Chest pain following successful balloon angioplasty or stent is a common problem. Although the development of chest pain after coronary interventions may be not a problem, it is disturbing to patients, relatives and hospital staff.
Possible Causes of Pain:
- acute coronary artery closure,
- coronary artery spasm
- heart attack,
- local coronary artery trauma
The distinction between these causes of chest pain is crucial in selecting optimal care. Early intervention can limit the damage. Management of these patients may involve repeat hospitalization for coronary angiography and/or additional intervention.
Commonly, repeat coronary angiography following Angioplasty (PTCA) in patients with chest pain demonstrates lesion to be widely patent/open suggesting that the pain was due to
- coronary artery spasm,
- coronary arterial wall stretching
- non-cardiac
Coronary arterial wall stretching is common and occurs significantly more often after stent implantation than after PTCA or coronary angiography alone. This may be a result of the overdilation and stretching of the artery caused by the stent implantation and the consecutively high degree of stretching and the elastic recoil is minimized. Kind of like a deflated balloon, the artery doesn’t go back to original circumference.
sciencedirect.com
After getting out of the hospital every little ache and pain makes you think “Is my heart giving me problems?” It is really difficult not to panic.
Here are some tips that should be of help you to know when to seek emergency care:
- Is the discomfort you are feeling the same or similar to the discomfort that brought you to the hospital? If so, this could be a problem. It is more likely to be a problem if it is similar…don’t wait until it is bad to seek treatment. Time is muscle and we don’t want you to lose any muscle.
- Does the discomfort also have other symptoms that pair up with it? These symptoms might include shortness of breath, profuse sweating, nausea, radiating discomfort into neck, jaw, arms or back. If there are multiple symptoms you should call 911.
- Can you reproduce the pain or discomfort with touch or movement of body. It is less likely to be a heart symptom if you can make it hurt through touch. This is usually muscle or skeletal origin or what is referred to as non cardiac chest pain.
- The 4 E test…does the discomfort come on with Emotional stress, Exercise, after Eating, or with a cold Environment? If so these are common triggers of heart symptoms. If you rest and they go away it probably isn’t emergent but you should notify your doctor as soon as possible. Keep a log of the frequency of these symptoms..when they come on, how frequently, what were you doing when they occurred, how intense was it, and what made them go away.
- Unstable Angina….this is angina or heart pains that are coming on more frequent, occurs at rest or wakes you from sleep, or you need more nitro than usual to relieve discomfort.
If your symptoms are that of unstable angina you contact your doctor - call 911
If you suspect you are having a heart attack chew up an adult strength aspirin and call 911.
Do not drive yourself to the emergency room. The ambulance crew is your first line of medical treatment, they will provide you with emergency medications, alert the hospital to your condition so they can manage your care quickly and efficiently. Time is muscle don’t waste any time.
Chew the aspirin even if you take an aspirin a day as regular medicine. The extra one helps more than it hurts. Only chew one not a handful that could causes more problems.
Antiplatelet effect of chewed, swallowed, and dissolved aspirin Chewing aspirin hastens its antiplatelet effect, as measured by the reduction in blood thromboxane B2 levels. It took only 5 minutes for patients who chewed aspirin to achieve a 50% reduction in baseline levels, versus almost 8 minutes after they took it in a solution and 12 minutes after they swallowed it whole.Source: American Journal of Cardiology Vol. 84, p. 404. |
May 2005 Update
It is best not to lie down. Try to stay calm, do some relaxation deep breathing – think belly breathes – make belly go out when you breath in. Avoid short shallow chest breathing. Focus on staying calm. If you think you are going to pass out try coughing or bearing down like you are having a bowel movement.
If you have Nitroglycerin tablets or spray that were prescribed by your doctor use them. I can’t tell you how many people forget about their nitro when they need it the most. Place one under your tongue, do not chew it. It should make you have a headache, or cause a flushing feeling, or tingle under your tongue. These are indications that your nitro is fresh. If you suspect your nitro is old (over one year if bottle unopened, or greater than 6 months since bottle was opened) find a fresh bottle. Nitro is a very volatile compound and breaks down rapidly if in contact with air, heat, light, or plastic.
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Great article. I’m dealing with a few of these issues as well..
i am a F and 59 years old . have stent for 3 years and have pain in my chest, i really sometimes want to be dead since cannot bare the pain. is there any way to get rid of this pain?
You really need to sit down with your healthcare workers to discuss the severity, frequency of your pain, and what relieves it. There are options out there, including external counterpulsation therapy EECP, long term nitrates or other medications to help keep arteries open or reduce spasm, further intervention such as more stents or perhaps surgery. You shouldn’t feel debilitated by this pain to where you don’t want to live further. Put together a good log, what triggers it, how many times a day does it occur, on a 1-10 scale what is the severity. If you can match it to your other vitals, such as blood pressure, weight, heart rate, then track stressors, sleep to see if there are any patterns. Good luck.
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I am a 51 year old female. I had a MI at 48 y/o with a 99% blocked artery. Subsequently, i had a drug eluting stent put in. Every since that time i have had a recurring pain in my heart. It happens occasionally, about 2-3 times a month. Not sure what makes it start or stop. It usually lasts from 2-3 days. It feels like a grating feeling inside an aretery. Nothing seems to help get rid of the pain. Does anyone else have this problem?
