Chronic Refractory Angina Pectoris

What is chronic refractory angina pectoris?

Chronic refractory angina pectoris (chest pain) is a sensation of pressure or pain in the chest that is the result of insufficient blood flow to the heart muscle and in which treatment with medication and heart surgery is either insufficient or no longer effective.


Chronic refractory angina pectoris is caused by insufficient blood flow to the heart muscle (a narrowing of more than 75% in one or more of the major coronary arteries). It is often seen together with physical activity or emotion, which causes the heart to work harder and to require more oxygen. The pain felt when a coronary artery is suddenly blocked by a blood clot is the same, although usually more intense. Complete blockage leads to a heart attack. Arterial spasm of the coronary arteries, as opposed to narrowing, can also lead to chest pain. Risk factors for angina pectoris are: smoking, obesity, high blood pressure, diabetes, and high cholesterol levels.

Signs and symptoms

Angina pectoris has classical symptoms, with the pain provoked by exertion and subsiding with rest. During exertion, a patient with severe atherosclerosis in the heart may feel varying symptoms of pain. The pain is usually felt beneath the breastbone, sometimes radiating to surrounding areas, mainly on the left side, such as the arms, neck, throat, jaw, or even the teeth. The pain is often accompanied by other signs such as sweating, nausea, and sometimes vomiting. At rest, angina pectoris is clearly influenced by stress, exposure to cold weather, meals and smoking.

How is angina pectoris diagnosed?

A physical examination is performed in order to exclude other disorders such as lung disease, diseases of the internal organs in the abdomen, diseases of the thoracic spinal column and ribs, abnormalities of the aorta, shingles , and panic attacks. However, first of all, the cardiologist will carry out a thorough examination.

Do I need any additional examinations?

  • Diagnostic examination for other non-physical factors important to your pain  already took place  after  you filled in your pain questionnaires.

What are my treatment possibilities?

Multidisciplinary Treatment

Depending on the cause of your pain, your pain specialist will decide whether or not to embark on physical treatment. Based on the results of the completed pain questionnaire, additional examinations can be carried out and, apart from physical treatment, other methods of treatment will be suggested.

Non-physical Treatments

If the results of your pain questionnaire are abnormal, your pain specialist will offer you one of the non-physical treatments listed below:

Physical Treatments

Interventional Pain Treatments

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