Chronic Chest Pain

Treatment

The following treatment options are available to Mayo Clinic patients, depending on the type, severity and cause of chest pain.

Standard Treatments

Standard treatment begins with coronary angiogram to determine the presence of disease and medication therapy. As disease severity progresses, treatment moves to interventional strategies, such as stents or coronary artery bypass surgery. The majority of patients with coronary artery disease achieve excellent results with these standard therapies.

Treatment of People with Advanced Obstructive Coronary Artery Disease

A growing number of patients with advanced atherosclerotic disease are not responsive to medication therapy, and are no longer candidates for traditional revascularization procedures. To this group of challenging patients, Mayo offers specialized therapeutic options. Recent innovations include:

Enhanced External Counterpulsation (EECP)

EECP is a noninvasive technique that has been used as an outpatient angina treatment for nearly 30 years. In studies at the Mayo Clinic over a three-year period, more than 90 percent of patients treated with it showed improvement. (See Clinical Update article on this subject.)

Transmyocardial Laser Revascularization (TMR) and Therapeutic Angiogenesis

The goal of these treatments is to grow new vessels in the heart. Gene transfer studies are currently underway to devise ways to improve the heart's blood supply.

Spinal Cord Stimulation

This may be used to reduce chest pain symptoms and improve blood flow — although this method is still in the clinical trial stage for the management of end-stage coronary artery disease. It has been used extensively in Europe to relieve symptoms in patients who are no longer candidates for revascularization options.

Treatment of People with No Significant Coronary Artery Disease

Patients with early atherosclerotic disease often have had multiple coronary angiograms showing either normal arteries or minimally diseased arteries. These patients are often uniquely challenging to manage due to the recurrent nature of their pain syndrome. They have frequently undergone extensive, costly and sometimes painful evaluations for noncardiac sources of chest pain — including gastrointestinal and psychological exams.

Patients with severe endothelial dysfunction are treated with drugs shown to improve endothelial function, such as ACE inhibitors, L-arginine and lipid-lowering drugs. Patients are also eligible to participate in studies using new therapies. Tests are performed to establish genetic abnormalities associated with endothelial dysfunction and premature atherosclerosis.