Successful Management of Chest Pain Through Cardiac Autonomic Rehabilitation

BACKGROUND: Some patients experience persistent chest pain after complete coronary revascularization without evidence of ischemia. Dysautonomia may be the underlying cause. CASE SUMMARY: A 43-year-old man with recurrent chest pain after multivessel revascularization showed poor response to standard cardiac rehabilitation. Evaluation revealed significant autonomic dysfunction (sympathetic overactivation), not ischemia. After implementing an integrated autonomic-regulation protocol (low-intensity aerobic exercise combined with abdominal breathing, standing meditation, and mindful walking), his symptoms and functional capacity improved markedly. DISCUSSION: Autonomic imbalance is a key pathophysiology. Success required a paradigm shift from the standardized cardiac rehabilitation exercise outlined in current international guidelines to a neural regulation-centered approach. TAKE-HOME MESSAGES: When developing cardiac rehabilitation plans, full account should be taken of the impact of the cardiac autonomic nervous system on symptoms, including palpitations, chest tightness, and chest pain. The targeted integration of neural regulation training leads to concurrent improvement in both clinical symptoms and functional status.