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Heart Disease (Expert Forum)
Post angioplasty/stent complications
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
Post angioplasty/stent complications
by beerhoch, Sep 29, 2004 12:00AM
Dear Doctor,
I am a 38 y.o. white male with coronary artery disease 3 months ago (My Dad died at age 42 from the same disease). I underwent angioplasty and stent placement in 2 clogged arteries. Immediately after the procedure I crashed due to a pericardial effusion that led to cardiac tamponade and had to be rushed into the OR for an emergency Pericardiocentesis, and was hospitalized in the ICU. I lost a lot of blood, and had a drain in my chest for 4 days while I was in the ICU. I was hospitalized again when the effusion grew 2 weeks later and have been treated with varying levels of prednisone for the past 12 weeks. A follow up echo showed the effusion to be gone 2 weeks ago, and I have now tapered off the prednisone. I continue to have some pains in my chest, like ‘pinching’ or stabbing feelings around my chest in different places under my breastbone rather often, they only ast for 1-2 seconds and disappear. My pulse was also racing to120 beats/min so my cardiologist put me on Atolenol which has helped my pulse rate, but I still get palpitations nearly everyday (pulse is regular but my heart pounds and thuds in my chest).I have three questions; 1. What could have theoretically caused the pericardial effusion? 2. What might be causing the palpitations and chest discomfort? 3. Is it usual to have some discomfort in the chest after procedures such as I have been through, or should I be more concerned? FYI, I am on 75mg Plavix, asprin, 25mg atolenol 2x’s daily, 20mg Enalapril, 80mg lipitor, 10mg zetia and .5mg lorezepam daily. My cholesterol is now in the good range.
I am a 38 y.o. white male with coronary artery disease 3 months ago (My Dad died at age 42 from the same disease). I underwent angioplasty and stent placement in 2 clogged arteries. Immediately after the procedure I crashed due to a pericardial effusion that led to cardiac tamponade and had to be rushed into the OR for an emergency Pericardiocentesis, and was hospitalized in the ICU. I lost a lot of blood, and had a drain in my chest for 4 days while I was in the ICU. I was hospitalized again when the effusion grew 2 weeks later and have been treated with varying levels of prednisone for the past 12 weeks. A follow up echo showed the effusion to be gone 2 weeks ago, and I have now tapered off the prednisone. I continue to have some pains in my chest, like ‘pinching’ or stabbing feelings around my chest in different places under my breastbone rather often, they only ast for 1-2 seconds and disappear. My pulse was also racing to120 beats/min so my cardiologist put me on Atolenol which has helped my pulse rate, but I still get palpitations nearly everyday (pulse is regular but my heart pounds and thuds in my chest).I have three questions; 1. What could have theoretically caused the pericardial effusion? 2. What might be causing the palpitations and chest discomfort? 3. Is it usual to have some discomfort in the chest after procedures such as I have been through, or should I be more concerned? FYI, I am on 75mg Plavix, asprin, 25mg atolenol 2x’s daily, 20mg Enalapril, 80mg lipitor, 10mg zetia and .5mg lorezepam daily. My cholesterol is now in the good range.
Doctor's Answer
by CCF-M.D.-MJM, Sep 29, 2004 12:00AM
Hello,
Sorry to hear about your recent heatlh problems--what a tough couple months.
1. Many causes to pericardial effusions. In your case the most likely are:
a. Trauma: There is chance you had a small leak in one of your coronary arteries after the stenting. This is a rare but real complications with coronary angioplasty and stenting. If this was the cause, the artery almost certainly has healed and should no longer be leaking, else your effusion would still be present.
b. inflammation: following a heart attack, infections, or other rheumatologic disease (rheumatiod arthritis, lupus, etc), can cause pericardial effusions, although these rarely progress to tamponade. This category of effusions would improve with steroids. Odds are, however, you had a small perforation in your coronaries following your stenting.
2. Palpitations may be from premature ventricular or atrial complexes. The best way to find out is an EKG and 24 hour holter monitor. This is likely benign. You are probably more sensitive to any sensations in your chest since your stents and unfortunate pericardial effusion. I am assuming you did not have a heart attack and you heart function by echo is normal.
3. Many people complain of vague chest pains following stenting or angioplasty. The pain often subsides over time or as you become less aware of all your body aches. Health problems play a large and often unrecognizied/under discussed psychologic toll on your body. If your echo showed that the effusion was gone, this likely will not recur.
Lipator 80 is the perfect choice for you.
If you smoke, stop.
If you are over weight, try to lose weight under the supervision of your doctor. America has an epidemic of obesity. A healthy body mass index is 20-22, I think American's average 28. Look up a body mass index on the internet and check out your own and act accordingly under the supervision of your doctor.
Exercise when your doctor says it is ok.
Good luck!
Sorry to hear about your recent heatlh problems--what a tough couple months.
1. Many causes to pericardial effusions. In your case the most likely are:
a. Trauma: There is chance you had a small leak in one of your coronary arteries after the stenting. This is a rare but real complications with coronary angioplasty and stenting. If this was the cause, the artery almost certainly has healed and should no longer be leaking, else your effusion would still be present.
b. inflammation: following a heart attack, infections, or other rheumatologic disease (rheumatiod arthritis, lupus, etc), can cause pericardial effusions, although these rarely progress to tamponade. This category of effusions would improve with steroids. Odds are, however, you had a small perforation in your coronaries following your stenting.
2. Palpitations may be from premature ventricular or atrial complexes. The best way to find out is an EKG and 24 hour holter monitor. This is likely benign. You are probably more sensitive to any sensations in your chest since your stents and unfortunate pericardial effusion. I am assuming you did not have a heart attack and you heart function by echo is normal.
3. Many people complain of vague chest pains following stenting or angioplasty. The pain often subsides over time or as you become less aware of all your body aches. Health problems play a large and often unrecognizied/under discussed psychologic toll on your body. If your echo showed that the effusion was gone, this likely will not recur.
Lipator 80 is the perfect choice for you.
If you smoke, stop.
If you are over weight, try to lose weight under the supervision of your doctor. America has an epidemic of obesity. A healthy body mass index is 20-22, I think American's average 28. Look up a body mass index on the internet and check out your own and act accordingly under the supervision of your doctor.
Exercise when your doctor says it is ok.
Good luck!
Had a follow up nuclear stress test yesterday, came back with some abnomalties, showed some ischemia on treadmill and films had some irregularities. The tech gave me the preliminary results (at my insistance) but cautioned that the DR needed to look at them & compare w/ my previous angiogram,look at the Holter monitor results, etc. before a definitive result can be made. I have been having some chest discomfort & palpitations and I am quite cetain that the results will show restenosis or a new blockage.
I want to be treated at the Cleveland Clinic due to my complications (I live in Cincinnati). How do I go about getting into the Clinic for treatment?