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Related Experiment Video

Updated: Oct 14, 2025

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Thinking Outside the 'Cage'.

Joshua Mercado-Maldonado¹, Javier Mirabal¹, Eric Aviles¹

¹and are PGY-5 Cardiology Fellows, is a PGY-6 Cardiology Fellow, and is a Staff Cardiologist, all at VA Caribbean Healthcare System in San Juan, Puerto Rico.

Federal Practitioner : for the Health Care Professionals of the VA, Dod, and PHS

|November 4, 2021

Summary

Persistent chest pain resolved for a patient after their mitral valve replacement surgery reached the target international normalized ratio. This indicates effective anticoagulation management is crucial for symptom relief in such cases.

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Area of Science:

Cardiology
Cardiac Surgery
Pharmacology

Background:

Mitral valve replacement is a common procedure for severe mitral valve disease.
Maintaining therapeutic anticoagulation is critical for patients with mechanical heart valves to prevent thromboembolic events.
Persistent chest pain post-mitral valve replacement can indicate various complications, including inadequate anticoagulation.

Purpose of the Study:

To report a case of persistent chest pain following mitral valve replacement.
To investigate the potential link between international normalized ratio (INR) levels and chest pain recurrence.
To highlight the importance of achieving target INR for symptom resolution in patients with mechanical mitral valves.

Main Methods:

A single-patient case report.
Clinical observation of chest pain symptoms.
Monitoring of international normalized ratio (INR) levels and adjustment of warfarin dosage.

Main Results:

The patient experienced persistent chest pain prior to achieving the target INR.
Chest pain completely resolved once the INR was consistently within the therapeutic range (typically 2.5-3.5 for mechanical mitral valves).
No recurrence of chest pain was observed during the follow-up period with adequate anticoagulation.

Conclusions:

Achieving and maintaining the target international normalized ratio is essential for managing patients with mechanical mitral valves.
Inadequate anticoagulation should be considered a potential cause of persistent chest pain after mitral valve replacement.
This case underscores the clinical significance of therapeutic anticoagulation in preventing adverse events and ensuring patient well-being.