Chest pain in heart-transplant recipients

Article Abstract:

It is commonly believed that patients who undergo heart transplantation cannot experience angina pectoris (the kind of intense chest pain associated with coronary artery disease) because the nerves that normally carry such pain signals do not regrow. An article in the June 20, 1991 issue of The New England Journal of Medicine reports results indicating that sensory reinnervation (regrowth of sensory nerve fibers) can, indeed, occur after heart transplantation. The patients discussed in the report experienced chest pain, and were subsequently found to have blockage of the coronary arteries in their transplanted hearts. This represents the first clear clinical evidence that sensory reinnervation of the heart can occur. This is significant because, now that heart transplant recipients live longer, coronary artery disease is becoming the major cause of death after the first year. By five years after transplantation, as many as 50 percent of recipients have signs of such disease; accurate estimates are difficult to obtain because diagnostic criteria vary. Traditional risk factors for coronary artery disease (smoking, high blood pressure, diabetes) do not accurately predict which transplant recipients will be the most susceptible. It is more likely that immunologic factors are involved. Optimal treatment approaches to such coronary artery disease have not been developed; angioplasty (mechanical enlargement of blocked coronary vessels) offers temporary relief, but the disease quickly recurs. Retransplantation may be attempted, but survival is poorer after this second operation and, again, coronary artery disease tends to recur. As the number of heart-transplant recipients increases, developing better approaches to the prevention of coronary artery disease in the transplanted heart is becoming more of a priority. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial, Risk factors, Physiological aspects, Chest pain

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A preliminary study of diltiazem in the prevention of coronary artery disease in heart-transplant recipients

Article Abstract:

Treatment with the calcium channel blocker diltiazem may prevent coronary artery disease in patients who have undergone a heart transplant. Heart transplant patients often develop coronary artery disease within a few years after the transplant. Among 75 patients who underwent a heart transplant, 35 were treated with 30 milligrams of diltiazem three times a day and 40 were not treated with any calcium channel blocker. Of the 57 patients who underwent an angiogram every year over a three-year period, the average diameter of the inside of the coronary arteries did not decrease in patients treated with diltiazem but it did decrease in those not treated with a calcium channel blocker. An angiogram revealed signs of coronary artery disease in five patients treated with diltiazem, compared with 14 patients not treated with a calcium channel blocker.

Usage, Prevention, Diltiazem

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Recent advances in cardiac transplantation

Article Abstract:

Two 1995 studies demonstrate the effectiveness of therapies in reducing the costs and complications associated with heart transplantation. One study showed that ketoconazole reduced the dose of cyclosporine needed to prevent potentially fatal infections in transplant recipients. Treatment of these infections is normally extremely costly. Another study showed that the drug pravastatin improved survival and reduced certain types of transplant rejection. This study suggests that pravastatin acts by inhibiting an immune response that normally damages blood flow. Ultrasound imaging can be used to measure the thickness of artery walls, and thus estimate the risk of vessel obstruction that increases mortality in transplant patients. Such ultrasound imaging will save on the costs of more expensive imaging tests known as angiograms.

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