Electrical spinal cord stimulation for the management heart failure?
DOI:
https://doi.org/10.47924/neurotarget2011287Keywords:
chest pain, heart failure, spinal electrical stimulation, lightning strikeAbstract
Introduction: The exact mechanism of action of spinal electrical stimulation (S.E.S.) is still poorly understood, however it is known that one of its mechanisms is the increase in coronary blood flow.
Case report: We describe the case of a 50 year old patient with unstable angina, ischemic heart disease with a fraction of ejection of 17%, who underwent angioplasty of three vessels and implantation of 2 stents. Even though there were persistence distal small vessel occlusive disease, which caused ischemic pain in spite of medical treatment with nitrates, calcium antagonists, beta blockers and aspirin (anti ischemic optimal medical management without pain control). This merited multiple hospitalizations for pain control and management of heart failure because the patient had further functional class 4 according to the The New York Heart Association (NYHA), avoiding the realization of minimum displacements due to pain and dyspnea, For this reason, in conjunction with cardiology, it was decided to perform a spinal electrical stimulator implantation, with the primary objective of alleviating pain and provide quality of life.
Results: Favorable results, in terms of pain control, were achieved. Two years later, the patient suffered lightning injury and decided switching off the stimulator. He went into heart failure which was reversed after turning on the stimulator again.
Conclusions: S.E.S. can be considered as a treatment of choice for nonrevascularizable angina. Due to its effect in increasing coronary blood flow, it might have some benefit and perhaps it could be an accurate indication in patients with refractory heart failure. Further studies are required.
Metrics
References
Rosano GM, Vitale C, Onorati D, Fini M. Quality of life in elderly patients with ischemic cardiopathy.Ital Heart J. 2004 Mar;5 Suppl 2:16S-22S.
Ministerio de Salud, Grupo de Vigilancia en Salud Pública. 2001. Causas de Mortalidad en Colombia por departamento según grupo de causas, 1999. In DANE. Archivos de defunciones. Disponible en: http://www.dane.gov. co/index.php?option=com_content&task=category§ionid=16&id=3 6&Itemid=148
Gomezese O, Aranda P, etal, Manejo de la angina Inestable con Estimulacion Electrica Espinal, Revision de la Literatura, Rev. Colombiana de Cardiologia Mayo junio 2008, vol 15 No 3.
American Heart Association. Heart Disease and Stroke Statistics-2004 Update. Dallas, Tex: American Heart Association; 2003.
Kannel WB, Feinleib M. Natural history of angina pectoris in the Framingham study. Prognosis and survival. Am J Cardiol. 1972;29:154-163.
Maseri A. Chronic stable angina. In: Maseri A, ed. Ischemic heart disease. New York: Churchill Livingstone, 1995:71–103; 477–505.
Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM, Grunwald MA, Levy D, Lytle BW, O‘Rourke RA, Schafer WP, Williams WV, Ritchie JL, Cheitlin MD, Eagle KA, Gardner TJ, Garson A Jr, Russell RO, Ryan TJ, Smith SC Jr. ACC/ AHA/ ACP-ASIM Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). J Am Coll Cardiol 1999; 33:2092-2197.
Mannheimer C, Camici P, Chester MR, et al. The problem of chronic refractory angina. Report from the ESC Joint Study Group on the treatment of refractory angina. Eur Heart J 2002;23:355--370.
Parker J. Angina Pectoris: A Review of Current and Emerging Therapies. Am J Manag Care. 2004;10:S332-S338.
Guidelines and indications for coronary artery bypass graft surgery. A report of the American College of Cardiology/ American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Coronary Artery Bypass Graft Surgery). J Am Coll Cardiol 1991; 17: 543–89.
Rihal CS, Yusuf S. Chronic coronary artery disease: drugs, angioplasty or surgery. Br Med J 1996; 312: 265–6.
Schoebel FC, Frazier OH, Jessurun GAJ, et al. Refractory angina pectoris in end-stage coronary artery disease: evolving therapeutic concepts. Am Heart J 1997;134:587–602.
DeJongste MJL, Haaksma J,Hautvast RWH, et al. Efects of spinal cord stimulation on daily life with myocardial ischemia in patients with severe coronary artery disease. A prospective ambulatory ECG study. Br Heart J 1994;71:413–18.
