Neurological mechanisms of chest pain and cardiac disease.

SCS is an efficacious, reversible, and safe therapy that improves quality of life, increases exercise tolerance, and relieves angina pectoris, but clinical trials in North America are needed to confirm the data coming from Europe. Neuronal convergence onto STT cells underlies the referred pain associated with angina pectoris. With pain referred to the chest and upper arm, cardiac nociceptive information is transmitted via sympathetic afferent fibers to thoracic cells. With pain referred to the jaw and neck, cardiac nociceptive information is transmitted via vagal afferent fibers onto cervical cells. SCS can modulate the responses of thoracic STT cells to nociceptive input originating from the heart. SCS modulates cardiac function. It stabilizes neurons in the intrinsic cardiac nervous system, and can reduce infarct size via adrenoreceptors.