Post-stent chest pain

by Carolyn Thomas     @HeartSisters 

A friend’s daughter (who happens to be a cardiac nurse) phoned to check on me a few days after I was discharged from the hospital following my heart attack. I felt so relieved to hear Kate’s voice because  something was really starting to worry me:  I was still having chest pain.

Hadn’t the blocked coronary artery that had caused my “widow maker” heart attack just recently been magically unblocked? Wasn’t that newly revascularized artery now propped wide open with a shiny metal stent? Shouldn’t I be feeling better?

And that’s when I heard the words “stretch pain”  for the first time.    .       . 

She explained to me exactly what I would later learn more about from cardiac researchers in Germany: moststretch pain” symptoms are due to the dilation and stretching of a coronary artery that’s caused when a coronary stent is being implanted inside that artery.(1)  And for the majority of heart patients, she added, stretch pain is not a danger sign.

But if you’re like me, you may still be concerned, after your stent has been newly implanted, to find that the chest pain that sent you to the hospital in the first place is still happening.

At the time, I could find no information about chest pain AFTER a stent procedure in any of the patient education material I was given before I was discharged from the CCU (the Intensive Care Unit for heart patients).

But now I was learning that this new chest pain might be BECAUSE of a stent procedure.

The German researchers agreed that post-stent chest pain is likely not a reason for us to panic. But they did acknowledge:

“This is a common problem. Although the development of chest pain after coronary interventions may be benign, it is disturbing to patients, relatives and hospital staff.”

Disturbing? No kidding. . . 

New chest pain is very disturbing to a person who has just survived a heart attack.

In the German study, researchers found that stretch pain can be experienced after different types of cardiac interventions:

  • about 40 per cent of the patients they studied developed chest pain after having a coronary stent implanted (Percutaneous Coronary Intervention, or PCI)
  • 12 per cent developed chest pain after balloon angioplasty
  • 9 per cent developed chest pain after diagnostic angiography

As cardiologist Dr. Allen Jeremias explained in his book, Your Personal Guide to Angioplasty:

“The air pressure in your fully inflated car tires is about 2 atmospheres. By comparison, the high pressure used to inflate a balloon inside a coronary artery during angioplasty is between 10-20 atmospheres.”

Researchers suggest that chest pain in recently stented patients can be associated with continuous stretching of the treated coronary artery during an invasive procedure, which they described like this in the journal, Circulation:(2)

“Non-ischemic chest pain develops in almost half of all patients undergoing stent implantation, and seems to be related to blood vessel over-expansion caused by the stent inside the diseased vessel.”

U.K. sources add that it’s common to experience this new chest discomfort in the first few days and weeks following a stent procedure.

“This is because your artery has suffered some trauma and bruising from the stent being fitted. You can have episodes of pain or discomfort as the stent settles into place. This pain is usually felt quite locally in the chest, and is often described as sharp or stabbing. This type of pain can often be relieved by taking acetaminophen (Tylenol).”

Symptoms have been generally described by patients as mild or moderate, and also “unlike the pain of angina” that they had experienced before they came into the hospital for treatment. Three-quarters of patients with this pain described it as “continuous, squeezing pain located deep in the chest.” 

What if stretch pain continues or gets worse?

Stretch pain is typically a short-term issue while we are recuperating.  But sometimes, it is not just short-term.

The Journal of the American Heart Association reported that about one third of heart attack patients studied were still reporting occasional chest pain at six weeks or longer.(3)  These symptoms happened infrequently – about 80 per cent experienced symptoms once a month on average, but of the remaining 20 per cent, chest pain was happening weekly or even daily.

This kind of chest pain may not be just your average stretch pain.

If chest pain persists or worsens over weeks, it may indicate another cardiac issue that must be checked out. In a 2018 U.K. study, researchers turned the cardiology world on its ear by suggesting that stents may not address chest pain as we have always believed – especially for patients who have not had a heart attack.(4)  Coronary artery disease (CAD) typically affects many blood vessels, and so stenting only the largest blockage may not make much difference in a patient’s symptoms. As the New York Times described the findings of this study:

A few arteries might be blocked today, and then reopened with stents. But tomorrow a blockage might arise in another artery, and cause a heart attack.”

Always consult your own physician for ongoing or new chest pain, or any distressing symptoms that simply do not feel right to you.  See also: ISCHEMIA Study: That Blockage Isn’t A Time Bomb In Your Chest (about the controversial 2019 research that found stents or bypass surgery are no more effective – except during a heart attack – than providing optimal medical therapy; as I noted at the time, however, fewer than 1/4 of the ISCHEMIA study participants were women).

