Long-term benefits of stellate ganglion block in severe chronic refractory angina

Chester, Michael R.; Hammond, C; Leach, Austin

doi:10.1016/s0304-3959(00)00270-0

Cited by 51 publications

(32 citation statements)

References 12 publications

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“…23,24 Also, unilateral SGB may be effective in severe chronic refractory angina and prolonged QT-syndrome, which is an electrophysiological disorder. 25,26 One report has also described the use of bilateral cervico-thoracic sympathetic ganglionectomy to treat disabling symptoms due to refractory ventricular tachycardia. 27 However, the effects of SGB on cardiovascular regulation remain controversial.…”

Section: Discussionmentioning

confidence: 99%

Effects of Bilateral Stellate Ganglion Block on Autonomic Cardiovascular Regulation

Song

Hwang

Lee

et al. 2009

Circ J

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Section: Discussionmentioning

confidence: 99%

Effects of Bilateral Stellate Ganglion Block on Autonomic Cardiovascular Regulation

Song

Hwang

Lee

et al. 2009

Circ J

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“…Clinical application of sympathetic blockade has been expanded to patients with hormonal imbalance, psychiatric disorders, and cardiovascular diseases, 27,28 and previous publications have demonstrated that sympathetic blockade can be applied repeatedly without serious adverse effects. 29 We found that monocrotaline treatment led to a significant increase in LF/HF ratio indicating increased sympathovagal balance, whereas SGB attenuated this monocrotaline-induced autonomic balance change.…”

Section: Na Et Al Cervical Ganglion Block In Pulmonary Hypertension 313mentioning

confidence: 99%

Cervical Ganglion Block Attenuates the Progression of Pulmonary Hypertension via Nitric Oxide and Arginase Pathways

Kim²,

Ryoo³

et al. 2014

Hypertension

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Abstract-It has been recognized that the sympathetic nervous system is activated in pulmonary arterial hypertension (PAH), and abnormal sympathetic hyperactivity leads to worsening of PAH via endothelial dysfunction. The purpose of this study was to examine whether sympathetic ganglion block (SGB) can treat PAH by increasing the availability of nitric oxide (NO). PAH was induced in rats by 50 mg/kg of subcutaneous monocrotaline. After 2 weeks, daily injections of ropivacaine into the left superior cervical ganglion were repeated for 14 days (monocrotaline-SGB group). Monocrotaline group received sham SGB with saline, whereas control group received saline instead of monocrotaline. PAH was evident in monocrotaline group, with right ventricular systolic pressures (47±4 mm Hg) that were higher than those of controls (17±2 mm Hg), whereas SGB significantly attenuated monocrotalineinduced PAH (35±4 mm Hg). The right/left ventricular mass ratios exhibited similar changes to those seen with right ventricular pressures. Heart rate variability showed significantly higher sympathetic activity in the monocrotaline group. Microscopy revealed a higher proportion of muscular arteries with thicker medial walls in the monocrotaline group, which was attenuated by SGB. Monocrotaline induced arginase hyperactivity, which was in turn decreased by SGB-induced endothelial NO synthase activation. SGB restored monocrotaline-induced hypoactivity of superoxide dismutase. In conclusion, SGB could suppress PAH and the remodeling of pulmonary arteries via inactivation of arginase and reciprocal elevation of NO bioavailability, thus attenuating disproportionate hyperactivation of the have been reported to attenuate the severity of symptoms and slow the progression of cardiovascular diseases including coronary artery disease, heart failure, and arrhythmias. According to the previous reports, there is a possibility that direct sympathetic nerve blocks are effective in patients with myocardial ischemia or systemic hypertension. 17,19 Given the relationship between sympathetic nervous system hyperactivity and endothelial dysfunction in patients with PAH, blockade of sympathetic hyperactivity may improve vascular reactivity by preserving endothelial function. To date, however, there is limited amount of data on the therapeutic effects of sympathetic ganglion block (SGB) on PAH. The purpose of the present study is to assess the therapeutic effects of SGB in a monocrotaline-induced PAH rat model. In parallel, we investigated whether SGB could attenuate the changes in arginase and NO bioavailability, as well as oxidative stress caused by monocrotaline. MethodsDetailed methods about animal preparation, experimental design, SGB, heart rate variability, hemodynamic analysis, right ventricular mass, pulmonary vessel morphometry, and NO (synthase)/arginase/ cGMP/oxidative stress assay are described in the online-only Data Supplement. Results Right Ventricular Systolic Pressure and Right Ventricular/Left Ventricular Mass RatioRight ventricular systolic pr...

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“…Previous studies have explored the effect of various therapeutic interventions, including stellate ganglion blocks [4], electrical neuromodulation devices, such as transcutaneous electrical nerve stimulation [5] and spinal cord stimulation [6,7], enhanced external counterpulsation [8], percutaneous myocardial laser revascularisation [9] and a specifically designed management program [10]. However, such treatments have failed to demonstrate a universal impact on the chest pain and dyspnoea associated with refractory angina.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Rehabilitation to Improve Physical Functioning in Refractory Angina: A Pilot Study

et al. 2012

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Objectives: Refractory angina patients suffer debilitating chest pain despite optimal medical therapy and previous cardiovascular intervention. Cardiac rehabilitation is often not prescribed due to a lack of evidence regarding potential efficacy and patient suitability. A randomised controlled study was undertaken to explore the impact of cardiac rehabilitation on cardiovascular risk factors, physical ability, quality of life and psychological morbidity among refractory angina sufferers. Methods: Forty-two refractory angina patients (65.1 ± 7.3 years) were randomly assigned to an 8-week Phase III cardiac rehabilitation program or symptom diary control. Physical assessment, Progressive Shuttle Walk test, Hospital Anxiety and Depression Scale, Health Anxiety Questionnaire, the York Angina Beliefs scale, ENRICHD Social Support Instrument and SF-36 were completed before and after intervention and at 8-week follow-up. Results: Following cardiac rehabilitation, patients demonstrated improved physical ability compared with controls in Progressive Shuttle Walk level attainment (p = 0.005) and total distance covered (p = 0.015). Angina frequency and severity remained unchanged in both groups, with the control demonstrating worsening SF-36 pain scale (63.43 ± 22.28 vs. 55.46 ± 23.98, p = 0.025). Cardiac rehabilitation participants showed improved Health Anxiety Questionnaire reassurance (1.71 ± 1.72 vs. 1.14 ± 1.23, p = 0.026) and York Beliefs anginal threat perception (12.42 ± 4.58 vs. 14.35 ± 4.73, p = 0.05) after cardiac rehabilitation. Physical measures were broadly unaffected. Conclusions: Cardiac rehabilitation can be prescribed to improve physical ability without affecting angina frequency or severity among patients with refractory angina.

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Long-term benefits of stellate ganglion block in severe chronic refractory angina

Cited by 51 publications

References 12 publications

Effects of Bilateral Stellate Ganglion Block on Autonomic Cardiovascular Regulation

Effects of Bilateral Stellate Ganglion Block on Autonomic Cardiovascular Regulation

Cervical Ganglion Block Attenuates the Progression of Pulmonary Hypertension via Nitric Oxide and Arginase Pathways

Cardiac Rehabilitation to Improve Physical Functioning in Refractory Angina: A Pilot Study

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