Chronic Cardiac Chest Pain Syndrome

Enrique A. Wulff, M.D.
Diplomate, American Board of Psychiatry & Neurology

Chronic Cardiac Chest Pain Syndrome (CCCPS) is a visceral functional pain syndrome. It is a poorly defined syndrome with no globally recognized clinical definition that represents a small element in the spectrum of cardiac chest pain. Response to traditional cardiac medications is poor.

CCCPS (sensitive heart syndrome, syndrome X) is a functional pain syndrome of angina pectoris without cardiac ischemia. Patients experience angina pain in the absence of irregularities on the arteriogram, no bundle branch block on resting or exercise electrocardiogram, and no evidence of diabetes mellitus, heart valvular disease, or cardiomyopathy.

The incidence of CCCPS is estimated to be 13% of all patients presenting to a cardiologist with chest pain.

Functional neuroimaging and examination of altered pain thresholds have shown the associated altered central pain processing similar to that seen in other functional pain syndromes.

Compared with patients with true coronary artery disease (CAD), CCCPS patients have greater anxiety, more stressful life events, and a tendency to seek reassurance, probably because the investigations are routinely reported as normal.

Patients with CCCPS demonstrate a reduced pain threshold compared with those with CAD or healthy controls when undergoing direct cardiac stimulation or peripheral stimulation of the forearm.

Many patients presenting with CCCPS will have already received coronary revascularization with either percutaneous coronary intervention or coronary artery bypass grafts. Medical therapy typically consists of an anti-platelet medication, an angiotensin-converting enzyme inhibitor and a statin. They may also be on either β-blockers or calcium channel blockers. Medical therapy must be maintained and optimized to reduce recurrence of myocardial ischemia.

Carmen Care Advanced Laser Therapy has created a comprehensive protocol for patients with CCCPS which includes Laser Energy Detoxification, Bella Shape, PSYCH-K and photobiomodulation that together with their cardiological therapy program may provide a significant clinical improvement.