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 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?”

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), 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.

205 thoughts on “Post-stent chest pain

  1. Wow I am so glad I ran into this article. My dad just had a stent placed about 2 days ago and is now complaining of this sharp chest pain.

    Reading this and everyone else’s experiences gives me some kind of comfort, but upset because there isn’t enough information given to the patient regarding life post-stent placement.

    While he was in the hospital, he kept asking prior to getting the stent placed and after what are the side effects of having this stent placed? The cardiologist said “nothing, don’t worry about the side effects, what you need to worry about is taking your medication every day, you cannot miss a dose”.

    To begin with, we had a pretty bad experience throughout my dad’s hospital stay with doctors not communicating, but to have the cardiologist be giving us that kind of attitude is unacceptable.

    It wasn’t until a nurse from the cardiac rehab facility within the hospital came and explained more thoroughly some things to watch out for like diet and good medication adherence. But still again she didn’t talk about side effects my dad may feel at home like the chest pain.

    There is still lack of communication in that regard and it’s upsetting to see that this is an ongoing issue everywhere.

    Liked by 1 person

    1. Hello Michelle – It’s unfortunate that even when your Dad asked direct questions about post-stent side effects, the response was “nothing – don’t worry about side effects”.

      I’m not a physician, but I’m guessing that there are two possible reasons for this kind of dismissively patronizing reply: either the doctor is simply unaware of post-stent “stretch pain”, or the doctor believes (as many doctors used to believe) that patients are so gullible that even the mention of a possible post-procedure issue is going to make these hyper-sensitive patients suddenly develop side effects.

      There are two frightening issues at play here: distressing chest pain during a time when patients reasonably expect that their cardiac symptoms have already been “fixed”, and what might be genuine ignorance of a commonly experienced post-discharge pain on the part of healthcare professionals.

      I hope that your Dad’s symptoms will be both benign and temporary. If his chest pain doesn’t ease up, or if it worsens over time, make sure his doctor knows about it.

      Good luck to both of you…

      Like

  2. My background as a PA/attorney/medical and legal educator makes me an annoying patient at times, as I’m always full of questions, I challenge orthodoxy and don’t accept rote and mechanical responses.

    Still, sitting here tonight after (painful) stent placement earlier in the day, I’m researching the topic and thinking about the irony of having what’s probably stretch pain when I never had any cardiac-related pain before the procedure!

    It’s really annoying, and more so because neither the information that I was offered spontaneously nor the answers I received in response to my questions led me to understand that this might happen.

    Your note jibes with studies that I’ve just read, and I appreciate the additional information.

    Liked by 1 person

    1. Hello Peter – I had to laugh at your background (PA/attorney/medical-legal educator). You are precisely the kind of person who knows what you need: basic information about risks/benefits, side effects, long- and short-term outcomes. To have that basic info withheld (either deliberately or because medical staff are simply unaware – this is the only possible conclusion I’ve been able to arrive at to explain WHY stent patients are not informed about the potential for post-stent chest pain BEFORE hospital discharge). This may be an artifact from the good old days when physicians widely believed that patients were too gullible to inform them in advance about possible side effects they would all go home and somehow imagine, so better not to mention side effects…

      Is that why so many of my readers share a common experience – that of NOT hearing words that adults deserve to hear? Something simple like:

      “Oh, by the way, here’s something that you may experience after you get home, it’s happening because _______ (insert research results here). This is typically temporary and benign while your arteries are healing…”

      Easy-peasey. Takes just a few seconds to say this. Would be a true comfort to the 40% of heart patients who experience post-stent chest pain by addressing in advance needless worry and stress…

      Meanwhile, it’s so ironic that you did not experience chest pain BEFORE your stent at all. Take care, good luck to you. . .

      Like

    2. Dear Peter,

      Trust me, I had the same experience. To make matters even worse, I am a doctor and a clinician-scientist.

      Imagine what my frustration levels would have been. I used to teach my postgraduate and undergraduate students about this procedure and I always took it too lightly that everything would be alright post-operatively.

      My whole life was up-ended back then after that fateful day on 17th November 2021. We need to seriously do something about this. As an academic and a doctor, I feel nothing has been done to address this and doctors nonchalantly demand patients man up to their new reality, none of which was addressed earlier on.

      I suggest we team up and do something about this once and for all. Some form of social activism, anything. I am open to suggestions. I no longer want to sit back and watch others suffer.

      Liked by 1 person

      1. Well, this is a first. . .

        Dr. CraftyWizard, you’re the first MD to share your own experience here about what countless heart patients have been going through, post-stent. I appreciate hearing from you.

        I think your observation about clinicians taking post-stent chest pain too lightly is SO true. It’s as if interventional cardiologists believe that their responsibilities end as soon as the patient leaves the cath lab. What goes on at home for those patients simply doesn’t interest them.

        If it WERE of any interest at all, these docs would ensure that all staff in the cath lab, in the CCU, in the Discharge Lounge (if their hospital even has a Discharge Lounge!) were not only well-informed about this very common post-stent reality but made sure that no heart patient would leave the hospital without a written note in any take-home follow-up material describing what MIGHT happen once they got home.

        As an MD, you’re in a privileged and powerful position to undertake your new project. You’re not, like me, a dull-witted heart attack patient who has been writing and speaking about this for years with little or no effect – except to hear from countless patients who have been shocked and frightened by their post-stent chest pain).

        My suggestion: consider contributing your own story to a journal. For example:

        – submit an 800-word (max) Opinion piece to the BMJ, or:
        – a 1,000 word (max) “On My Mind” Commentary piece to Circulation , or:
        – a 650-word (max) Opinion piece to Nursing Times – or any other journals that are read by nursing staff (since the last person to interact with a newly-stented heart patient is typically a nurse at discharge).

        These are just a few journals off the top of my head – you can do some homework on other publications read by the medical professionals who are sending their heart patients home without adequately educating them on the predictable reality of post-stent chest pain.

        They need to hear from heart patients like you, one of their own.

        Good luck to you on this new social activism! And please keep me posted if you do submit your own story for publication so I can help to share a link to it here for my Heart Sisters readers.

        Like

  3. It was such a relief to find this post. I had a stent placement two days ago and yesterday I was very concerned that I was worse.

    I totally agree “why aren’t heart patients like me warned about this before hospital discharge”? When I was discharged, they said you shouldn’t feel anything in my chest!

    Thank you for this and my wife thanks you.

    Liked by 1 person

    1. You are welcome, James. I hope this helps to lighten concerns for you – and of course for your wife, too! If your symptoms continue or worsen, do not hesitate to contact your cardiologist.

      Best of luck to you both. . .

      Like

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