chest discomfort

[kathy426]

I am a 40 year old female who had a mild heart attack last august 2006 I had a DES placed at that time.In october 2006 I experienced some chest discomfort between my shoulders and also in the center of my chest. My doctor admitted me and I received another DES in a smaller valve.That valve was only 40% blocked at the time the other stent was placed(August) but not blocked enough for the stent. In october the doctor did not see any other blockages so went ahead and stented the smaller blockage. Since then I had many days og chest discomfort ranging from pain to mild discomfort off and on Sometimes my heart actually aches. Then I can go a week or two feeling really good and then it will start again. I can not contribute it to anything specific I do I also have a hernia.I take plavix every other day, lopressor,aspirin 81mg,wellbutrin, nexium and xanax daily. I also recently started taking motrin which has helped a lot. The tylenol was not doing anything.Dr said it was ok to take motrin as long as i don't take to much I guess it can interact with the plavix. When I feel good I feel really good but when I feel bad it is really bad. I feel like i am going to have another heart attack and what is strange is this feeling of air I get deep in my chest between my breasts almost like I have been breathing cold air for a while. It is hard to explain but when i get symptoms that is one that I always have along with the pain. It is the feeling I had when they were placing the stent in. Does this mean my stent is moving? Is this how I will feel for the rest of my life or is this healing?

[CCF-M.D.-MJM]

Hi Kathy,

Sorry to hear about your recent health problems.  The first things is that you need to make sure your doctor knows about the continued pain.  There are many causes of chest and the distinguishing between atypical and typical pain is more difficult after someone has known coronary disease, especially if there pain is atypical.

The arteries we see on angiograms (heart caths) are on the outside of your heart and branch into smaller vessels as the penetrate into the heart muscle.  It is possible you have small vessel artery disease -- cannot be seen on cath.  It is also possible that you are having intermittent spasms of the arteries which are difficult to detect on heart cath.  Stents are pretty stable devices and do not move.  A non invasive stress test may help distinguish small vessel disease -- a positive stress test with a negative heart catheterization.

It is also possible the chest pain you feel is not cardiac in nature -- this is a diagnosis that should only be used once coronary artery disease is ruled out.

The other thing I want to mention is that plavix is typically taken every day.  This is probably worth asking your doctor about if you haven't already discussed it.  I do not think the dosing of plavix is the reason for your pain.

I hope this helps.  Thanks for posting.

[Ianna]

Just an interesting link..

http://www.heartcoherence.com/index.html#mainEKG50

Be well,
~ Ria

[Al Dente]

just curious, why are you on Plavix every other day?

i understand your frustrations and pain post-stent.  i would definitely talk to your cardiologist about the same feeling pain as when the stent was placed.  i had considerable angina for several months post stent until i was on the right meds.

good luck.

[kathy426]

I take the plavix every other day due to severe side effects. I have constant flu symptoms from the plavix. I can not stop taking it but the every other day helps the symptoms to be more tolerable until I can stop taking it altogether. Also I have a high sensitivity to medications. When one patient would need (for example) two pain pills I would only need a half of one and so forth. I have been like this for the last 6-7 years. I used to take SSRI's for OCD but am unable to take them anymore. Even a 1/4 of a pill!! Weird, I know. docs can't figure out why I am so sensitive. If i am not being to nosy, may i ask you Al Dente what kind of meds you take after DES placement and how long ago you had the procedure? Do you feel pretty good for the most part with your angina. Also I am seeing cardiologist this tuesday and will definetly mention these symptoms. Saw my family doctor last week. EKG was good.

                                     Thanks, Kathy
P.S. Will check out heartcoherence.com site!

[Al Dente]

Hi Kathy,

It's not unusual for people to be more sensative to medications.  It's quite frustrating trying to find the right one that doesn't give you side effects.

I had my DES placed 22 months ago--time has gone by fast.  I had alot of post-stent pain.  It took several caths and alot of tests to confirm what was going on.  I have large vessel diffuse CAD, as well as small vessel disease.  I take alot of meds to help the situation, but overall things have stabilized.

