Intractable angina pectoris. Combined therapy with propranolol and permanent pervenous pacemaker

ANGINA pectoris is a manifestation of myocardial hypoxia¹caused by an imbalance between myocardial oxygen demand and available oxygen supply. In some patients, increased sympathetic tone and heart rate cause oxygen-wasting and provoke recurrent attacks of anginal chest pains at lower levels of physical activity.^2-3Selective blockade of excessive cardiac sympathetic responses by specific β-adrenergic receptor blocking agents, eg, propranolol hydrochloride, has been shown to reduce the frequency and severity of ischemic chest pains and to increase the effort tolerance in these patients.^4-6Unfortunately, the higher dose of propranolol required to control the symptoms of angina pectoris in some of these patients may lead to severe symptomatic bradycardia.⁷Three such patients (Table) were treated with propranolol and the use of a permanent pervenous pacemaker (rate, 60 beats per minute), with good control of anginal pains.

Comment

Several advantages derive from the combined use of a pervenous