Chest Tightness After Heart Stent Placement: Causes and Concerns

The chest feels constricted?

Hello Dr.
Yang, I have a stent in my heart, and after one year, I occasionally experience sudden contractions in the area of my sternum, at the height of my heart.
When this happens, I find it difficult to catch my breath, and it is sometimes accompanied by nausea and dry heaving.
If there is no nausea, the sensation persists until the nausea and dry heaving occur, at which point the heart contractions gradually lessen.
(There is no burning sensation or gastric acid involved during the dry heaving.) It is quite terrifying.
The cardiologist indicated that multiple routine tests showed no abnormalities, no new blockages, and no signs of hypoxia, only mild arrhythmia.
I also consulted a pulmonologist who took X-rays, and compared to the ones from a year ago, there were no abnormalities, and they suggested I return to the cardiologist.
I also visited a gastroenterologist for an endoscopy, which also showed no issues, and they advised me to go back to the cardiologist.
However, the aforementioned symptoms still occur intermittently, especially after overeating, climbing stairs with slight shortness of breath, during stressful situations, or after squatting for too long (due to my body type).
I would like to ask Dr.
Yang, what could be the possible cause of these symptoms? It is quite concerning that I have not been able to find a clear or potential direction.
Thank you for your guidance, Dr.
Yang.

Mr. Zhang, 50~59 year old female. Ask Date: 2016/05/03

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Dear Mr.
Chang,
Regarding the symptoms you described, if cardiac issues have been ruled out, gastroesophageal reflux disease (GERD) should be considered.
Some patients with acid reflux may experience the acid traveling up to the throat, which may not give them the sensation of reflux, yet the gastric acid can still erode the esophagogastric junction, leading to discomfort.
An endoscopy may not reveal any abnormalities.
Additionally, esophageal spasms can also present with similar symptoms.
It would be advisable to have a gastroenterologist evaluate your condition further.
Thank you for your inquiry.
Changhua Hospital cares about your health.

Reply Date: 2016/05/03

More Info

Chest tightness after heart stent placement can be concerning, especially when accompanied by symptoms such as nausea and difficulty breathing. Given your history of stent placement and the symptoms you describe, it is essential to consider several potential causes and concerns.

Firstly, it is important to understand that after the placement of a stent, patients may experience various sensations in the chest, including tightness or discomfort. This can be due to several factors, including the healing process of the heart tissue, the presence of scar tissue, or even anxiety related to the previous heart condition. However, the symptoms you are experiencing, particularly the sudden onset of tightness and associated nausea, warrant further investigation.

One possibility is that you may be experiencing angina, which is chest pain or discomfort due to reduced blood flow to the heart muscle. Although your recent tests have shown no new blockages or significant ischemia, it is still possible to experience angina due to microvascular dysfunction or other non-obstructive coronary artery disease. This condition can occur even when major coronary arteries appear clear on imaging studies.

Another consideration is the role of gastrointestinal issues. Given that your symptoms worsen after eating or during physical exertion, it is possible that gastrointestinal reflux or esophageal spasms could be contributing to your discomfort. These conditions can mimic cardiac symptoms and may require evaluation by a gastroenterologist, which you have already pursued.

Additionally, anxiety and stress can exacerbate physical symptoms, leading to a cycle of discomfort and worry. It is not uncommon for individuals with a history of heart disease to experience anxiety about their health, which can manifest as physical symptoms, including chest tightness and nausea.

Given the complexity of your symptoms and the fact that multiple specialists have not found a definitive cause, it may be beneficial to return to your cardiologist for a comprehensive evaluation. They may consider additional testing, such as a stress test, echocardiogram, or even a Holter monitor to assess your heart rhythm over a period of time. This could help identify any intermittent arrhythmias or other cardiac issues that may not have been evident during previous evaluations.

In summary, while your symptoms may not indicate a new blockage or significant heart issue based on recent tests, it is essential to continue monitoring your condition and communicate openly with your healthcare providers. Keeping a symptom diary, noting when symptoms occur and any associated activities or foods, may provide valuable information for your doctors. It is crucial to address both the physical and emotional aspects of your health, as both can significantly impact your overall well-being. Please continue to advocate for your health and seek further evaluation until you feel confident in the management of your symptoms.

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