des stent

[amit5368]

hi,
       i am concerned with the affects of stent
ie a foreign material in the body. My dad suffered
a silent heart attact some years back and had symptoms
of chest pain recently . after angiography a des stent
was put in , but i am not sure was it required because
that portion of heart supplied by that artery has
got damaged and can not be recovered . he still has mild
chest pain and heaviness .i want to know that is there
any risk of stent getting infected inside the body, and
what could be done to eliminate the situation.
thanks

[kenkeith]

A nitrate, isosorbide, is a slow acting coronary vessel mediciation that can dilate the vessel to enable a better flow of blood to heart cells.  Nytro provides quick relief if there is angina and usually appropriate for individuals that have unstable angina.  Unstable angina is chest pain that occurs without any exertion is a more advanced condition.

I have stable angina, meaning chest pain accurs with exercise.  With stable angina one can take a nitrate prior to an exercise regimen...my situation for the past 6 years and no advancement of symptoms.

I provided conditions that can occur with stent implants, and the statistics are low, but possilbe..  Of course the experience of the cardiologist is a consideration, and I haven't seen any documented evidence for a downside with medication other than personal opinion.  

Thanks for the followup question, and don't let fear of having a stent implant influence you with a dotor's decision,,,Just keep in mind there are other options, and a good doctor should provide accurate information....I had a cardiologist that did not believe the patient and the doctor are a team, and doesn't/didn't believe the patient is capable of knowing what is best for himself or herself.  

Take care.

[ed34]

In an angio-suite there should be a highly qualified cardiologist with a lot of experience following the actions of everyone with each procedure. In a professional hospital there should be no reason why a stent should be the wrong size and it is certainly very rare for  a stent to drop off the catheter before expansion. If a stent falls off the catheter, it can be retrieved if seen, because it hasn't been expanded yet. Once expanded, they are squeezed very tightly against the artery wall. I had to watch 20 expansions of a balloon down my LAD and the pressure it exerted, I could see the artery bulging. It relaxes back down again, but a stent would be very tight in there. New tissue grows through the sides of the stent quite quickly and it basically becomes part of the artery, embedded in the lining. Nothing will move it, even if you was vigorously shaken upside down. Magnets wont even move them. The only thing that can happen with magnets, as used in some scanners, is they can heat the metal which is why you make sure you tell the examiner you have a stent. They then adjust the scanner accordingly.
Nitro (glyceryl trinitrate) is a chemical which stimulates the arteries to widen, open up. This allows blood to flow easier and in more volume to the heart tissue. It's available in pill form which is usually held under the tongue, or a spray form, again sprayed under the tongue. The effects are very quick, within a few seconds. Due to the sudden drop in blood pressure, it can make you feel dizzy or get a headache. The effects usually last around 20 mins.

[amit5368]

hello,
      i am tensed after reading this  . can you please tell what is
meant by stent could migrate, is it that it can move in artery and block
other arteries. Also plz tell what is nitro is it sorbitrate tablet taken
for relief of chest pain.
thanks .

[kenkeith]

There could be a problem with a stent implant.  It can migrate, there can again be occlusion, incorrect size, and possibly stent collapase.  If nitro doesn't provide relief, then the symptoms may be related to another cause, but it doesn't rule out any other heart problem.

[amit5368]

i have read on various sites online that chest pain may be
due to several reasons including angina , gastric or due to lungs
etc. also some where it was written that in cases where patient
has undergone angioplasty or bypass earlier the first thing to
suspect is of angina and heart problem. my father had angioplasty
six months ago with a stent in rca for 95% blockage and 40% blockage
in lca and lcx. Doctor is not considering it due to heart and suspecting
some other problem. I am afraid that if this could be angina and heart related problem . if so how to check and cure it. Thanks for help.

[kenkeith]

The pain could be a spasm of the coronary vessels that happens with an electrolytic imbalance and a blood test could rule that out.  That may have already been done.  There is pericarditis (inflammation of the fluid that surrounds the heart.  That can be a conditon that comes, sometimes goes away and again returns,etc.