But meanwhile, my own question on stretch pain is still this: 

“If stretch pain caused by having a stent implanted is as common as cardiac researchers seem to suggest, why aren’t heart patients like me warned about this before hospital discharge so we don’t need to panic during recovery?”

1.  Chao-Chien Chang et al. “Chest pain after percutaneous coronary intervention in patients with stable angina”. Clin Interv Aging. 2016; 11: 1123–1128.
2. Jeremias, A. et al. “Nonischemic Chest Pain Induced by Coronary Interventions: A Prospective Study Comparing Coronary Angioplasty and Stent Implantation”. Circulation. December 1998: 2656–265.
3. Fanaroff, A. et al. “Management of Persistent Angina After Myocardial Infarction Treated With Percutaneous Coronary Intervention: Insights From the TRANSLATE‐ACS Study”;  Journal of the American Heart Asssociation.
4. Rasha Al-Lamee et al. “Percutaneous Coronary Intervention in Stable Angina (ORBITA): a Double-Blind, Randomised Controlled Trial”. The Lancet, Volume 391, ISSUE 10115, P31-40, January 06, 2018.
 

NOTE FROM CAROLYN:  In my book, A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press, 2017), I wrote much more about chest pain and other (common and uncommon) cardiac symptoms. You can ask for this book at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from Johns Hopkins University Press. Use their code HTWN to save 20% off the list price when you order.

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Q:  Have you ever experienced stretch pain after a cardiac procedure?

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Please do not leave a comment here asking me about your current symptoms. I  am not a physician and cannot offer you medical advice. Always see a healthcare professional if you’re experiencing distressing symptoms.

166 thoughts on “Post-stent chest pain

  1. Thank you!
    I just had 5 stents, 3 on the right @ 70%, and 2 on the left 90% blocked. I’m a 43 year old in what I thought was pretty good health. Learning now we have a family history. But was taken down at Christmas 2021 with chest pain.

    Reading your site has explained why I feel like it is still painful. And having to learn to trust that I am okay again. But the anxiety, that’s my worst part. Afraid that it’s not fixed when the pain occurs, afraid that something new is wrong.

    Learning to come to peace and acceptance of this new normal. Had my first follow up on Friday and they said I look great, but that doubt always creeps into the back of my head. When no one tells you, the term stretch pain.

    Thank you for sharing this, I understand now that I am at the beginning, and that this will be a long journey.
    My best to all…

    Liked by 1 person

    1. Hello Taylor – Five stents! That must have been quite a shock for a 43-year old in good health! You are still in what doctors consider “very early days” as your body continues to heal from your procedure.

      I believe that there are few things in life more anxiety-producing than chest pain – especially after you’ve already had a cardiac diagnosis. “Is this something? Is it nothing? Should I call 911?” are very common reactions among heart patients to almost any future twinge in the chest. As Len Gould, cardiac psychologist (and a heart patient himself) likes to say: “Before my heart attack, every chest pain was just indigestion. But afterwards, every chest pain is another heart attack!” No wonder you’re feeling anxious.

      You’re so right – right now, you’re learning to trust that something you likely never gave much thought to (how your heart is doing) is working well. And you’re also learning to trust your doctors when they tell you everything “looks great”. In fact, with five former blockages now re-opened, your heart is likely doing far better than before Christmas because blood flow to your heart muscle has been restored. I wrote more about this in “The Day I Made Peace With an Errant Organ” – which might help you with this perspective.

      Like many (most?) heart patients, you weren’t warned in the hospital that stretch pain is very common, usually benign and temporary as your body heals. Knowing in advance how common it is would help to reassure patients once they get home. This is very unfortunate failing in cardiac patient care – as you can tell from so many of the other reader comments here.

      Hang in there, Taylor. One day at a time. And if you haven’t yet been referred to cardiac rehabilitation, get a referral from your doctor and GO!

      Take care, stay safe. . . 🙂

      Like

    2. Taylor…hello . I just had my 3rd stent (1st one in widowmaker, 2nd in right).. I have consistent little stabs and even some longer lasting chest pressure that can be scary. But for the most part, they’re nothing. Some of those post stent meds bring a lot of unpleasant, even alarming,side effects. It might help if you keep a small journal to write these down as they happen, so you can remember to ask your doctor.

