Chest Pain following stent placement. All tests show normal.

[hburns]

62 years old. Do not smoke.  Cholesterol 150, 5'10" 190 pounds.  Walk 3 miles per day.
Had shortness of breath.
Recently diagnosed with a 70% blockage in the LAD.
Had angioplasty and a drug eluding stent installed.
Now after the procedure I have chest pain in the exact center of my chest when I exert myself.  Sometimes pain is also in the center of my back and sometimes on the left upper side of my right hand.  Occurs when I walk up long hills or exercise on my Nordic Track.  Pain develops when heart rate reaches 120.  Seems to be related to blood pressure.  If I stop and relax pain subsides in less than a minute.
Doctors have run ekg - normal.
Stress test - developed pain at 160 over 110 blood pressure but the stress test showed normal.
Doctor conducted another cardiac cath, normal, did not show any blockage, stent appears fine.

Doctor says to continue to exercise, don't over do.  Does not know what is causing the pain.

Pain did not exist prior to the procedure.  LAD was abnormaly small, put in a 2.5 stint.  Just barely fit. Did have extreme violent vomiting 36 hours after procedure.  Condition lasted for twelve hours.  Doctor believes unrelated.

Pain has existed for two weeks, does not seem to be getting any better.  Still occurs like clockwork when pulse excedes 120.

[CCF-M.D.-MJM]

Hi hburns,

It is encouraging that the stress test is negative.  One possible reason for the pain is microvascular disease.  Macrovascular vessels are the coronary arteries we see on the angiogram, microvascular vessels cannot be visualized on an angiogram and requires some more sophisticated tests during your angiogram.  It is hard to tell why this is happening after the stent but I must admit I've seen this once or twice before.

The negative stress test shows that you have a good prognosis.  Increasing your beta blocker may help improve your symptoms.

Good luck.  I hope this helps.

[Carolina03]

Hi,

For what it's worth, I had the more extensive angiogram mentioned by the CCF doc to check for microvascular disease. The test provoked the same chest pain I had been experiencing for months. Bottom line, my coronary arteries constrict under pressure -- no focal coronary spasm -- but a global narrowing under stress like exertion. "Endothelial dysfunction" is a marker for heart disease.

Prior to this highly specialized test, I had an ergonovine angiogram to check for coronary spasm, plus a stress test. All tests were normal, i.e., no EKG changes. Apparently, the more classic tests to look for large macrovascular disease are not sensitive enough to diagnose disease of the smaller vessels.

My prognosis is good, even though I experience chest pain. I'm under the care of one of the leading cardiovascular researchers for microvascular disease. I take an ACE-inhibitor, statin and Eplerenone, (a new diuretic) which have cut my symptoms in half and help protect me from "events," i.e., heart attacks, heart failure, etc. I also exercise and eat a heart-healthy diet.

Microvascular disease isn't always benign, so I hope you're taking the necessary interventions.

Best,
C

[triq]

I also had drug eluted stent in small caliber LAD 23 months ago.  After the stent I had some chest pain for about 4 months which eventually went away(no chest pain prior to procedure). They could not explain it but had had patients who had similar complaints.  Despite recent normal stress test, I had cardiac cath at 20 months for unexplained shortness of breath and it was good with stent wide open with no restenosis.  Therefore, the initial chest pain may be part of healing process (who knows) . Good luck to you.  
         My shortness of breath has improved after going off low dose statin-hope you don't have problem with statins since they are beneficial but do have side effects  which I feel are under reported.

[MRO]

Sounds like chest pain after stent placement is a common thing.  I had a heart attack at 35 due to an abnormally small LAD.  When a stent was placed in the LAD (the end of the LAD) my LAD tore.  I ended up with four drug eluting stents.  I had chest pains after the stent placement as well.  Unfortunately, I also had restenosis.  I ended up having six heart caths and six stents in the end.  This all took place in 2004.  My last heart cath was October 2004.  I continue to have chest pain when under stress but not necessarily when I'm exercising.  I also have the mid-back pain.  I take IMDUR, Toporol,Lotrel, Lipitor, Asprin and Plavix.

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