Managing Side Effects After Heart Stent Placement: A Guide for Patients

Inquire about post-stent issues for father?

Dear Doctor,
My father (55 years old) underwent the placement of a drug-eluting stent due to LAD stenosis last December.
Postoperatively, the doctor prescribed DAPT (aspirin + Plavix) along with propranolol to be taken daily.
However, after starting the medication, my father has experienced some side effects:
1.
He occasionally coughed before, but the frequency of his cough has increased after taking the medication (it is more pronounced after consuming cold drinks or meals; I suspect his airways have become overly sensitive.
He has undergone examinations by an ENT specialist and even a chest CT scan, both of which reported no abnormalities).

2.
His complexion has slightly turned yellow, and the blood vessels in the whites of his eyes have become more prominent, but there are no significant symptoms of jaundice.
3.
In the past few weeks, I have also noticed that he is more easily fatigued and drowsy, and he seems to have a calmer demeanor, but he is also more easily distracted.
4.
He experiences cramps in the inner thighs when walking briskly, but simple examinations show that the temperature in both feet is normal, and the pulses in his feet are still clear, so it should not be peripheral artery disease (PAD).
These symptoms remind me of the side effects associated with first-generation beta-blockers mentioned in pharmacology class.
I wonder if these symptoms could improve by switching to a third-generation beta-blocker or by changing to a different class of medication.
Since my father's next follow-up appointment is scheduled for about three months from now (early April), I am concerned whether continuing the current medication during this period could have adverse effects on his health, or if there are any precautions we should take.
I apologize for the lengthy description.
As a fourth-year medical student, my knowledge is limited, and I can only seek your assistance.
Thank you.

Chou, 20~29 year old female. Ask Date: 2023/01/24

Dr. He Dongjin reply Cardiology

Hello, if the father is not experiencing an acute myocardial infarction, he can temporarily refrain from taking INDERAL and observe whether the symptoms resolve.
If the symptoms disappear, it is likely a side effect of the medication, and he should stop taking it and discuss it with the physician during the next appointment.
If the symptoms persist, they are likely unrelated to the medication, and he can continue taking it without concern.
Generally, there is no strict requirement to take a beta-blocker.
Changhua Hospital cares about your well-being.

Reply Date: 2023/01/24

More Info

Managing side effects after heart stent placement is crucial for ensuring patient comfort and adherence to medication regimens. Your father's case, particularly with the combination of dual antiplatelet therapy (DAPT) and propranolol, highlights some common concerns that can arise post-procedure. Let's address each of the symptoms you've described and discuss potential management strategies.

1. Increased Coughing: It’s not uncommon for patients to experience increased sensitivity in their airways after starting beta-blockers like propranolol. While propranolol is generally well-tolerated, it can sometimes exacerbate pre-existing respiratory conditions, particularly in individuals with reactive airway disease. If your father has a history of occasional coughing, it may be worthwhile to discuss this with his healthcare provider. They might consider adjusting the dosage or switching to a different class of medication, such as a cardioselective beta-blocker (e.g., metoprolol or atenolol), which may have a lesser impact on the respiratory system.

2. Slight Yellowing of the Skin and Eyes: The symptoms of slight yellowing of the skin and sclera (the white part of the eyes) could indicate a mild elevation in bilirubin levels, possibly due to liver function changes. While propranolol is not typically associated with significant liver toxicity, it’s essential to monitor liver function tests (LFTs) if these symptoms persist. If there is a concern about liver function, switching to another medication or further evaluation by a specialist may be warranted.

3. Fatigue and Drowsiness: Beta-blockers can cause fatigue and drowsiness, particularly in the initial stages of treatment. This is often due to their effects on heart rate and blood pressure, which can lead to a feeling of lethargy. If your father is experiencing significant fatigue, it may be beneficial to discuss this with his doctor. They might consider adjusting the dosage or exploring alternative medications that may have a more favorable side effect profile.

4. Muscle Cramps: The occurrence of cramps, particularly during physical activity, could be related to several factors, including electrolyte imbalances or reduced blood flow to the muscles. While peripheral artery disease (PAD) seems unlikely given the normal findings, it’s still essential to ensure that your father is adequately hydrated and that his electrolyte levels are within normal ranges. If cramps persist, a review of his medication regimen and lifestyle factors should be conducted.

Recommendations Moving Forward:
- Medication Review: It would be prudent for your father to have a medication review with his healthcare provider. Discussing the side effects he is experiencing may lead to adjustments in his treatment plan, such as switching to a different beta-blocker or modifying the dosage.

- Monitoring Symptoms: Keep a detailed log of your father's symptoms, including when they occur, their severity, and any potential triggers. This information can be invaluable during follow-up appointments.

- Regular Follow-ups: Although his next appointment is in three months, if symptoms worsen or new symptoms arise, it would be advisable to seek earlier medical advice.
- Lifestyle Modifications: Encourage your father to maintain a healthy lifestyle, including a balanced diet, regular physical activity (as tolerated), and adequate hydration. These factors can significantly impact overall cardiovascular health and may help mitigate some side effects.

- Education and Support: As a medical student, your proactive approach to understanding your father's condition is commendable. Continue to educate yourself about the medications and their side effects, and don’t hesitate to reach out to healthcare professionals for guidance.

In conclusion, while some side effects are common with beta-blockers, they should be managed appropriately to ensure your father's comfort and adherence to his treatment plan. Open communication with his healthcare provider will be key in navigating these challenges effectively.

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I recommend that you: 1. Discuss the above situation further with your attending physician. 2. Consider consulting a cardiologist at a major hospital. Wishing you good health. Thank you!