It appears your father's doctors are taking the symptoms seriously, and it is difficult to assess just based on information with a post.  Sometimes getting a second opinion from a doctor who may review with a different perspective can be positive.

[amit5368]

My father still has chest pain that radiates to back in center. The pain
is not associated with exercise or physical activity . This pain appears
any time at rest early in the morning or sitting in the office.
last time two month ago doctor said it may be related to acidity or digestive problems and gave several antacids. He feels better when
he take these medicines but it reappears as these are stopped.
we can not still figure out what is the main cause of the pain whether
it is related to heart or some other problem . can you please guide
what to do in this situation. He is taking aspirin150 , plavix,tonact40, and medicines for BP , Sugar besides these antacids .

[kenkeith]

I experienced almost identical to your Dad's experience.  I had had a silent heart attack, and didn't realize a medcal problem until I had symptoms of congested heart failure. There was mild pulmonary edema, an enlarged left ventricle, and the EF was below 29%.  The heart was weak and was unable to pump the amount of blood received from the lungs causing blood to backup in the lungs ad fluids leaked into the lung tissues.  

I had 98% blockage of the RCA, the LAD was totally blocked and ICX was 70% occluded.  The RCA was stented, and medication has reduced the left ventricle size and and EF is 59% (normal is 50 to 70%).

Your Dad's 50% is low normal, but it does indicate there was very little damage if any of the heart cells. I had heart cell damage that was revitalized with a good flow of blood to the area supplied by the RCA (that may happened for your Dad).  The total LAD occlusion developed collateral vessels over the years and was/is suppling a source of oxygenated blood to the area supplied by the LAD.  Heart cells can go into hibernation (kept alive and develops a low need for blood/oxygen).  My experience and possibly your Dad's experience as well.

Because chest pains can indicate a serious condition your father's doctor should get to the underlying cause.  It can be respiratory such as clots (embolism) in the lungs, pulmonary thrombosis (clots) in the pulmonary vessel.  Pericarditis is inflammation of the outer lining of the heart is a possible cause.  There could be new occlusions or restenosis of the old stent, etc.

Hope this helps, and thanks for your response.  Keep us informed and take care.

[amit5368]

Thanks for helping me.
As you have asked about the EF after heart attack and the present EF,
the Present EF is around 50%. The heart attack
was silent and we don't know when did it happen. When some symptoms occurred
doctor said for thallium test and said he had a silent attack may
be 3-4 years back. There was blockage in rca of 98% and mild blockages
in lca and lad. A des stent was put in rca. But since than the symptoms
are not improving and he does have chest pain and tightness in center of
chest. I am not sure what's the reason for chest pain and what should be done.

[kenkeith]

It is true a stent implant can't help perfuse dead (necrotic) cells, and therefore ineffective.  The risk is restenosis is the greatest within a year with Drug Eluding Stent and that hurdle has been eliminated.  

The highest probability if related to the heart  would be another occluded vessels.  Just curious, what was your father's EF after the heart attack, and what is the current EF.  EF would be the fraction of blood pumped with each heartbeat.  If your father had had a heart attack, that would almost always reduce the blood pumped because the heart cell damage reduces the heart muscle to effectively contract for strongerpumping power.  

If you father has some occluded vessels that are causing chest pain, the medication (nitrate) can relax the coronary vessels and that will help provide more blood to the deficit area. It is highly unlikely there is an infection...

Sorry to hear of your father's medical problem.  Thanks for sharing. and if you have any followup questions you are welcome to ask.  Take care.

[ed34]

The material itself will not possess a problem, the only risk is developing a blockage in the stent. Maybe they installed the stent in the hope that some of the tissue would recover, ie some of the tissue was not dead but stunned.
A Drug eluting stent poses less risk for forming clots especially if Plavix is taken with Aspirin. They also help to prevent scar tissue from forming, a problem known to exist with bare metal stents. The contraversy seems to be regarding how long plavix should be taken. I believe the USA say 1 year min, whereas the UK is leaning more towards 3 years or even life. The stent won't get 'infected'.