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.

116 thoughts on “Post-stent chest pain

  1. I found this site informative. It’s been two weeks since I had two stents placed in the same artery. I had a non-STEMI heart attack the week before the procedure. I find fear to be present a little as I wake each morning, glad and elated to be here. I am so achy and sore in muscles from rib cage down to my toes.

    I know it isn’t the same as the event as it was fixed. I haven’t taken any Tylenol for pain, but I think I will.

    I am thankful that I found this site. 🙂

    Liked by 1 person

    1. Hello Brenda – you are in very early days yet since your heart attack so it’s not unusual that you’re still recuperating. Your “down to my toes” comment suggests that you may have had your stents implanted via your femoral (groin) artery, which can cause bruising, swelling or soreness in many heart patients afterwards. It can take several weeks to fully heal.

      I’m not a physician but I can tell you generally that Tylenol (acetaminophen) is considered safer for heart patients than Advil (ibuprofen) or Aleve (naproxen). Check with your doctor just to make sure.

      Best of luck to you in your recovery. . . Take care, stay safe! ♥

      Like

  2. Thank you, I can sleep tonight now. 3 weeks ago, blood clot, heart attack and stent. Still experiencing intermittent discomfort. This all makes sense.

    Thank you, I’m going to purchase the book now. Ignorance is not bliss, it just scares you stupid. Facts and reasons help you move on!

    Liked by 1 person

    1. Hello Amanda – welcome to the very exclusive club that nobody ever wants to join! You have been through a lot – and you’re still in relatively early days as they say. You’re so right – facts and reasons are better than ignorance – or as I like to say, knowledge is POWER! By the way, you might want to read this helpful series of ‘homecoming’ essays by Dr. Wayne Sotile (excellent for freshly diagnosed heart patients). Part 1 starts here with links to the rest at the bottom.

      If your intermittent discomfort feels worse, or if it goes on for what seems like TOO long, see your doctor just to be on the safe side. But if this IS stretch pain, you’ll likely experience fewer episodes of discomfort as the coronary artery continues to heal up week by week.

      Good luck to you! Take care, stay safe… ♥

      Like

  3. Week into stenting my LAD, I am still experiencing mild left arm pain front of the armpit. I went to the ER on the second day after the procedure on advice from the nurse when I called to discuss this after-stenting pain. I was kept in the ER for 40 hrs observation. All the EKG and enzyme tests were negative but no physician or cardiologist said this is normal pain after PCI.

    Liked by 1 person

    1. Two possible reasons for this lack of information, Raj: either
      1. the physicians were reluctant to definitively blame stretch pain for your symptoms until they ruled out every other possible cardiac reason, or
      2. they are unaware of how common stretch pain is following PCI

      Many people have told me the same story, that not one person had warned them before hospital discharge about this very common post-stent side effect. As this article suggests, stretch pain can last for several weeks as the coronary artery heals from being stretched during your procedure.

      Take care, stay safe. . .

      Like

  4. Very useful and educative. I got a stent implanted five days back and going through, probably, stretching pain. I wish Drs would explain these aspects/dimensions to their patients.

    Like

  5. I had one stent implantation in my LAD in July 2017 four years back. Since then I am feeling chest pain very often, sometime after 2 months or 3 months which lasts for few days. I had another angiography done in March 2018 . Everything was OK. I have consulted many cardiologists but no-one could tell the reason. I am always tense due to this recurring chest pain despite diet restrictions, regular exercise and prescribed medicines.

    Like

  6. I had a heart attack 4 years ago and immediately after my emergency stent procedure while recovering in ICU experienced stabbing pains in my chest I would describe as a quick jolting pain. I told everyone, the nurses and my doctors, and no one knew what it was.

    Since then I have them every month less frequent, but still the same sometimes during the day and while in bed and sometimes jolts me up. It’s a very scary sensation and I never knew what it was until I came across this article! Why don’t doctors know or tell you about this? 🤔

    Liked by 1 person

    1. Hello K – I’m not a physician, but I can say generally that the stabbing chest pains shortly after your stent procedure may have indeed been stretch pain due to the coronary arteries being over-stretched during the balloon angioplasty procedure in the cath lab, but I’m wondering if your occasional scary symptoms four years later can still be blamed on recuperating from that stent? Mention these pains to your cardiologist to see if there are other possible explanations for them.

      Best of luck to you – take care and stay safe . . . ♥

      Like

  7. Hi Carolyn,
    I had a silent AMI/ STEMI widowmaker and have ischemic cardiomyopathy as a result along with other conditions. My stretching pain didn’t start until a year after my heart attack and stent placement. My cardiologist did a cardiac cath at the end of two years to make sure that I didn’t have any blockages. He told me everything was clear and I didn’t have any other blockages and that it was stretching pain and I would have them until my heart healed. He said it was in the healing phase. I was close to five years out before they stopped.
    Take care,
    Robin

    Liked by 1 person

    1. Hi Robin – I’m not a doctor, but it does seem odd that stretching pain caused by the coronary artery being overstretched in the cath lab would take five years to heal. We know that there are other reasons for chest pain that lasts that long (e.g. microvascular disease, vasospasm, etc) that could be the culprit. In any case, I’m glad this pain finally stopped!

      Take care, stay safe. . . ♥

      Like

  8. Thank you!!! I had a stent 3 weeks ago and am freaking out from this new/other heart pain. It doesn’t feel like when I was on the verge of a heart attack, but somewhat mild squeezing pain that gets no better or worse with exercise. I was quite relieved to find this information.

    And, DEFINITELY, why don’t they TELL you this upon hospital release? I could not attend cardiac rehab due to arthritis (back, shoulder, hips, hands) since there was no machine I could use. So I was just left to wonder if this is “normal”. Mind you, had it gotten bad, I’d have gone straight to the hospital. But it was never THAT bad, just annoying and quite concerning!

    Thank you for sharing your experience!

    Liked by 1 person

    1. Hi Brenda – I’m so glad you found my site and this article specifically. Like you, I had never even heard of ‘stretch pain’ caused by my stent before I was discharged. That’s so maddening – to think that this is so common, yet few if any of us are warned about it. At three weeks, you’re still in very early days yet – I hope that your symptoms will gradually ease up and that you’ll feel so much better. Best of luck to you.

      Take care, stay safe. . . ♥

      Like

    2. Hi! I have three stents. All placed at once. I’m 40 years old female. I had the pain for several months before it eased off. I could do very little activity. I also have micro vessel and branch vessel disease on top. I’m still healing from December.
      Best wishes.

      Liked by 1 person

      1. Hello Sally – I too have had stretch pain following my stent, plus a subsequent diagnosis of microvascular (or small vessel) disease. My understanding is that stretch pain is typically defined as a short term recuperation following the stretching of the coronary artery during an angioplasty procedure, whereas microvascular disease is considered a separate diagnosis that can last a long time. If stretch pain is severe and continues for a long time, it might be time to suspect that it’s coronary microvascular disease.

        Take care, stay safe. . . ♥

        Like

  9. Totally agree with all who said great article.

    I came to my own conclusion, that the stent made of metal does not expand and contract like your artery does when you body temperature changes. So I guess when this temperature change occurs the artery at the edge of the stent may have a hissing fit and we feel the dull pain. This can also occur when there are any emotional feelings happening.
    2 years since my stenting and I still feel it.

    Liked by 1 person

    1. Hello Vittoria – interesting theory. I know that patients who have had metal orthopedic implants can experience more pain in cold weather.

      A stent, however, is so much tinier than a metal rod in the leg, I just don’t know!

      Take care, stay safe. . . 🙂

      Like

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