CORONARY EMBOLISM AND ANGINA IN MITRAL STENOSIS

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Abstract
The incidence of angina and the causes of myocardial ischemia in mitral stenosis have been studied. Twenty per cent of 194 patients with pure mitral stenosis of critical degree had angina. Coronary atherosclerosis, a high pulmonary vascular resistance, and low cardiac output with relatively fixed coronary blood flow accounted for angina in only a minority of our patients with this symptom. In the remainder, coronary artery obstruction appeared to be the probable cause. Four patients with non-fatal coronary embolism and one fatal case are described. Evidence has been produced to suggest that embolic rather than thrombotic coronary occlusion may be the commonest cause of ischemic cardiac pain in mitral stenosis and that coronary embolism may be less rare that is commonly supposed.