      Taylor, when we have a heart attack, that day, you lose a big part of your life habits and must change things for our new life…but you do still have life..

      You can be anxious, depressed, scared, but hang in there….ya gotta learn how to take care of your new life, because you’re just starting over. I will be wishing you the very best …you are already ahead of me…..I’m 66!! Take care of yourself!!

      PS..On Amazon there is a book called 109 Things You Can Do for a Healthy Heart. EASY read. and small daily thing you can do, that will really help you. This book can be a good friend.

      Take care of yourself and BEST OF LUCK.
      LARRY

      Like

  2. I had two stents place in the LAD (Left Anterior Descending coronary artery), 99 and 85 percent blocked on December 1, 2021. It’s now Jan 2, 2022.

    I’ve been taking Brilanta. I get a feeling of “out of breath” while exercising, and a burning sensation in my chest when in a cool environment. But no crushing, painful chest pain occurring before the procedure.

    Liked by 1 person

    1. Hello Richard – you’re in what doctors generally describe as “early days” post-treatment (one month). I’m not a physician so cannot comment on your specific symptoms, but I can say that symptoms on exertion and/or cold temperatures are indeed common among heart patients. These should gradually begin to decrease over time. If they don’t, or if they get suddenly worse, see your doctor.

      Since my own heart attack in 2008, I continue to have chest pain symptoms in the cold, so have learned to really bundle up warmly (especially to cover my chest) on cold days – or even when walking down the frozen food aisle in the grocery store!

      Take care, Happy New Year and good luck to you!

      Like

  3. Hello Carolyn
    I am 5 days post stent placement, 2 in LAD, 2 in RCA, just sitting tonight watching TV, and had a pain reminiscent of the heart attack. After furiously looking on Dr Google I found your article. It provided me with reassurance I may not be back at square 1.

    Thanks to you and the others who have shared here.

    Liked by 2 people

    1. Hello Mitch – chest pain immediately after having four stents implanted is indeed frightening. You’re in early days yet, so the timing seems appropriate for stretch pain. But if your chest pain episodes get worse or more frequent, see your doctor again. I wish cardiac staff would warn heart patients BEFORE hospital discharge that stretch pain post-stent is common, almost always benign, and temporary.

      Good luck to you. . .

      Like

  4. Hi Carolyn,

    On 9-1-21, I had a stent procedure. My LAD was 85% blocked. No heart attack. My Heart doctor said I needed 2 more stents but wanted my heart to rest for 60 days. On 9-3, I went to the ER for Stabbing Chest pain. My numbers were good and I was released. I had another incident and went to the ER on 10-12-21. Same thing. My tests were good and I was released.

    I did some Googling and read the info on your site about stretch pain. Your information was a relief to me. On 10-27-21, I had the other 2 stents placed. In late November I started cardiac rehab. After 2 sessions, I was feeling good and tried some slow jogging on the treadmill. I went for 15 minute, no issues until 4am the next morning. I had some moderate stabbing chest pain that went away. At 630 am it happened again. At 7am I went to the ER, got lots of blood work and several EKGs. Everything checked out fine and I was released.

    Now I have reduced my daily walks and started walking slowly on the treadmill. I know the stretch pain is not life threatening but it is still very scary. I want to eventually get back to running but it looks like it is going to take longer than I thought. My6 cardiologist is so busy, I can only see his PA. I told them about the situation and they said to do nothing now and just observe the situation.

    No one in their office has mentioned the words “stretch pain” to me.

    Al Wallace

    Liked by 1 person

    1. Hi Al – I’m very glad to hear you’re in cardiac rehab, where your exercise can be monitored and your progress supervised. Good for you! I’ve found that the key seems to be finding that sweet spot between enough exertion to strengthen the heart muscle vs. over-exertion which can bring on symptoms. You’re so right – stretch pain IS scary, yet over time should gradually decrease in severity and frequency as the body heals. Just take it nice and slow – and enjoy the ride! You WILL get back to running – just maybe not this week!

      When I was in cardiac rehab, I was so keen to be “normal” again that I was determined to speed through rehab as fast as possible, while ignoring my extreme exhaustion, chest pain and shortness of breath – until the rehab nurse told me one day to slow down. In your case, a cardiac event that requires three stents takes time for the body to heal – both physically and psychologically.

      Keep “observing the situation” as your PA advised, but don’t hesitate if your symptoms increase or worsen significantly to seek medical help. If your cardiologist prescribed nitroglycerin for chest pain, don’t be afraid to take that next time the chest pain hits.

