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 her 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.

77 thoughts on “Post-stent chest pain

  1. In August of this year I had a heart attack, I had 2 blockages in my LAD and two more in my RCA. I had the 2 stents placed in the LAD then a month later had 2 more stents placed in my RCA.

    I continue to have chest pain off and on but it is nothing like the pain during my heart attack. My nurse during the first hospitalization told me I would more than likely experience chest pain from the stent placement.

    I know the arteries in my heart are open; no blockages because during the last hospitalization the doctor reviewed my entire heart health after the procedure on his iphone. Ask your doctor to review your angioplasty with you. Never leave with unanswered questions, peace of mind is priceless.

    Pam

    Liked by 1 person

  2. My father had 2 stents (100%) in his heart on 25 August. I want to know how long does the stretch pain last after angioplasty, because my father still feels some mild pain on a daily basis.

    Liked by 1 person

    1. Prateek, I’m not a physician but I can tell you generally that studies suggest that about 1/3 of stent patients continue to experience stretch pain for six weeks or longer. If your father’s mild symptoms continue for some time, or if they get worse, he should see his doctor.

      Like

  3. I am 48, had two blockages 80% and 60%. My mom passed at 49 from cardiovascular disease, her last heart attack was massive and her heart was too weak.

    However my blockages were found before any damage to my heart. Two stents were placed. That was in early January this year, it’s now September and I’m continuously having squeezing pain where the stents are.

    I’m scared. Four years ago when I complained of chest pains I was told it was anxiety, which I’ve never had in my life! Then the heart attack – so I’m at the point I really don’t have faith in the doctor anymore.

    But I’ve told numerous doctors and they have no idea or shrug it off. My mom was so young to have passed at 49. That was 25 years ago, they must be able to give me some idea what it is.

    Any stress at all makes it hurt where the stents are, I’ve read this article, and it explains it but how do I get my doctor to listen to me?

    Liked by 1 person

    1. Hi Sue – I’m sorry you’re having these distressing symptoms. Your question “how do I get my doctor to listen to me?” is the key to good doctor-patient communication, isn’t it? I wish I knew the answer but since I don’t know your doctor or you, I’d just be guessing at an answer to that question.

      Your family history is no doubt adding to your distress now – 49 was so young when your mother died of a heart attack. But remember that a family history of heart disease is not a death sentence. So much depends on your mother’s lifestyle, and on what yours has been, etc. Like many people, for example, I had zero family history of heart disease before my own “widowmaker” heart attack, while other people with a strong history of immediate family members having heart attacks at a very young age never go on to have one themselves. Focusing on your mother’s experience (at about the same age) may be intensifying your own distressing symptoms.

      My overall approach is to try to be honest and very direct, especially when describing symptoms. We know from research (e.g. Dr. Catherine Kreatsoulas at Harvard, who has studied how women talk about their cardiac symptoms to ER staff) that women tend to generalize or minimize their symptoms instead of being specific. A specific description might be: “the symptoms are so debilitating that I can no longer do _______ ” (insert normal daily activity). Read more at: “Words Matter When We Describe Our Heart Attack Symptoms” https://myheartsisters.org/2014/11/16/language-describing-heart-attack-symptoms/

      When one of my blog readers was prescribed anti-anxiety drugs for her chest pain and crushing fatigue she’d been suffering for months, for example, she asked her cardiologist if this new drug would help her carry her laundry basket up the stairs, “because right now I’m no longer to lift it anymore…”

      My only suggestion would be for you to start a Symptom Journal to show your doctor: including the date/time of day, description of pain, what you were doing/eating/feeling in the hours before the incident worsened and what if anything (e.g. Tylenol, going for a walk, talking to a friend, taking a dose of nitroglycerin, which I hope you have) that may have relieved your symptoms even temporarily. This can be especially useful if you find out that there are times when pain feels much worse, and times when it feels better. Observing a pattern like this may help your doctor solve this mystery.

      Good luck to you. Take care, stay safe…

      Like

  4. Hi Carolyn,
    I had a mini-heart attack while playing tennis on Aug 2nd, 2020. Before the heart attack, I was a very active individual, exercise regularly, so the event was a shock to me.

    I had a stent placement the next day and it has been exactly 7 weeks now. Every now and then, I feel this dull pain in the middle of chest and sometimes it can radiate to my right jaw. The pain is not significant and it doesn’t happen daily, but it makes me worry. I had an echo test 2 weeks ago and everything was normal!

    I am currently on blood thinner, cholesterol med (statin) and blood pressure med. If the dull pain comes and goes, should I be worried? My next appointment with my cardiologist is next Feb 2021.
    Thanks Carolyn.

