Living with pain
Luis Henrique Wolff Gowdak, MD, PhD, FESC
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
- In this issue of Heart & Metabolism, our attention is focused on the challenging clinical condition of refractory angina. William Heberden’s classic description of angina pectoris was first presented to the Royal College of Physicians in 1768 and a few years later published in the Medical Transactions of the College. Although receiving praise for his detailed description of the symptoms accompanying the natural history of patients with exertional angina, Heberden humbly acknowledged that “with respect to the treatment of this complaint, I have little or nothing to advance.” Exactly two and a half centuries later, we are awed by the great developments we have witnessed in the treatment of patients with stable angina, ranging from effective antianginal drugs to revascularization procedures (percutaneous or surgical). But despite all the advances, we are occasionally faced with a patient with disabling symptoms related to myocardial ischemia and who becomes unresponsive after an initial course of medical therapy. To make things worse, because of the anatomical complexity of the disease, including the diffuseness of the obstructive lesions, or because the patient is considered high risk, the Heart Team deems that revascularization is unsuitable, and the patient is said to have refractory angina. What happens then? The articles in this issue will give the reader a broader, updated, and (hopefully) uplifting perspective on the topic.
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