Unstable angina pectoris and spinal cord stimulation

Angina pectoris is characterized by an oppressive pain in the chest due to inadequate blood flow to the heart muscle. If patients with chronic angina are refractory to conservative therapies and cannot undergo coronary revascularization surgery, spinal cord stimulation can be proposed as a possible treatment option. We present a case of a 70 years old female patient, who presented with angina pectoris at rest, which could not be relieved although surgical revascularization and cardiac stenting were performed previously. Angiography was performed but no lesions were found to require the repetition of surgery or cardiac stenting. She could only walk up to 20 meters despite maximum medical therapies. During sleep, chest pain woke her up. An eight-contact paddle electrode was placed with its cephalad tip at the T1-T4 level on the left of the midline followed by test stimulations. The test stimulations should extend over the areas that are painful during angina attacks. The symptoms of the patient improved remarkably in 24 hours. His nitrate consumption could be reduced by 80% by the end of 3 months. If all available medical and invasive treatment options fail, SCS can be used as a viable alternative for treatment.