Symptoms Related to Angioplasty?

[Rich__0]

  Great forum, thank you for the past advice!.
  2 1/2 weeks ago I had an angioplasty performed, successfully I'm told.  One 85% blockage in the LAD was opened and a 20 mm Nir stent inserted.  I'm taking Plavix along with aspirin.  I've felt good since the procedure.
  Yesterday I developed (at rest) mild-moderate chest discomfort and mild shortness of breath.  I took 2 nitro tablets with no relief, but the s.of b. was relieved somewhat when I chewed an aspirin.  I believed the stent may have started to occlude, so I saw my cardiologist today.  He performed an EKG (normal), and listened to my heart (fine) and lungs (clear).  (Today, both symptoms are less noticeable but still present.)
  He does not believe these symptoms are due to stent clotting, as he states that usually manifests itself within the first 10 days, and he feels he would have seen something in the EKG or heard something in my lungs.  I certainly trust (and welcome) his judgement, but am looking for a second opinion before I talk to my internist about other causes.  
  Please let me know if you agree, and, if so, what other causes could be responsible.  I should state that I've had a recent chest X-ray and upper GI, both negative.  Thanks so much.
  Rich

[Cleveland Clinic, MD]

Dear  Rich ,
I agree that it would be highly unusual for the stent to occlude this early.  There are many other possible causes of your symptoms.
Amongst the cardiac causes of chest pain are:  pericarditis (inflammation of the sack around the heart), myocarditis (inflammation of the heart), cardiomyopathy (heart failure) and rarer causes such as coronary artery dissection, acute rupture of the heart and valves and infections of the pericardium.
Gastrointestinal causes of chest pain include reflux (acid from the stomach washing back into the esophagus), gallstones, esophageal spasm, esophageal rupture, varicose veins of the esophagus, strictures of the esophagus, tumors of the esophagus and other less common GI problems.
Pulmonary (lung) causes include pneumonia, pulmonary embolus, pneumothorax, pleuritis and bleb rupture.
Other potential causes are aortic dissection, back and spine problems and musculoskeletal (muscle strain, rib fracture, etc.).
Psychological causes of chest pain are common and include panic attacks, anxiety, stress and mental duress.
As you can see the list of potential causes in long and may take a little bit of time to determine the precise cause.  A good Internal Medicine doctor should be able to work through the potential causes of your symptoms.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.