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: most “stretch 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 suggested stents or coronary bypass surgery are no more effective – except during a heart attack – than providing optimal medical/drug therapy; as I noted at the time, however, fewer than 1/4 of the ISCHEMIA study participants were women. Until women are appropriately represented, researchers will continue to study (white, middle-aged) men whose experience may or may not be comparable to our experiences.
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?”
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1. 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.
2. Chao-Chien Chang et al. “Chest pain after percutaneous coronary intervention in patients with stable angina”. Clin Interv Aging. 2016; 11: 1123–1128.
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. Oct 2017.
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.
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NOTE FROM CAROLYN: In my book, “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press), 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 bookshop (please support your favourite independent family-owned shop!) 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 30% 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.
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Heart Sisters 
I happened upon this article by chance – I think it’s a God wink! Thank you for this!
I had a stent put in 2 weeks ago and still get these ghost pains that, as you said, are pretty darn scary.
This helped. And I shared!!
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Thanks magisark for taking the time to let me know that this article was helpful to you!
You’re in very early days still, so remember to take one day at a time. If these ‘ghost pains’ get worse instead of getting very gradually better as your coronary artery slowly heals, call your doctor.
Meanwhile, take care. . . ♥
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That was a great read, and it describes my experience, and although I’ve had pain and discomfort in my chest for three months, it seems to be almost gone after four-plus months. I’m taking Nattokinase (NTK) and supplements daily. NTK saved my life and dissolved plaque, and during my widowmaker, my ER doctor told me it unblocked me about 1% and allowed blood to flow just enough to keep my heart from being damaged.
But the answer to this question, I believe, is easy.
“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.”
Every Doctor and Nurse I saw told me often if I have any pain or problems, go to the ER. They say this instead of telling us we might feel some pain, it’s normal, don’t worry, because the pain might be more heart trouble. What if we all accept that we might feel some post-stent pain and not go to the ER, then have another heart attack?
I had this conversation with others during cardiac rehab, and we all agreed medical staff would rather see us in the ER and find no problem than have us in ER in the middle of another serious problem.
Three weeks after my stent and dealing with extreme pain, I took their advice and went to the ER five times. As much as I hated going to the ER, I did get good care, two CT-Scans, Stress Tests, Gamma scans, multiple X-rays, and a lot of attention. My PC, Cardiac Dr. and others told me whatever was causing my trouble was not my heart. Well, who can say that and be totally sure?
Still, the tests showed my heart was in excellent shape. I walked 45 minutes a day, sometimes through snow storms, and I walked to rehab halfway up a long tall hill and back 3o times. I have been on a strict Mediterranean diet and lost about 20 pounds. On my last visit to rehab, I ran up the hill as I told myself I would when I began. At 65, I’m in better shape than during the covid ordeal, during which my health declined a lot, as I’m sure many others experienced the same thing.
But why, after three months, did I have periodic bouts with pain in the middle of my chest, sometimes sharp pain when I took a deep breath, and why did the pain sometimes move an inch to the right and left of the center of my chest? No one knows the answer. But now, after four months, I have less pain, and I have no longer reached the limit of worrying. I think I have to live with this; if any troubles come again, I’ll have to deal with it. This is not an ideal solution, but at this point, there’s not much I can learn from more tests unless something happens again.
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Hello Gene – thanks for sharing such a comprehensive overview of your experience, and for the valid point about WHY hospital staff don’t warn heart patients before discharge about this very commonly experienced post-stent pain. This makes sense. And the other valid possibility in my experience is that many hospital staff are simply unaware of this common reality once patients are discharged home.
Deciding against sharing information to patients reminds me of the ‘good old days’ when drug side effects were not part of prescription drug packaging inserts as they are now, because physicians believed that if patients were warned about possible side effects, they would start imagining that they too had them. (The reverse has turned out to be true: patients who were appropriately informed generally feel less anxious, not more). Ditto for not warning heart patients at hospital discharge about the very common experience of new-onset situational depression. Had I been told in advance that this reality is common, temporary and treatable, I would not have felt terrified that I was losing my mind back then.
Despite your five trips to the ER, you’ve done a terrific job in becoming fit and healthy. (I too walked to and from my cardiac rehab program, which I viewed as the outdoor warmup to the indoor program). You may never know the cause of your severe chest pain for all that time. There are many non-cardiac reasons for chest pain which you’ve probably already learned about (I wrote more about them here).
Good luck to you – stay healthy! 🙂
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I’ve had a PCI, one stent 6 weeks ago, and still experiencing stretch pain with most exertion. Called the cardiologist, they said ‘don’t exert’. But there are no real guidelines on what to expect, how much one should do…or not. They said ‘everyone’s different’…
And “if you have pain,go to the E.R.” was not significant patient teaching!
I learned more from your site than the doctor.
Thanks!
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Hello Dana – welcome to the exclusive club nobody ever wanted to join! You’re still in relatively early days – post-stent ‘stretch pain’ should be easing up day by day over time as your coronary artery heals. If it gets worse, don’t hesitate to seek help.
If your doctor has not referred you yet to Cardiac Rehabilitation, please contact their office immediately and request a referral. If there are no Cardiac Rehab programs in your area (some smaller towns or rural areas don’t offer them), consider a professionally run ONLINE Cardiac Rehab class. Here’s an example I like from Vancouver General Hospital in Vancouver, B.C. Canada, taught by clinical exercise physiologists. These classes are NOT a substitute for in-person, medically supervised rehab classes (which are the very best way to do rehab), but they are straightforward and easy, and will get you moving your body safely. There are a number of different videos (links on the right hand sidebar) that you can watch to see which class you’d like to try first.
With spring in the air, you should also be taking walks every day, nice and slow to start, gradually adding more minutes each week. As one researcher told me, “What the heart patient needs after a cardiac event is WORK, not rest!” And meanwhile, keep reading here starting with this series of four articles on learning to live with heart disease – based on the work of cardiac psychologist Dr. Wayne Sotile. Here’s the first article (links to each of the other 3 articles are at the bottom of this post).
Take care. . . ♥
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