Why treatments don't always work
		Non-traditional alternatives
		Enhanced external counterpulsation(EECP)
		Transmyocardial revascularization (TMR)
		Spinal cord stimulation (SCS)

Perhaps you and your doctor have tried various options to help control your angina attacks. You may have tried one or several medications, and even possibly non-surgical and surgical procedures. You've exhausted the traditional options, but your angina pain continues to be unrelenting. What can you do?

The following is an overview of non-standard treatments you may want to discuss with your doctor. Only your doctor can determine if these therapies are safe for you to try.

Why treatments don't always work

First, you may wonder why traditional drugs and surgery may not always solve your angina problems.

Medicines.
Finding just the right medicine—or combination of medicines—can be a matter of trial and error. Some people may not be able to take certain medicines because they have other illnesses. Side effects may also be a problem; the chance of experiencing side effects may be increased if a person is taking multiple medications. Some people may be so ill that medications aren't effective at controlling all the symptoms. And not taking medications strictly to your doctor's order may not provide the drug levels needed to treat the condition. All of these situations may result in less than satisfactory results for controlling your angina.

Surgical and non-surgical heart procedures. Some people are unable to tolerate heart procedures. For people who have other chronic illnesses or whose overall health is poor, surgery may not be an option at all. Or, your coronary artery disease may be too widespread throughout the heart. In this case, a procedure to correct all the damage may not be possible.

In the same way fingerprints differ among people, the pathways the coronary arteries take around the heart may differ, too. If the pathways are complicated, surgery may be too difficult—and too risky—to try. And for some people who have tried surgery once, it may be too risky to try again.

Non-traditional alternatives

Some intriguing techniques for easing angina pain and improving your heart's health include the following.

Enhanced external counterpulsation (EECP).^1,2,3 Sometimes called a "natural bypass," enhanced external counterpulsation (EECP) does not involve surgery. The procedure works by increasing blood flow to the areas of the heart that may not be getting adequate blood supply. Cuffs are placed over the legs and rhythmically inflated and deflated. The timing is based on your electrocardiogram (EKG) signals.

Studies to date indicate this treatment improves painful angina symptoms and depression related to angina. It also appears to be safe. However, a significant time commitment is involved. You must devote up to 35 hours of treatment divided into one or two 60-minute sessions five days per week for seven weeks.

Transmyocardial revascularization (TMR). Transmyocardial revascularization,⁴ or TMR, uses a laser to make small channels in the wall of the heart into the pumping chamber. It is believed that the increase in the flow of oxygen-rich blood through these channels helps small new blood vessels grow, a process called angiogenesis.

More recent research suggests TMR may not work as well as surgeons originally believed.^5,6,7 In the past, this procedure has been done during open-heart surgery. But the risk can be high. Open-heart surgery is risky anyway, with or without TMR. Recent studies seem to show that using a small surgical cut (incision) through the skin and not opening the chest may be safer. However, larger studies are needed to confirm this finding.

Spinal cord stimulation (SCS). Ill health or other problems may also make traditional therapies such as angioplasty and open heart surgery out of the question. In these cases, some patients have sought relief through spinal cord stimulation, or SCS.

In this procedure, electrodes are inserted into tissues that surround the backbone. The electrodes are then connected to an electrical generator, implanted under the skin, that emits electrical signals that may reduce angina pain or discomfort. According to an article in Clinical Cardiology, spinal cord stimulation may work by changing the way you feel pain. It may also help increase blood flow through the coronary arteries, and possibly reduce signals from the nervous system for the heart to beat stronger and faster.⁸

Possible drawbacks may include dislocation or breakage of the electrodes and infection. Spinal cord stimulation is a reversible procedure; the equipment can be removed if necessary.

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Sources

1. Barsness, G., A.M. Feldman, et al. "The International EECP Patient Registry (IEPR): Design, Methods, Baseline Characteristics, and Acute Results." Clinical Cardiology, 2001, Vol. 24, Number 6. 435-442. PubMed

2. Lawson, W.E., J.C. Hui, and P.F. Cohn. "Long-Term Prognosis of Patients with Angina Treated with Enhanced External Counterpulsation: Five-Year Follow-Up Study." Clinical Cardiology, 2000, Vol. 23, Number 4. 254-258. PubMed

3. Springer, S., A. Fife, et al. "Psychosocial Effects of Enhanced External Counterpulsation in the Angina Patient: A Second Study." Psychomatics, 2001, Vol. 42, Number 2. 124-132. PubMed

4. Shawl, F. "Clinical Internventional Approaches to Patients with Diffuse Coronary Artery Disease." Journal of Invasive Cardiology, 2001, Vol. 13, Number 3. 251-254. PubMed

5. Thambar, S., L.L. Johnson, et al. "Inability of Computer-Guided Endomyocardial Laser Revascularization To Relieve Ischemia Acutely: Observations from a Porcine Coronary Occlusion Model." American College of Cardiology Annual Meeting, 2001. Abstract #1224-39.

6. Nahrendorf, M., K. Hiller, et al. "Transmyocardial Laser Revascularisation Improves Perfusion but Enhances Left Ventricular Remodeling in Rats After Myocardial Infarction." American College of Cardiology Annual Meeting, 2001. Abstract #1224-41.

7. Allen, R.J., S.R. Redwood, and D.J. Coltart. "Percutaneous Myocardial Laser Revascularisation (PMR): Is the Symptomatic Benefit Maintained to Two Years?" American College of Cardiology Annual Meeting, 2001. Abstract #821-2.

8. Latif, O.A., et al. "Spinal cord stimulation for chronic intractable angina pectoris: a unified theory on its mechanism." Clinical Cardiology, 2001: 24: 533-541. PubMed