    Liked by 1 person

    1. Hello Derrick – welcome to the very exclusive club that none of us wanted to join…

      I’m not a physician so of cannot comment specifically on your situation, but I can tell you very generally that seven weeks sounds like it *might* be within the reported limits of stretch pain. Nobody can tell you for sure in the absence of cardiac diagnostic tests…

      But one thing you might do while you’re waiting for 2021 to roll around for your next Cardiologist’s appointment (that seems a very long time to wait when you are feeling worried!) is to start a symptom journal – that way, instead of telling your cardio that “every now and then” you feel this dull chest pain, you may in fact begin to observe a pattern emerging from your journal entries, e.g. write down the date, time of day, description of the pain (location, severity, etc), what you were doing/eating/feeling in the 2-3 hours leading up to the onset of symptoms, etc. If you do observe a pattern, it may give your doc some useful additional data to help come up with the reason for your symptoms.

      Meanwhile, I’m hoping that you were referred and are attending some sort of cardiac rehabilitation program (most programs have moved online during the pandemic). This is a valuable program offered to people with all kinds of heart disease, even for people who have already been very physically active.

      My only other suggestion might be about your usage of nitroglycerin. If you weren’t prescribed this on an ‘as-needed’ basis before hospital discharge, you can ask your GP about this. It’s a vasodilator, one of the oldest heart medications, inexpensive, very few if any adverse effects, used for decades to help manage chest pain.

      Since you’re a tennis player, I’ll tell you about a woman I met at Mayo Clinic who was a competitive tennis player too, living with chronic angina. She’d take a dose of her nitro before each daily game, and then halfway through the game she would sit down, take a second dose, wait five minutes and then continue playing. She had been doing this FOR YEARS, with her symptoms staying essentially unchanged. Something to think about/ask your doc. Here’s more on what pioneer cardiologist Dr. Bernard Lown calls a “wonder drug”. Personally, I would never leave home without my nitro.

      Good luck to you – take care…

      Like

  5. I had a stent placed in my LAD nine months ago. Ever since, I have been experiencing excruciating pain at the exact location of the stent. It is unrelenting, and nothing like the mild angina I had before the stent. I’ve seen two cardiologists, a pulmonologist, a gastroenterologist, had a cardiac nuclear stress test, a CT angiogram, a CT chest scan, an upper endoscopy, a full pulmonary function test, several X-rays. All tests were negative. No evidence of anything wrong. None of the doctors suggested the possibility of the stent being the cause.

    I asked BOTH cardiologists if it was even remotely possible that the stent was causing the pain, and they told me no. They then suggested that the problem was in my head. Doctors in Nevada are the worst. When they fail at their job, they gaslight the patient.

    I am going to UCLA next month, in hopes that a top-rated cardiologist might actually investigate my case in-depth and reach a diagnosis. It will be a tremendous burden financially, but I’m at a point where I have no other choice. I am grateful for this article. While I may not have “stretch pain”, it is by far the best fit for my symptoms. Thank you.

    Liked by 1 person

    1. Mark, I’m so sorry you are experiencing such a distressing situation. SOMETHING is causing these “excruciating” symptoms – but what? The good news: you’ve had a whack of appropriate diagnostic tests to try to solve the mystery. So much of medicine is simply trying to figure out what the problem is NOT. The bad news: if doctors now believe it’s “all in your head”, what treatment options did they recommend to reduce your symptoms? There are many causes of chest pain; some are heart-related, some are not.

      I’m NOT a physician so cannot comment specifically on your unique case, but I can tell you generally that nine months does seem long for a case of unrelenting pain to be caused by stretching in that coronary artery. After that period of time, it’s appropriate to suspect an alternative issue. I’m so glad you’re going to UCLA (professional home of Dr. Noel Bairey Merz, considered an expert on non-obstructive coronary artery disease (severe symptoms but NO blockages) Some animal studies have suggested that the size of the stent selected can also impact injury to the artery (there’s a common trend towards “bigger is better” when interventional cardiologists decide on what size stent to implant in which coronary artery (the rationale suggested in some studies is that if the diameter of the stent is too small, this may result in restenosis (a new blockage). The LAD is the biggest coronary artery, so requires a larger stent. I’d also be curious if taking nitroglycerin helps at all with this chest pain.

      The question of non-obstructive disease (coronary microvascular disease) should also be discussed while you’re at UCLA.

      Good luck to you, Mark…

      Like

  6. I had my heart attack in January of this year. Just tonight, I was experiencing a small, sharp pain to the left of my heart. It happens every so often, while sitting. I am encouraged to learn of stretch pain, but a bit worried by the amount of time that has passed. I have my third visit with cardiologist in November. I agree, there is so much we should be told in the hospital or upon discharge that we are not.

    I will get your book. Another book I got that has been helpful is 10 Questions to Ask Your Doctor After a Heart Attack.

    Liked by 1 person

    1. Hi Clair – I think once you’ve had a heart attack, any pain anywhere near the heart – no matter how long ago you were diagnosed – is a very scary event.

      My own heart attack was 12 years ago, and I also live with ongoing chest pain now due to Coronary Microvascular Disease – we just NEVER get used to chest pain – nor should we! The difference is that I have somehow learned to live with it and not freeze in terror the way I used to do in the early days.

