Three case reports

OBJECTIVE: To demonstrate the use of transcutaneous electrical nerve stimulation (TENS) in the treatment of refractory angina pectoris. CLINICAL FEATURES: Three cases are presented. Patient 1 was a 56-year-old man with a 20-year history of angina pectoris. Angiography revealed extensive stenoses of coronary arteries. He was deemed unsuitable for coronary bypass surgery due to significant distal coronary disease. Patient 2 was an 81-year-old woman with angina that responded poorly to increasing drug therapy: she also had extensive stenoses but was judged unsuitable for surgery. Patient 3 was a 69-year-old man who had previously undergone two coronary bypass procedures and presented with unstable rest angina. The patient was deemed unsuitable for a third coronary artery bypass operation due to distal disease and the small calibre of the intermediate artery. INTERVENTION AND OUTCOME: Each patient had TENS added to their treatment regimen (one hour twice a day for Patient 1; one hour three times a day for Patients 2 and 3). Patient 1 experienced a marked reduction in pain which lasted for over a year before symptoms of angina again worsened. Patient 2 has experienced no further pain of angina except on occasions when her TENS unit was not working or she neglected to use it as prescribed. Patient 3 had been free of angina from commencement of TENS therapy on review three months later. CONCLUSION: TENS may be useful in the treatment of angina pectoris which is refractory to medical therapy when the patient is not suitable for revascularisation procedures or revascularisation has failed. The mechanism of action is probably a combination of analgesia per se and inhibition of sympathetic nervous stimulation of the heart.