comp Physiol 301: R775-R782, 2011. First published June 15, 2011 doi:10.1152/ajpregu.00140.2011The response to myocardial ischemia is complex and involves the cardio-cardiac sympathetic reflex. Specifically, cardiac spinal (sympathetic) afferents are excited by ischemic metabolites and elicit an excitatory sympathetic reflex, which plays a major role in the genesis of ventricular arrhythmias. For example, brief myocardial ischemia leads to ATP release, which activates cardiac spinal afferents through stimulation of P2 receptors. Clinical work with patients and preclinical work with animals document that disruption of this reflex protects against ischemia-induced ventricular arrhythmias. However, the role of afferent signals in the initiation of sustained ventricular tachycardia has not been investigated. Therefore, we tested the hypothesis that cardiac spinal deafferentation reduces the susceptibility to sustained ventricular tachycardia in adult (12-15 wk of age), conscious, male Sprague-Dawley rats. To test this hypothesis, the susceptibility to ventricular tachyarrhythmias produced by occlusion of the left main coronary artery was determined in two groups of conscious rats: 1) deafferentation (bilateral excision of the T1-T5 dorsal root ganglia) and 2) control (sham deafferentation). The ventricular arrhythmia threshold (VAT) was defined as the time from coronary occlusion to sustained ventricular tachycardia resulting in a reduction in arterial pressure. Results document a significantly higher VAT in the deafferentation group (7.0 Ϯ 0.7 min) relative to control (4.3 Ϯ 0.3 min) rats. The decreased susceptibility to tachyarrhythmias with deafferentation was associated with a reduced cardiac metabolic demand (lower rate-pressure product and ST segment elevation) during ischemia. cardiovascular risks; ischemia; dorsal root ganglia SUDDEN CARDIAC DEATH (SCD) causes more than 350,000 deaths annually in the United States (1,76,78) and is most commonly caused by ventricular tachyarrhythmias that culminate in ventricular fibrillation (VF) (6, 28). The most common cause of SCD is acute myocardial ischemia. Multiple ischemic metabolites, including ATP, thromboxane A2, serotonin (5-hydroxytryptamine), histamine, lactic acid (protons), reactive oxygen species, and bradykinin are released during myocardial ischemia and reperfusion and stimulate cardiac spinal afferents (5, 24 -27, 45, 53, 70, 71) leading to angina pectoris and excitatory cardiac-cardiovascular reflex responses (35,45,49). The excitatory cardiac-cardiovascular reflex plays a major role in the genesis of ventricular arrhythmias (59). Disruption of this excitatory sympathetic reflex has been used successfully to reduce arrhythmias in high-risk patients with structural heart disease (8), following myocardial infarction (67), patients with long QT syndrome (19,62), and patients with cat...

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Influence of Stellate Ganglion Block on Angina Pectoris and the Post-Exercise Electrocardiogram

Cited by 6 publications

References 0 publications

Interventional treatment of pain in refractory angina. A review

Interventional treatment of pain in refractory angina. A review

The expanding role of lipoprotein apheresis in the treatment of raised lipoprotein(a) in ischaemic heart disease and refractory angina

Cardiac spinal deafferentation reduces the susceptibility to sustained ventricular tachycardia in conscious rats

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