There are certain persons who suffer so intensely from frequent paroxysms of cardiac pain that life becomes burdensome. They do not form a large group, but their plight is pitiable. Glyceryl trinitrate affords momentary relief, but they are not helped for any length of time by prolonged rest or by any of the usual medicinal remedies. In the preponderant majority, coronary sclerosis is at the basis of the trouble; a smaller number have aortic insufficiency resulting from either rheumatic fever or syphilis; to a few with no demonstrable anatomic lesions is applied, for want of a better term, the diagnosis "coronary spasm." In all these conditions the available evidence indicates that anoxemia of the heart muscle due to coronary insufficiency is the major factor concerned in causing the pain.
Various surgical procedures have been suggested and tried in the effort to bring relief. Among them may be mentioned cervical sympathectomy,
LEVY RL, MOORE RL. PARAVERTEBRAL SYMPATHETIC BLOCK WITH ALCOHOL FOR THE RELIEF OF CARDIAC PAIN: REPORT OF FORTY-FIVE CASES. JAMA. 1941;116(23):2563–2568. doi:10.1001/jama.1941.02820230007003
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