Post-Cardiac Catheterization: Symptoms and Concerns

Post-cardiac catheterization?

Hello Doctor: On November 21, I underwent cardiac catheterization and had two stents placed.
The reason for the stent placement was that during a health check, a 70% stenosis was found in the left anterior descending coronary artery, although I did not have symptoms of angina.
My symptoms included shortness of breath, occasional chest tightness requiring deep breaths, and feeling dizzy after doing household chores, especially when climbing stairs, where I would become very breathless.
However, after the stent placement, I have experienced some symptoms that I did not have before: 1.
I constantly feel my heartbeat, especially when lying flat on my back, to the point of discomfort, and occasionally it feels heavy, as if I am experiencing something stressful.
2.
I often feel a lack of breath and need to take deep breaths, even when talking to others or sitting still in a chair.
Sometimes I also feel a twinge in my back and frequently experience dizziness, as if my brain is lacking oxygen.
When I measure my blood pressure, my heart rate is normal, but my systolic pressure is below 100, around the 90s, and my diastolic pressure is about 70.
3.
While driving or riding a bike, when I hit a bump, my heart feels like it’s not secured properly and gives a jolt, which is uncomfortable.
Occasionally, I also feel a sharp pain in my heart.
It has been 20 days since the procedure, and I am still experiencing these symptoms.
Is my heart function impaired, and what kind of tests should I undergo to find out? Thank you, Doctor.

Huang Zi Ling, 50~59 year old female. Ask Date: 2021/12/10

Dr. Li Han reply Cardiology

Hello, regarding your inquiry about your wheezing, chest tightness, and "heart pain" sensations...
honestly, there are many potential underlying causes, but it doesn't quite resemble typical angina symptoms.
An evaluation can be conducted from both physiological and psychological perspectives.
However, the presence of coronary artery disease is a fact; it may or may not be related to your symptoms, but treatment is lifelong.
It is essential to strictly manage controllable risk factors such as blood pressure, lipid levels, and blood sugar, as well as to provide preventive antiplatelet medication.
Procedures like angioplasty and stent placement are only temporary solutions; consistent medication management is necessary.
I still recommend discussing your concerns in person with your attending physician.
The Changhua Hospital of the Ministry of Health and Welfare cares about you.

Reply Date: 2021/12/10

More Info

After undergoing cardiac catheterization and the placement of two stents due to a 70% blockage in the left anterior descending artery, it is understandable to have concerns about new or persisting symptoms. The symptoms you describe, such as shortness of breath, chest discomfort, and an increased awareness of your heartbeat, can be concerning, especially after a procedure aimed at alleviating coronary artery disease (CAD).

Firstly, it’s important to recognize that while stenting can significantly improve blood flow and alleviate symptoms related to coronary artery blockages, it does not cure the underlying condition of CAD. The presence of risk factors such as hypertension, hyperlipidemia, and diabetes can continue to affect heart health. Therefore, ongoing management of these risk factors is crucial.
Your symptoms of shortness of breath, especially during physical activity like climbing stairs, could be attributed to several factors. After stent placement, it is common for patients to experience some degree of anxiety or heightened awareness of bodily sensations, which can manifest as palpitations or a feeling of an irregular heartbeat. This is often benign but can be exacerbated by stress or anxiety.

The sensation of needing to take deep breaths frequently may indicate a few possibilities. It could be related to anxiety, especially if you are feeling more aware of your heart and its function post-procedure. However, it could also suggest that your heart is still adjusting to the changes in blood flow or that there may be residual ischemia (reduced blood flow) in areas not addressed by the stents.

The occasional discomfort in your back and the sensation of dizziness could be related to several factors, including anxiety, changes in blood pressure, or even musculoskeletal issues. It’s important to monitor your blood pressure regularly, as you mentioned that your systolic pressure is around 90, which is on the lower side. Low blood pressure can lead to symptoms of dizziness and fatigue, especially upon standing or during exertion.

Given that you are experiencing these symptoms 20 days post-procedure, it is advisable to follow up with your cardiologist. They may recommend several evaluations to ensure that your heart is functioning well and that there are no complications from the stenting procedure. These evaluations could include:
1. Echocardiogram: This ultrasound of the heart can assess the heart's structure and function, including the ejection fraction and any wall motion abnormalities.

2. Stress Test: A cardiac stress test can help determine how well your heart is functioning under physical stress and can identify any areas of ischemia that may not have been addressed by the stents.

3. Holter Monitor: If palpitations or irregular heartbeats are a concern, a Holter monitor can record your heart's rhythm over 24-48 hours to identify any arrhythmias.

4. Blood Tests: Checking levels of electrolytes, kidney function, and cardiac enzymes can provide additional information about your heart health.

In conclusion, while your symptoms may be related to anxiety or the body's adjustment post-stenting, it is essential to rule out any significant issues. Regular follow-up with your healthcare provider is crucial to managing your heart health effectively. They can provide personalized advice and treatment options based on your specific situation. Remember, managing CAD is a lifelong process that involves both medical treatment and lifestyle modifications.

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