New Treatments for Chronic Angina

Physicians at the University of Chicago Hospitals Cardiac Center are offering some innovative treatment options for people who suffer from chronic angina--a common, sometimes disabling, symptom of coronary artery disease. Angina is recurring chest pain or discomfort caused by reduced blood flow to the heart.

Traditionally, most people with severe angina find adequate relief with drug therapy, angioplasty, or coronary artery bypass graft surgery. However, a significant portion of people who undergo these FDA-approved and effective treatments still experience troubling chest pain. And, in some cases, people are not candidates for angioplasty, stents, or surgical intervention--leaving little hope for pain relief. Many of these people are told they have no further options to treat their ischemic heart disease. (Ischemic heart disease refers to heart problems caused by narrowed arteries that reduce the amount of oxygen-rich blood flow to heart muscle.)

John J. Lopez, MD, director of cardiac catheterization and interventional cardiology at the University of Chicago Hospitals, is challenging the "no option" notion. "No person with severe coronary artery disease and chronic angina should be viewed as having exhausted all treatment options after consideration of traditional bypass and catheterization approaches," he says.

"There are several investigational and FDA-approved treatments for people with angina," Dr. Lopez adds. "These options are especially beneficial for people who are not candidates for angioplasty or bypass surgery due to age, additional heart problems, or other health concerns."

The University of Chicago Chronic Angina Program

Dr. Lopez and his colleagues at the University of Chicago Hospitals have formed a unique, multidisciplinary program specifically designed to help people who have chronic angina that cannot be relieved by traditional treatment methods. The University of Chicago Chronic Angina Program brings together specialists from cardiology, anesthesiology (pain management), and cardiac surgery to provide focused and innovative ways to treat angina. These scientists are also conducting research into new and better ways to treat chronic angina.

Angiogenesis/Gene Therapy

Dr. Lopez and his colleagues from the University of Chicago Chronic Angina Program can offer a wide range of alternative methods to treat chronic ischemic heart disease. One option currently under investigation involves "angiogenesis," the formation of new blood-flow pathways. U of C physicians are studying the use of gene therapy to trigger the creation or enlargement of blood vessels to the heart; thereby improving previously impaired blood flow. These substances are delivered directly into the arteries. If successful, this gene therapy treatment may either reduce or stop angina, and decrease the severity of heart disease.

Spinal Stimulation

Another method under study works to block the sensation of chest pain. This approach, called spinal stimulation, involves the implantation of a small device that sends low-voltage electrical stimulation to the spinal cord in interrupt pain fibers. Similar devices are currently used to treat patients with back and leg pain. The University of Chicago Hospitals Cardiac Center is involved in a 14-site national study to determine the effectiveness of this approach.

Enhanced External Counterpulsation

One uncommon, FDA-approved option for angina is enhanced external counterpulsation (EECP). This noninvasive approach uses three large inflatable cuffs that are wrapped around the legs and buttocks. These cuffs, much like blood pressure cuffs, are then sequentially inflated to assist blood flow through the body. "Many people who have EECP experience less chest pain. Some are also able to exercise for longer periods of time," Dr. Lopez notes.

Transmyocardial Laser Revascularization

Cardiac Center heart surgeons are using lasers to reduce cardiac chest pain. Transmyocardial laser revascularization (TMR) is an FDA-approved surgical technique that uses lasers to create small holes in heart muscle. These laser "channels" may destroy nerve fibers that cause pain or they may stimulate new blood vessels to grow.

"If left untreated, chronic angina can lead to an inactive lifestyle that only contributes to disease progression," Dr. Lopez says. "These new treatment techniques offer hope to patients who had little to no options for pain relief or treatment for their heart disease."

More Information

• Diagnostic Services
• Medical & Nonsurgical Care
• Angioplasty
• Coronary Bypass Surgery
• Chronic Angina Program