Significance of angina pectoris in aortic valve stenosis.

Abstract

Of 60 patients aged 45 to 66 years with aortic valve stenosis, 28 (47 per cent) had angina pectoris. Significant coronary arterial obstruction was shown by selective coronary cineangiography in 14 of them. Systolic pressure gradients across the aortic valve were lower in patients with angina than in those without. In those with angina, systolic gradients were higher in those with normal coronary arteriograms than in those with demonstrable coronary arterial disease. Aortic valve replacement relieved the angina in all patients who had normal coronary arteriograms. When valve replacement was combined with coronary bypass grafting in those with coronary arterial disease, surgical mortality was higher and symptomatic relief less predictable. Incapacitating angina in patients with aortic stenosis was nearly always associated with significant coronary disease. In those with less severe angina it was impossible to predict the state of the coronary arteries. Two patients, who did not have angina and who did not undergo coronary arteriography, died after aortic valve replacement and were found at necropsy to have unsuspected severe coronary disease. We, therefore, suggest that coronary arteriography should be carried out in all patients over the age of 40 years in whom surgery is being considered for aortic stenosis.

Report: Association of coronary artery disease and valvular heart disease in chile

“…Age differences do not explain this variation since the mean age was comparable in a11 these series. However, some of these publications may deal with a biased sample because they performed coronary angiography only in patients with clinical suspicion of CAD, (Basta et al, 1975;Hancock, 1977;Mandal and Gray, 1976). In this series, 11.8% of the patients with aortic stenosis and angina had CAD, 50% of the patients with aortic regurgitation and angina had CAD, and 40% of the patients with aortic stenosis and regurgitation with angina had CAD.…”

“…Among patients with aortic valve disease, angina was present in 63% of the cases, similar to previous reports in the English literature ranging from 47% to 63% (Basta el ul., 1975;Baxter et al, 1978;Harris et al, 1976;Mandal and Gray 1976). Angina was present in all patients with aortic stenosis, 7 l % having typical angina and 29% atypical.…”

“…In nations with a higher prevalence of CAD it may be reasonable to perform coronary angiography routinely from an earlier age. Indeed it has been recommended that patients with valvular heart disease over age 40 years undergo coronary angiography at the time of diagnostic cardiac catheterization (Baxter et al, 1978;Harris et al, 1975;Mandal et al, 1976;Roberts, 1982).…”

Symptomatic presentations of severe aortic stenosis

“…The incidence of angina pectoris in patients with AS has been reported to range between 30% and 40% in the absence of associated obstructive coronary artery disease [32][33][34][35]. The pathophysiological mechanism of angina is not clear but seems to be due to unbalanced myocardial oxygen supply and demand.…”

Pre‐infarction angina secondary to calcific aortic stenosis with bernheim's effect

“…This is usually true in patients with incapacitating angina (12). Therefore, a progressive anginal syndrome at rest, in patients with aortic stenosis, is infrequently encountered in the absence of coronary artery disease.…”