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
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.
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 aspirinChewing 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.