      Good luck, stay safe. . .

      Like

  5. Hello Carolyn! My name is Genaro. I had 2 stents put in 6 months ago and still go through stretch pain regularly. As a man, I can say that it’s painful. I want to thank you for opening my eyes about the so-called stretch pain.

    I was never informed about it at any time. But now I know what it is, and I have you to thank.

    Thank you so much.

    Like

  6. Well it’s Thanksgiving day, and I had 4 stents implanted on Monday afternoon, 3 days ago, and 2 implanted in 2015. NO ONE EVER TOLD ME ABOUT STRETCH PAIN!

    SO RELIEVED TO HEAR ABOUT THIS 🤗 because I feel the chest pain just walking to the bathroom. Actually I was in pain during my procedure and in the recovery room, I was crying it hurt so bad. I was told the Dr. had to do a lot of work, such as breaking up the plaque…and I had to work through the chest pain. I thought you have to be kidding me, they gave me more Nitro and Tylenol for the headache I was bound to get from the effects of the medication.

    So anyway here I sit, 3 days later, no pain thank god, while sitting, hoping, praying I can change my lifestyle habits and start a better way of living free of chest pain in the years to come. I will keep you updated.

    Thank you so much for the article, it has given me MUCH HOPE !!!
    YOURS TRULY,
    KELLY LEWIS
    by the way I just turned 56 on the 11th of November 🦃 Happy Thanksgiving everyone.

    Liked by 1 person

    1. Hello Kelly – I’m glad you found my site! You’re not alone – if you read some of the comments below, you’ll see many many others who say “NO ONE EVER TOLD ME ABOUT STRETCH PAIN!” Given how common researchers tell us that this post-stent chest pain is, it’s hard to believe that so many healthcare professionals working in cardiology do not know this. Yet every person like you or me who do experience this, and learn more about it, are helping to spread the word to others, in the hope that one day nobody will be unaware of this very common after-effect of having a stent implanted, because the likelihood will routinely be explained before hospital discharge.

      Hope you continue to feel better – good luck with your decision to change some habits! You can do it!!

      Take care, stay safe. . . ♥

      Like

  7. I was so relieved when a friend found this article and sent it to me.

    I am 6 days since my heart attack and 4 days after having two stents put in my artery. The whole time I complained in the hospital to all medical staff, doctors and nurses about the continuing sharp jabbing pain I was still having in my chest, specifically my heart.

    They would just tell me, “But your numbers look good”. I didn’t want to hear that my pain continued and I had been told I had a widow maker artery that was 45 percent blocked but they only do stents in arteries that are 70 percent blocked. I just knew my pain has been leading up to the
    “big” heart attack.

    I feel relieved reading this article and promptly send messages to both my doctors so perhaps they could learn something new from it too. I am very grateful to the author and every comment.
    Thank you!

    Liked by 1 person

    1. Hello Angie – I’m glad your friend forwarded this article to you. The thing that makes stretch pain really annoying is that research suggests it’s VERY COMMON – yet so few physicians or nurses seem to be aware of it as a potential culprit when hearing reports of ongoing post-stent chest pain. Many heart patients worry needlessly for weeks after hospital discharge, believing that another heart attack is imminent, all because nobody warned them how common this post-stent symptom actually is.

      You are still in very early days yet – I hope that your sharp jabbing pain will ease up as healing continues over time. If it doesn’t, or if it gets worse, see your doctor. Good luck to you…

      Take care, stay safe… ♥

      Like

  8. Hi again Carolyn,

    My post-stent stretching pain lasted exactly 3 months. My Cardiac rehab nurse didn’t give it much credence.

    Not only that, I received a call after 3 weeks (instead of weekly check-in) while I was brushing my teeth. When I called back I couldn’t get through to the nurse, left a message, no call-back.

    Best part: in my post-review report, she stated exactly that patient brushing teeth, will call back. I am wondering if this was a joke or does someone actually care, is paying attention to the patient, or just checking a box ‘done’……

    Liked by 1 person

    1. Hi again Romi – I’ve run across some medical studies that were so obscure that “patient brushing teeth” might actually have been something they’d record! 🙂

      Just imagine: a research paper on how often a heart patient is busy brushing her teeth when a nurse phones.

      Sounds like a tickbox needing checking off to me. . .

      Take care, stay safe. . . ♥

      Like

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