Here's what I take:
-Plavix, 81mg ASA, Atenolol, Cardizem, Cozaar, Imdur (long acting nitro), Crestor, Zetia.

I'm a type II diabetic/insulin resistant and take Actosplus MET and Januvia--this has helped with endothelial dysfunction and small vessel disease.

I do have occasional angina (actually this past week I had enough to take sublingual nitro a few times, which is a bit odd).

For the first several months after the stent, I had alot of angina, and it was relieved by nitro.  It wasn't anxiety or heart burn.  After adjusting the Atenolol and Cardizem to rather high levels, I started to get relief.

I hope your docs can be helpful.  If not, get to a large center that has more experience.

[kathy426]

Thank you for taking the time to listen to me. I guess the hard part for me is that I haven't had enough time to adjust to what has happened. Until last August I never had any health problems (other than wisdom teeth) in my life. All of a sudden this happened and it is very scary every time I feel something unusual I think the worst is happening. The xanax helps me a lot with that. The OCD makes me dwell a little more than i would if I was being treated for it but I have learned to live with it without meds for years now and I'm sure I will eventually adjust to this problem as well. I am glad you are doing good after your stent placements and have found meds to help you feel good for the most part. I guess we have to deal with what life throws our way!! This site has been wonderful to me being able to read all the different things people experience. When this first happened I felt I was the only 40 year old in the world who had a heart attack. Now I know that I am not. My one doctor (family) feels I have the heart of an 80 year old and the other (cardiologist) feels that I have the heart of a 20 year old. I guess I will live one day at a time and see what happens!!! Thanks again and be well.

[Al Dente]

the heart truly is an amazing thing.  it does take time to heal.  i'd take more into account of what your cardiologist has to say.  i have some ugly heart issues that run on both sides of the family, and i expected to have heart issues in my early 40s, but it popped up early a couple years ago at 28--it threw me for a bit of a surprise.

there's nothing wrong with being concerned about the heart and how we feel--i look at how the heart works with as much enthusiasm i have for other things.  most docs aren't used to patients learning and understanding the body--I look at the subject like learning finance or economics, or even as a hobby like building model boats.

as patients, we know when something isn't working or feeling right, and it's time to talk to the doc.  the worst thing a person can do is shrug it off.  talking is good.  8 ^ )

[jmike1_]

Kathy,
   Thanks for your post - it was quite interesting for me (and really liked reading the docs reply).  I have not had a heart attack, but do have 5 stents (4 DEL) and continue to have chest discomfort as well (by the way, I am 39 and have a pretty strong family history of CAD).  I also have several "good" days in a row, and then will out of nowhere start having the chest discomfort again.  Also, lately I have also starting having a sensation during exercise where I have a strong heartbeat sensation in my ear (probably nothing, but strange).  And being a recipient of 5 stents, any chest pain or strange sensation is a little discomforting.  I did have a heart cath about 2 months ago (done because my blood tests in the ER showed elevated levels of whatever indicates a possible heart attack and I showed ischemia during a preceding nuke stress test) which came out clear, but am convinced that I either have small vessel disease or spasms, although no one has diagnosed that (just my gut feeling).  I have been pushed in every other direction (GERD, respiratory, etc) for other diagnoses, but they all come up negative.  Anyway, just wanted to share with you a similar experience so you know you aren't alone, and that you have found a good place to discuss such issues.  By the way, I always click on posts where Al Dente has commented, because he always provides good info and supporting comments.  Best of luck to you, and I hope you feel better soon.  By the way, I was shocked to hear you are taking Plavix only every other day as well.  So sorry you have symptoms while taking it.  I wish there was something that could offset those symptoms for you.  Again, best of luck to you and God bless!