Sanderson JE, Ibrahim B, Waterhouse D, Palmer RBG. Spinal electrical stimulation for intractable angina: long-term clinical outcome and safety. Eur Heart J 1994;15:810-4.
Hautvast R W M, DeJongste M, Staal M, Gust W, Lie K. Spinal cord stimulation in chronic intractable angina pectoris: A randomized, controlled efficacy study. Am Heart J 1998;136:1114-20.
Eliasson T, Augustinsson LE, Mannheimer C. Spinal cord stimulation in severe angina pectoris: presentation of current studies, indications and practical experience. Pain 1996; 65: 169–79.
Ekre O, Eliasson T, Norrsell H, Wa hrborg P,Mannheimer C. Long-term effects of spinal cord stimulation and coronary artery bypass grafting on quality of life and survival in the ESBY study. Eur Heart J, 2002; 23: 1938–1945.
Murray S, Carson K G, Ewings P D, Collins, James M. Spinal cord stimulation significantly decreases the need for acute hospital admission for chest pain in patients with refractory angina pectoris. Heart 1999;82:89–92.
Eddicks S, Maier-Hauff K, Schenk M, Muller A, Baumann G, Theres H. Thoracic Spinal Cord Stimulation Improves Functional Status and Relieves Symptoms in Patients with Refractory Angina Pectoris: The First Placebo-Controlled Randomized Study. Heart. 2007 Jan 19.
Svorkdal N. Pro: anesthesiologists‘ role in treating refractory angina: spinal cord stimulators, thoracic epidurals, therapeutic angiogenesis, and other emerging options. J Cardiothorac Vasc Anesth 2003;17:536-545.
Panza JA. Myocardial ischemia and the pains of the heart. N Engl J Med. 2002 Jun 20;346(25):1934-5.
Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM, et al.ACC/ AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina. Circulation 1999; 99:2829–2848.
Andrell P, Ekre O, Eliasson T, Blomstrand C, Borjesson M, Nilsson M, Mannheimer C. Cost-effectiveness of spinal cord stimulation versus coronary artery bypass grafting in patients with severe angina pectoris long-term results from the ESBY study. Cardiology. 2003;99(1):20-4.
Deer TR, Raso LJ. Spinal cord stimulation for refractory angina pectoris and peripheral vascular disease. Pain Physician. 2006 Oct;9(4):347-52.
Hautvast RW, DeJongste MJ, ter Horst GJ, Blanksma PK, Lie KI. Angina pectoris refractory for conventional therapy is neurostimulation a possible alternative treatment? Clin Cardiol. 1996 Jul;19(7):531-5.
Five-year clinical and functional outcome comparing bypass surgery and angioplasty in patients with multivessel coronary disease. A multicenter randomized trial. Writing Group for the Bypass Angioplasty Revascularization Investigation (BARI) Investigators. JAMA. 1997 Mar 5;277(9):715-21.
Kim MC, Kini A, Sharma SK. Refractory angina pectoris: mechanism and therapeutic options. J Am Coll Cardiol. 2002 Mar 20;39(6):923-34.
Costantini A. Spinal cord stimulation. Minerva Anestesiol. 2005 Jul-Aug;71(7-8):471-4.
Bueno EA, Mamtani R, Frishman WH. Alternative approaches to the medical management of angina pectoris: acupuncture, electrical nerve stimulation, and spinal cord stimulation. Heart Dis. 2001 Jul-Aug;3(4):236-41.
Mannheimer C, Camici P, Chester MR, et al. The problem of chronic refractory angina. Report from the ESC Joint Study Group on the treatment of refractory angina. Eur Heart J 2002;23:355-370.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2011 Omar Fernando Gomezese, Luz Helena Caceres, Erika Liliana Plata Rueda, Oscar David Poveda Diaz, José Luis Camacho, Jairo Moyano, Carlos Guerrero
This work is licensed under a Creative Commons Attribution 4.0 International License.
The article is distributed under the Creative Commons Attribution 4.0 License. Unless otherwise stated, associated published material is distributed under the same licence.
