title: Management options for angina refractory to maximal medical and surgical interventions.
abstract: Despite the seemingly daily advances in the primary, secondary, and tertiary prevention for coronary artery disease, many patients will ultimately experience progression of their disease and experience angina refractory to further active treatment. In these patients, disabling angina occurs at rest or during simple activities of daily living. When this occurs, symptom management, a predominant focus of nursing, becomes the goal of care. Several medical and surgical alternatives are available to patients with refractory angina. Enhanced external counterpulsation and transmyocardial laser revascularization are Food and Drug Administration approved therapies that can be used to attempt to restore the balance of supply and demand. Modulation of sympathetic tone via procedures such as stellate ganglion blocks has also been employed. Other methods to control the pain are techniques that alter pain perception such as spinal opioids, transcutaneous electrical nerve stimulation, and spinal cord stimulation. Too few patients with refractory angina are referred for any of these palliative therapies. Armed with knowledge regarding these therapies, nurses will be better prepared to provide anticipatory guidance to patients and their families and to support the patient's hope for relief as they cope with this devastating condition.
authors.affiliation: School of Nursing, Johns Hopkins University, Baltimore, Maryland 21205-2110, USA. JStanik1@jhmi.edu
authors.forename: Julie A
authors.initials: JA
authors.lastname: Stanik-Hutt
mesh_terms: D000200:Action Potentials; D000203:Activities of Daily Living; D000787:Angina Pectoris / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D000075202:Contraindications; D015908:Counterpulsation / Q000379:methods; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D009204:Myocardial Revascularization / Q000379:methods; D009407:Nerve Block / Q000379:methods; D024802:Nurse's Role; D010147:Pain Measurement / Q000379:methods; D012720:Severity of Illness Index; D012944:Social Support; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods; D014481:United States; D014486:United States Food and Drug Administration