Oh, i forgot to mention, that i have had 2 other stents placed since that time for blockages. I am of normal weight. At the time of my heart attack i was 5’7″ and 135 lbs. No health problems except hypercholesteremia. I have a family hx of heart disease. During the stent placement an artery was damaged and i had to have a triple bypass. I have recovered and am back to work but, miss alot of work due to the same pain as mentioned above. I am a Registered Nurse and have a stressful job but i must work to support myself. The pain is almost disabling at times. Sometimes, i too, don’t know how long i can stand it. Doctors dont believe me since my cardiac stress echo was normal and chest xray was normal. Cardiologist said at first he would find it but, after tests were ran and returned normal i received a letter in the mail stating he did not believe it was cardiac related and that i needed to get a Family Doctor. Okay, so i get a family Doctor and what does he say? Well, i don’t know what it could be. Well, i Do!!!! It’s my heart. I know my body and i know what i feel. I just some help on how to proceed from here other than finding another Cardiologist. (I have been to 2 different Cardiologist so far.)
Have you looked into enhanced external counterpulsation therapy? It is known as EECP. It is cuffs – similar to mast pants or bp cuffs that are wrapped around legs, calves, hips they sequentially inflate immediately after the heart contracts. It is a treatment that typically you take for 35 session, one or two session per day. What this does is it increases the smaller collateral arteries which also feed the heart wall, thus the heart wall contracts better. It relieves angina in many patients, but the benefits won’t last if you don’t exercise. Vasomedical.com is a good place to begin with researching this treatment.
For many women the arteries are too small to see on catheterizations and it is known as microvascular disease. They continue to have angina symptoms even though traditional testing cannot find anything to intervene upon. Thus your medical teams have a tendency to say they can’t do anything and pawn you off to the others.
You could also research Prinzmetal angina which is treated with nitroglycerine and calcium channel blockers.
I am a 50 year old who had 95% blockage, following a successful angioplasty with a stent placement, I experience chest discomfort after eating. After discussing this with my cardiologist, he believes it may be acid reflu. Anyone else experience similar symtoms?
The challenge here is some medications may cause clopidogrel aka. Plavix to not work as well. Examples include certain acid reducers (proton pump inhibitors/PPIs such as omeprazole, esomeprazole), fluvoxamine, fluoxetine, cimetidine, fluconazole, ketoconazole, voriconazole, etravirine, felbamate and ticlopidine, among others. Promptly ask your doctor or pharmacist for more details.
Do not use non-prescription medications that contain PPIs (such as omeprazole, esomeprazole) or cimetidine for relief of upset stomach or heartburn. These medications can prevent clopidogrel from working well. Ask your doctor or pharmacist about safer alternatives such as liquid antacids, ranitidine, or famotidine.
This is where I see a future change in medicine. We should be able to analyze a person’s genetic makeup and know what drugs will and won’t work, rather than by trial and error.
I had two stents put in about a year and a half ago (95% LAD blockage) and have been doing well, exercising, etc, since, but occasionally I experience tightness across my chest. It isn’t really pain. More like a low level burning. The symptoms I had when I was admitted with a heart attack were not similar – extreme pain in the shoulders and neck. I saw my doctor yesterday and he said it may just be spasming, but he did schedule a stress test, EKG and sleep test. I asked if it might be stress, and he said more likely spasming. This didn’t happen for nearly a year after the stents, so I’m wondering what is triggering it now, and how concerned I should be. (Family history of heart disease and cholesterol problems).
Jim,
You did the right thing by discussing it with your doctor. I would ask you if the burning sensation follows any particular pattern, such as occurring with activity, lying down, after eating, with emotional stress, cold or very humid environmental conditions. The other thing is what relieves it? Nitrates, rest, antacids? Put this information together and discuss with your physician when you review your stress test results.
Different locations in the heart may produce different symptoms and heart disease is progressive. It isn’t unusual to have symptoms, you can do everything right through diet and exercise and still have further issues develop, that is what we mean when we talk about heart disease being progressive. Know that you will need further interventions in the future and it is better to identify the issues before you lose any further heart tissue due to a heart attack.Work with your your healthcare team to make sure you have nitro in the event of another blockage and you know when and how to use it, keep it fresh.
Stress can produce heart symptoms, it would be good to track your symptoms in relationship to your high stress, and evaluate your blood pressures during these episodes. You could consider asking for a referral to your local cardiac rehabilitation department for “stable angina”. Cardiac Rehabilitation does a great job of tracking symptoms, EKG, blood pressure responses of patients.
Thanks for stopping in and reading the blog and hope you found value in the discussions.
Beth
Thanks so much for your reply, Beth. I don’t have nitro, but my doctor has told me to take 6 Effients if an attack occurs, which I do keep handy. My guess is that this is entirely stress related. I’m a single parent of two teenagers, we’re moving this weekend, and I’m struggling with financial issues with my ex-wife. I sincerely hope it is stress, because this is transitory and will get better. I never experience the pain when exercising, and we go to the gym 4 nights a week. I will look into cardiac rehab and stable angina. My blood pressure yesterday was 126/84, and it’s almost always in that range. I did find it odd that he immediately asked me how I slept and do I snore. He scheduled me for a take home sleep monitor that I’ll pick up in a couple of weeks.
As for timing of the pain, it almost always occurs when I am sitting (and probably worrying). The only thing that seems to relieve it is passage of time.
Thanks again:)
Jim