      The trouble is that we just cannot know if this is a weird but harmless symptom, or if it means something is wrong. For sure mention this to your cardiologist and when you do, do NOT minimize how distressing this chest pain has been for you. Cardiologists need to know all of the post-procedural effects of their interventions. Most are not signs of imminent danger, but it’s good to raise their awareness so that in the future, other patients can be fully informed before hospital discharge.

      I haven’t heard of that book you recommended so I looked it up – is it Dr. Dede Bonner’s book? I will check it out!

      Take care, stay safe… ♥

      Like

  7. I had a stent put in August 13th. Stabbing pain is all over heart area. I probably should call 911 but the pain goes away after a minute or so. My cardiologist is no help what so ever. I wish now that I never had this done. I feel worse now than before. So very frustrating and helpless.

    Liked by 1 person

    1. Hello Robert – stabbing pain around your heart does sound very distressing. It’s tempting to call 911 because chest pain is so scary, but the fact that it goes away after a minute or so seems reassuring.

      I’m not a physician so cannot comment specifically on your situation but I can tell you generally that you’re still in very early days yet (just over two weeks so far). Research suggests that symptoms within this time frame are likely a benign sign of healing, not of new damage.

      Try imagining your coronary artery healing with each pain episode, while breathing deeply during that minute or so (otherwise we tend to hold our breath when we’re frightened). If these symptoms continue over a long time or get significantly worse, please see your doctor.

      Hang in there…

      Like

    1. Hello Katie – You’re still in very early days yet. I’m not a physician so I cannot comment specifically on your situation of course, but I can tell you generally that it’s not unusual, as the German study suggests, to experience this benign ‘stretch pain’ for a few weeks as the coronary artery recuperates. If your symptoms continue or worsen over time, call your physician just to rule out any cardiac issues.

      Good luck – take care and stay safe… ♥

      Like

      1. I love your site and your compassionate replies to people who comment here. All your replies end with “call your physician or cardiologist if your condition worsens”.

        First of all, cardiologist seem to NEVER tell their patients that this is going to happen and it almost ALWAYS does.
        Secondly, once you have this procedure done and you experience problems, getting any help or any answers from cardiologist is near impossible.

        Once you are able to reach them by phone or in person,, their answer is ALWAYS the same, “give it time and it will pass”. No explanation to why this is happening. They just leave you in limbo to deal with fear on your own.

        Thank you for this site. Reading it does help us because we now know that it’s not just us and we are not alone!!!!

        Liked by 1 person

        1. Thank you Robert for your kind words. You are correct – cardiologists rarely warn their patients before hospital discharge of this very common and very stressful side effect of stent implants.

          Given the research that has confirmed how predictable these symptoms can be, it’s curious that all hospitals don’t already implement routine pre-discharge instructions like, “Oh, by the way, don’t be alarmed if you notice that you’re experiencing ____ once you get home….”

          In my opinion, instructions like this should also include symptoms of situational depression (extremely common, temporary and treatable) among newly-diagnosed heart patients.

          There seems to be a patriarchal attitude throughout medicine that sounds like this: “We don’t want to even mention any possible side effects in advance because these gullible suggestible patients will all become hypochondriacs!”

          So they say NOTHING to us, forcing us to suffer in ignorance, and then call their office in great distress – which makes us sound like hypochondriacs! But had they initially treated us like adults instead, we might not panic if and when these known side effects actually occur.

          You are definitely NOT alone! Take care, stay safe …

          Like

  8. I just had the procedure done 2 days ago, I am so glad to hear of this because it describes exactly what I have been experiencing, thank you!

    All my best to all of you, for a speedy recovery!
    LB❤️

    Liked by 1 person

  9. Well – I have had constant chest pain for 3 weeks, and it is only now that i have worked out it is reflux pain, exacerbated by the aspirin and platelet inhibitors i’m taking. I started taking omeprazol twice a day and the pain went away after 1 day. (I was on omeprazol once per day).

    Like

    1. Neil, I’m not a physician but I can tell you generally that there has been some controversy about heart patients taking omeprazol, especially if taken for more than 14 days in a row.

      If you’re saying that you have doubled your daily dosage of omeprazol (also known as Prilosec) please read this study published in 2017 in the American Journal of Cardiovascular Drugs before you start celebrating the joys of omeprazol.

      It’s one of the family of antacid drugs called Proton Pump Inhibitors (PPIs) which have been shown in a number of studies to be associated with increased risk of poor cardiovascular outcomes.

      You don’t mention if you’re buying this drug over-the-counter or under a doctor’s prescription. Please discuss possible alternatives with your physician.

      Take care, stay safe…

      Like

  10. Thank goodness I found this article. I certainly need to do more personal research because the sharp stabbing – ‘stretch’ pains are not nice to experience esp given I haven’t had a heart attack.
    Cheers

    Liked by 1 person

    1. Good luck to you, Rosemarie – you didn’t mention if you had a stent implanted. Stretch pain is associated with having a stent, not with a heart attack. So if your symptoms are indeed ‘stretch’ pain, remember that they are typically a short-term problem after a stent is implanted. If these symptoms continue or worsen over time, please see your doctor!

      Take care, stay safe… ♥

      Like

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