Wat may be the cause of chest pain even after 2 Angioplasty?

[ANH21]

Hello doc,
My dad was getting chest pain only when he did some heavy work.On consulting the doc,Angiogram was done.Upon the results of that doc told us that there is 95%,90% and 40% blockage in 3 different arteries.They put a medicated stent on right artery with 90% clot and 2 ordinary stents on the left artery.After 3 months my Dad  started getting similiar pain.On approaching,the doc told us that the left artery is rejecting the stents so this time they will put a medicated stent(38 mm long).Following Angioplasty procedure,my Dad recovered soon and all but again today(after 1 week of 2nd Angioplasty) my dad got some chest pain while walking!!!!

My question is:
1)What may be the reason for chest pain again?
2)After 1st Angioplasty my Dad is facing a new problem i.e,his hands and shoulders often "go to sleep" and gets severe body pain for some moments.What may be the reason behind this pain?Is this due to the medicines intake after the procedure?


I studied from your website that non-medicated stents often cause risks,and so did my Dad face.But our doc told us Dad's body was rejecting the stents.Doc is telling that the body pain which my Dad is facing now is in no way concerned to heart,but i dont think so and have a doubt.

Please respond to my question as soon as possible Sir/Madam.Thank You.
                                                                                                                                            ANH.
                                                                                                                                            23/01/2010

[kenkeith]

"Does the complete absence of pain during  either hard, prolonged exertion or lying down idle mean there's enough oxygen for the heart tissue."

Lack of oxygenated blood to heart vessels does not always cause chest pain or any symptoms.  In fact the first symptom, I had was congested heart failure.  Heart cells were slowly becoming nonfunctional from lack of oxygen until heart wall movement was impaired and blood backed up into the lungs causing edema.

Often the individuals that have a silent heart attack (no previous symptoms) are diabetics and older people but not always...you never know.

[kenkeith]

QUOTE: "I studied from your website that non-medicated stents often cause risks,and so did my Dad face.But our doc told us Dad's body was rejecting the stents.Doc is telling that the body pain which my Dad is facing now is in no way concerned to heart,but i dont think so and have a doubt".

Anyway one looks at it, there is a heart problem.  There can be a rejection of the stent, and that would involve inflammation due to immune system's response to a foreign object.  Or restenosis of an endovascular stent may be caused by thrombus (blood clot), **intimal hyperplasia, or extrinsic compression (tumor).  

For some insight: When a stent is placed in a blood vessel, new tissue grows inside the stent, covering the struts of the stent. Initially, this new tissue consists of healthy cells from the lining of the arterial wall (endothelium). This is a favorable effect because development of normal lining over the stent allows blood to flow smoothly over the stented area without clotting. LATER, scar tissue may form underneath the new healthy lining. In about 25% of patients, the growth of scar tissue underneath the lining of the artery may be so thick that it can obstruct the blood flow and produce an important blockage. In-stent restenosis is typically seen 3 to 6 months after the procedure; after 12 months have passed uneventfully, it is rare.

Hope this helps you.

[oldie]

You say: 'the chest pains are from angina showing that the heart tissue is'nt getting enough oxygen due to a blockage'  
I have had very valualbe advice from you on several occasions. Can I come at you again on the  above quote?
Does the complete absence of pain during  either hard, prolonged exertion or lying down idle mean there's enough oxygen for the heart tissue?

[ed34]

Personally I think the term 'reject' used by the Doctors is misleading. I think they are referring to scarring. When a bare metal stent is inserted, scar tissue grows quicker than the artery lining tissue and can cause a considerable blockage. This is a well known problem. Drug eluting stents inhibit scar tissue from forming. Sometimes Doctors will decide to use a bare metal stent, but usually only in blockages which are very short in length. I wouldn't consider 38mm to be very short, that is huge.
If that was my father, I would want another angiogram to ensure that the new stent hasn't collapsed. Perhaps the stent isn't strong enough to hold back all the scar tissue.
Did they remove the old stent? or put the drug eluting stent inside the old stent?
Personally I think it's a real guessing game until a new angio is done. To feel fine and then suddenly start to get chest pains again is more than a coincidence after having a stent inserted. The chest pains are from angina, showing that the heart tissue isn't getting enough oxygen due to a blockage.