[justlookingforanswers]

Hi, I haven't had any stents but have had chest pain for over a year now.  I have had lots and lots of tests--all normal.  The one thing about your post that grabbed me was the cold air comment.  I have been telling all my docs that for a year, that it feels like I am breathing in icy cold air and my chest burns.  I have been tested with cardios, gi docs, pulmonary docs and a couple more.  No answers.  I had a CT-Angiogram which isn't quite as accurate as an actual angiogram but I was wondering if the small artery thing was an avenue I should pursue.  Have you heard of the cold air thing in relation to this?

I wish you well.

[kathy426]

Thanks for your post! I also have been pushed in all directions. I have had a lot of stomach testing. Prior to my heart attack I was diagnosed with a hernia just below my ribs. was going through a lot of GI testing when my heart attack stopped everything. When I was in the hospital for my first stent they continued with GI testing as well. Docs thought  my hernia may have played a part in my heart attack. They want to operate on the hernia but now I am on the blood thinner so they won't and I have to wait until I am no longer taking thinners. A few days after I came home from the hospital I was back in with a kidney stone for another week so I think my body is just shocked from everything! Can I ask how far apart in time your stents were placed? I went to cardio the other day and he put me on yet another medication. It is called Ranexa. I have not started it yet. He said it should help my chest pain. He believes it is small vessel spasm. If it does not help he wants me back in the cath lab. I can't stand the thought of going back in there again!By the way, I also read Al Dente's posts as well, he is very informative and supporting. Thanks Al and thank you for your post. I do not feel so alone and I hope your chest discomfort goes away and stays away! God bless.

[kathy426]

Thanks for your post! You are the first person to identify with the cold air feeling that I have spoke with. The doctors in the hospital were not sure what I was talking about. It is a hard sensation to explain. The other day I went to the cardio. I saw the one who put in one of my stents and I explained to him that the cold air feeling is the same feeling I felt when the stent was being placed in my vessel. He explained that when they place the stent they temporarily block the vessel for a few seconds and that is the feeling you get when this is done. Not good news since I am still feeling it he thinks I may have another blockage or my stents are not holding up but is trying me on a new medication before he puts me back in the cath lab. I don't know what answer to give you. It sounds like you have had a lot of testing done and they came back negative and that is good news. I would see the cardiologist again and see if their are any other tests he may want to do especially if you are having chest pain. Hope this helps and good luck to you!

[jmike1_]

Responding to your question about the time between the placement of my stents.  I am probably somewhat of an odd case.  I'm 39 and my problems all started in Febuary 06 (never a symptom before that), and at the end of March 06 I had my first heart cath.  I had 3 stents (1 DES and 2 non DES) all placed in my LAD during that one.  I've pretty much had a heart cath every month or two since.  Four weeks after the first heart cath, they did another one and added a stent. Within 3 weeks, they did another cath and found distal blockage, but thought the area was too small to treat w/ intervention.  About 2 months later, the pressure got very severe again and had to get another heart cath and did angio b/c one of my existing stents blocked up.  About 2 months later, I had another heart cath and had to have angio and another stent placed that covered up the 2 previous non-DES stents.  And finally, I had another heart cath about 1 1/2 months after that but was deemed clear.  Basically, I've not had too many completely discomfort-free (I don't really have pain, but strong discomfort and/or pressure) days since I had the first cath.  Life has gotten much better after they put in the DES stent that covered up the 2 non-DES stents but I still have discomfort quite often.  In between all the caths, I've had nuke stress tests of one kind or another that have typically shown ischemia, and until the last stent, was popping nitro frequently.  Now I'm taking a long-acting nitro (imdur) and maybe that is helping.  I've only had to take a few sublingual nitros over the past 6 or so weeks.  I still have discomfort almost daily, but at least it is to a level I'm confident I can just deal with.  Another odd fact about my treatment - I'm in the military, and until I recently moved and have been receiving care from a great civilian cardiologist, each cath was done by a different doctor.  So I've had 5 different cardiologists perform the 6 caths I've had.  Thank gosh I've found a good cardio and have settled down so I don't have to go through the army system anymore!  Anyway, I do hope you are able to get to a point where you feel well.  And again, thank you for your post....it was very helpful to me.  God bless!
Jmike

[AdamMenist]

Hello sorry to respond to this question with a question.

