Chest Symptoms Following Coronary Stenting

Introduction

Coronary artery disease (CAD) is a type of heart disease caused by the accumulation of plaque (cholesterol deposits) along the walls of the arteries that provide blood supply to the heart (coronary arteries). The plaque accumulation gradually results in the narrowing of these arteries, partially or completely blocking the blood flow, known as atherosclerosis. It is characterized by chest pain radiating to the arms or shoulders, weakness, sweating, shortness of breath, nausea, and discomfort. Atherosclerosis can be treated either by medications and bypass or through procedures that open these narrowed arteries. It helps reduce the symptoms and restores the blood flow to the heart muscles.

What Are Coronary Stents?

Coronary stents are small, flexible, thin, tube-shaped metallic devices inserted into the coronary arteries (blood vessels that supply the heart) that have become clogged due to an underlying disease. It is placed during or immediately after coronary angioplasty or percutaneous coronary intervention (PCI). It was first developed in the 1980s and has evolved in structure, shape, and material used for the procedure. Coronary stents are available, such as bare metal stents, drug-eluting stents (DBS), bioresorbable stents, and drug-eluting balloons (DEB), which help prevent the coronary artery from closing up again.

How Is Coronary Stenting Performed?

Coronary stenting is mainly used to treat a blockage in one or more coronary arteries that can affect the proper functioning of the heart. It may also be recommended for patients with narrowed arteries that reduce blood flow and cause frequent chest pain (angina) and for whom medications are not effective.

• Before the angioplasty, the patient receives a local anesthetic at the catheter (flexible tube) insertion site and a sedative to relax. The patient is asked to lie on a padded table. However, the patient stays awake during the procedure and constantly monitors the vital signs.

• A sheath or introducer (a plastic tube) is put into the blood vessel through the catheter and is advanced toward the heart. The doctor uses live X-ray images to monitor the catheter in the arteries.

• A liquid contrast (dye) is injected to help detect the blockage in the blood vessels. After the narrowed artery is located, a balloon catheter is pushed over a guided wire into the blockage area.

• The balloon is then inflated, opening the blocked artery and restoring proper blood supply to the heart.

• A small expandable metal mesh coil (stent) is placed in the blocked area and inserted along the balloon catheter. It also expands when the balloon is inflated and is left in the area to keep the artery open. Mostly, the stent is coated with a drug to reduce the chances of the artery closing back in the future.

• The sheath and the catheter are removed from the insertion site, and the area is sealed with a collaged material or by sutures or manual pressure to prevent bleeding.

What Are the Risks Associated With Coronary Stenting?

Coronary angioplasty is usually safe but may be associated with certain risks, such as:

• Bleeding or blood clotting at the site of catheter insertion.

• Allergic reactions to the drug, contrast agent, or the stent material used during the procedure.

• Heart attack.

• Kidney failure.

• Stroke (a blood clot blocking the flow of blood).

• Damage to a blood vessel or heart valve.

• Cardiac arrhythmia (irregular heartbeat).

What Are the Chest Symptoms Following Coronary Stenting?

A coronary stent usually reduces the symptoms of angina and improves the patient's quality of life. However, some symptoms may still occur following coronary stenting; these include:

• The tissue from the inner walls of the artery can grow over the metal stent, similar to a scab on the wound. This usually occurs during the first three to 12 months of receiving the stent. It can re-block the blood flow and cause chest pain or sometimes heart attack.

• Thrombosis can occur at any time, but it is usually seen within the first month of receiving the stent. It can be due to stopping or skipping the prescribed anti-clotting medications, which causes nausea, palpitations, cold sweats, shortness of breath, chest pain, and discomfort.

• Some symptoms are not severe and do not require treatment; medications manage these as the stent may require time to adapt to the body. However, the doctor can be consulted if the patient or the caregivers are concerned about the symptoms.

• Studies were conducted on patients who received coronary stents after a few weeks of discharge to assess the pattern and presence of chest symptoms. It demonstrated that chest symptoms were recurrent (almost daily) in approximately 33 percent of patients, especially of young age. The symptoms were mainly dull, tight, sharp, pressing chest pain and discomfort. It was also described as intermittent and brief, lasting for a few seconds to a few minutes, particularly in the chest's upper and left central areas.

• Several explanations have been developed for the cause of chest symptoms following a coronary stenting procedure, which includes vasoreactivity (response of the blood vessel) at the stent site and microemboli (small blood clots).

• More than 68 percent of patients experienced chest symptoms at some time during ten weeks after discharge. Some patients were investigated with certain diagnostic tests that showed ischemia (reduced blood flow and oxygen) and required further intervention. In studies conducted after four to ten weeks, most patients expressed their symptoms as worse and more discomforting.

How Long Does It Take To Recover After Coronary Stenting?

After a planned coronary angioplasty, the patient may be discharged in a day or two and is advised to take the medications and follow a healthy diet and lifestyle. Patients are also instructed about wound care and hygiene to prevent infections. The chest area may be tender (pain on touch), which is mostly normal and resolves in a few days. Activities such as lifting heavy objects, driving, sexual intercourse, and strenuous work must be avoided for a few weeks or until the wound heals. Most patients experience the results of percutaneous coronary angioplasty or coronary stenting within a short period, along with reduced symptoms and improved cardiac function.

Conclusion

Coronary stenting is mainly performed to treat a narrowed blood vessel that restricts the blood flow to the heart. Chest symptoms following coronary stenting are mostly common and frequent and may occur up to ten weeks post-discharge. These include chest pain, breathlessness, and discomfort for a brief duration, especially in the upper and left central areas of the chest. The healthcare team is responsible for providing appropriate instructions for the patients following the coronary stenting procedure. The patients must follow all the instructions exactly as recommended and take proper medications to avoid any symptoms or complications following coronary stenting. However, most patients can return to normal within a few weeks after a coronary angioplasty with stents.