Phantom angina.

A 49-year-old man with a history of traumatic left above-elbow amputation was hospitalized for surgical management of a phantom pain syndrome. Evaluation revealed a history of exertional chest pain radiating into the phantom limb. Exercise testing reproduced the pain symptoms and demonstrated electrocardiographic ischemic S-T segment depression. Coronary angiography revealed severe three-vessel coronary artery disease. The patient underwent coronary artery bypass graft surgery which eliminated the anginal component of his phantom pain syndrome and abolished evidence of exercise-induced myocardial ischemia. This case illustrates that myocardial ischemia can produce phantom pain with the characteristics of typical angina and indicates the need for thorough evaluation of patients presenting with unusual features of phantom pain.