I too am experiencing chest pains. I am a 21 year old male, average weight and height. I recently quit smoking. Recently I have been getting these chest pains on the left side of my chest right below my pectoral muscle. It feels almost like a sharp pain that hearts a little every time I breathe. Also I experience discomfort when lying on my sides. Is this a problem with my heart? Is it wit hmy lungs? My doctor's said it was stress related, but honestly I am not stressed much. I understand I am about to get married and have a kid but these things do not fully bother me. I just am rushing to find an answer, because as a soon to be father.. I don't want to leave my kid and fiance behind :(

[AdamMenist]

errr I meant hurts a little everytime I breathe ; ; sorry.

[kathy426]

Hi and thanks for your post. First let me say congrats on your marriage and your quitting smoking. I hope you continue to not smoke. I smoked for 25 years and just quit when I had my heart attack. Docs contribute a lot of what happened to me to my smoking so keep it up!!! Also I was under a lot of stress at the time. Sometimes we do not think we are stressed but deep inside we are and do not realize it. From everything I have heard and read heart problems generally do not have sharp pain, they tend to be more pressure feeling and tightness. However I am not a doctor but I would suggest seeing a cardiologist and telling him/her how you feel. A few tests will relieve your mind and can't hurt. Sometimes just worrying about chest pain and why you have it will cause more chest pain. I hope this has helped and good luck to you and your family.

[shoe56]

Kathy,
I was unable to take Plavix after my stent due to a severe allergic reaction.  My cardiologist prescribed Ticlid (brand name), Ticlopidine (generice)  I take it twice a day,  with no side effects.  As for your symptoms, if you are not getting a proper diagnosis, don't give up.  You know your own body better than the doctors.  

[kathy426]

Hi shoe56,thanks for the info. Ticlid was mentioned when I was in the hospital and started having problems with the Plavix. My doctor did not want to put me on the Ticlid because he thought I would have more side effects. I think at this point it is worth a try! May I ask if you require weekly blood work while you are on the Ticlid? My doc said I would have to test weekly if I do take it. Thanks, Kathy

[jastill]

I have symptoms very simular to yours...including the cold feeling.  It was so great to hear someone else describe it! I had quad by-pass in 2000, about a month ago, got 2 med eluting stents one week, and one the next.
After the first 2, for a day and a half, I felt GREAT! The the discomfort/pains, etc. started again.  That's when I got the 3rd stent, with no relief.  I thought at first that is was better, but it is not.  I have periods of feeling better, but never have a "free" feeling in my chest...always some "presence" (not comfortable).  Then, the rest of the time, I feel "challenged".

Guess, I'm just saying thanks for sharing.  It helps to know we are not alone....neat about sharing the "cold" feeling.  

I am skeptical of receiving help from my doc.  I go for a nuclear stress test Wed.  I will not be my choice to just continue having tests trying to find what is wrong.  That is frustrating to me.

Sorry for your struggles.  I understand about the fears.  I have them, too.  I think depression excerbates the discomfort.  After reading about others having post stent pain, I just got up and got busy, and felt better for it. I just can't always keep it up.  Sorry for the long missive!  I wish you the best! - JoAnne

[kathy426]

Hi and thanks for the post. I'm sorry to hear about your struggles. I am at the same point as you are. Tired of all the testing. The last month I have felt a little better. Almost like I am finally healing from all the stent placement. My doc says I probably will never be completely "pain" free. I seem to go for longer periods of time without pain as time goes on and like you said I finally got up and started keeping busy and that has helped a lot. It seemed like the only thing to do. I am still taking xanax (small dose) occasionally as I have a lot of discomfort in my chest when I get anxious and it helps. Also I have a hernia that swells from time to time and causes pressure on my chest. The docs won't operate because of the blood thinner I take, so I guess I have to live with it. I hope as time goes on you will continue to heal and feel better. I was never told  it took so long to heal from stent placement but when you think about the fact that they are in your heart messing around I guess it makes sense!! Good Luck to you. Kathy