Angina After Valve Repair: A Review of the Causes and Treatment Options

Angina After Valve Repair: A Review of the Causes and Treatment Options
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What is Angina

Angina or angina pectoris is severe chest pain or squeezing of the chest or a discomfort that occurs owing to decreased blood oxygen supply to the heart muscles. It manifests as pressure, heaviness, tightening, squeezing or aching across the chest, and may induce indigestion, heartburn, sweating, nausea, weakness, cramping and shortness of breath.

Angina is not the same as a heart attack, but requires immediate medical attention on occurrence and preferably pre-emption. The condition often serves as a precursor to heart attacks, and very often becomes fatal by itself.


The most common cause of angina is reduced blood supply to the heart owing to narrowing of the coronary arteries induced by arteriosclerosis. The coronary arteries supply oxygen to the heart muscles through blood. Smoke, tobacco, high blood pressure, diabetes, a sedentary lifestyle and other factors all cause arterial plaque build up, narrowing the arteries by about 50 to 70 percent, and causing a proportionate reduction in the flow of blood to the heart.

Angina induced by arteriosclerosis usually occurs after a period of heavy exertion or emotional stress, when the heart muscle demands more blood oxygen than the narrowed arteries deliver, and lasts anywhere between one to 15 minutes.

Another major cause of angina is coronary artery spasms. Rapid contraction of muscle fibers that surround the artery walls may cause a sudden narrowing or spasm of the arteries, leading to reduced blood supply to heart muscles. Such “variant” or Prinzmetal angina may occur at rest, usually in the early morning hours.

Treatment Options

The most common treatment options for angina are:

  • rest, to reduce the demand of oxygen to the heart.
  • placing a nitroglycerin tablet under the tongue. Nitroglycerin relaxes the blood vessels and decrease the workload of the heart.
  • intake of cholesterol lowering drugs such as anti platelet agents, anticoagulants and antihyperlipidemics, or blood pressure lowering drugs such as beta-blockers and antihypertensives.
  • nonsurgical cardiac catheterization procedure to increase blood flow to the heart muscle.
  • angioplasty or percutaneous coronary intervention to remove blockages by suctioning out blood clots, or opening a blocked artery.
  • coronary artery bypass surgery to replace the valves. Such surgery reroutes blood through a new artery or vein grafted around the diseased sections of the coronary arteries

Rest and medication effect a temporary reversal of symptoms, and rarely reverse the condition. Surgery and other methods removes angina, but need not effect a permanent cure.

Post Surgery Angina

Surgery removes angina, but does not guarantee a permanent cure. Post surgery angina is a common occurrence, with the condition recurring in about 4 out of 100 cases. The major causes for such recurrence are:

  • new valves suffering from arteriosclerosis
  • progression of atherosclerosis in non bypassed vessels
  • valves subject to spasms
  • technical problems with the graft, graft disease or early graft closure
  • the heart not pumping enough blood

Treatment options for angina after valve repair remains the same as that of angina before valve repair, but surgery stands a lesser chance of success when repeated. As the adage goes “prevention is better than cure,” the most effective method to counter post surgery angina is reducing risk factors such as lowering cholesterol, controlling blood pressure, quitting smoking and keeping diabetes in check.

A proper understanding of the causes and treatment options of a major condition such as angina contributes towards leading a healthy lifestyle.


  1. WebMD. “Heart Disease and Angina.” Retrieved May 15, 2011.
  2. WebMD. “Coronary artery bypass graft (CABG) surgery.” Retrieved May 15, 2011
  3. The Ohio State University Medical Center. “Angina.” Retrieved May 15, 2011.

Image Credit: J. Lynch