Angina pectoris in a cardiac allograft recipient

Following cardiac transplantation, the cardiac allograft is denervated and, based on most evidence, remains so over time. The consequences of this are, among other things, lack of efferent nerves regulating heart rate responses and lack of afferent nerves which carry pain fibers. A cardiac allograft recipient is presented who, as a consequence of cardiac allograft vasculopathy, developed an acute anterior wall myocardial infarction and post-infarction ischemia, both accompanied by typical angina pectoris. The issues of post-transplant cardiac denervation are reviewed.