Sometimes, chest pain caused by angina may be difficult to treat. Thankfully, our world-leading cardiologists have alternative treatment options available when others haven’t worked. 




What is angina?

Angina is the name given to pain or discomfort felt in the chest when there is a reduced amount of blood flowing to the heart muscle. This is most often caused by coronary artery disease, where the arteries supplying the heart muscle become narrowed or blocked due to a build-up of fatty deposits.

There have been great advances in the treatment of angina, such as the insertion of minimally invasive stents – small tube-like structures that help hold coronary arteries open to increase blood flow to the heart muscle.

However, sometimes, even despite the best available conventional therapies, patients can still feel symptoms of angina. When this happens, they have what is called ‘refractory angina’.

Refractory angina may occur when, for example, the narrowed or blocked coronary arteries are too small to treat with conventional stent procedures. This can be particularly true for those with diabetes, where the condition can impair small blood vessels of the heart.

Unfortunately, refractory angina can leave patients with negative feelings about their general health and can result in depression.

How is refractory angina diagnosed?

Diagnosing refractory angina can be challenging and requires extensive investigation by a specialist. Due to this, the exact number of patients is unknown. However, estimates suggest there are 30,000 to 50,000 new cases of the condition each year in Europe alone.

Patients are diagnosed with the condition when they have experienced chronic angina-type chest pain for 3 months or more despite having optimal treatment, which can include medication, the insertion of stents and/or coronary artery bypass surgery.


Thankfully, alternative treatments are available

Our hospitals are one of only three specialist centres in the UK that can accurately diagnose and treat refractory angina. The treatments we offer include:

Coronary sinus reduction

A stent shaped like an hourglass, called a Neovasc Reducer™, is used to create a narrowing in a vein collecting blood back from the heart muscle, called the ‘coronary sinus’. This works to increase blood pressure, helping re-distribute oxygenated blood throughout the heart muscle.

“It is a quick, safe and minimally invasive procedure that takes approximately 20 minutes to complete, with patients often discharged within 24 hours,” explains our consultant interventional cardiologist, Dr Ranil de Silva. “We are pleased to say that we see a response rate in three out of four patients, whereby symptoms of angina and their quality of life significantly improve after treatment.”

Cognitive behavioural therapy

Scientific studies have shown that pharmaceutical treatments unfortunately do not significantly improve the symptoms and quality of life of patients with refractory angina.

However, cognitive behavioural therapy, which is a type of talking therapy to help positively change the way we think and behave, can assist with the management of symptoms as well as help patients feel more positive about their health.

It has been shown to: 

  • improve mental wellbeing, including anxiety and depression
  • reduce symptoms of angina to three episodes or fewer per week
  • reduce glycerol trinitrate use (a treatment for angina)
  • improve a patient’s ability to perform daily activities, including daily walking.

“The programme is delivered by our nurse specialists and clinical psychologists as part of an ongoing interaction with each patient to help improve their quality of life. We also have online consultations available to prevent patients from travelling long distances,” explains Dr de Silva.

To find out more about how we treat refractory angina, or to book an appointment, please contact our customer service team.

Dr Ranil De Silva

Consultant interventional cardiologist

Dr de Silva specialises in the treatment of angina, coronary angioplasty procedures and intracoronary imaging.