Post-Heart Attack Symptoms After Angioplasty: A Patient's Journey

Concerns about physical condition after cardiac catheterization following acute myocardial infarction?

Hello Doctor,
On December 18, 2013, around 4:30 PM, I went to the emergency room of a hospital in northern Taiwan due to symptoms such as chest tightness and upper body weakness.
After diagnosis, I was found to have an acute myocardial infarction and was immediately taken to the catheterization lab for coronary angiography, which confirmed a 100% blockage of the right coronary artery.
A drug-eluting stent was placed.
The first coronary angiogram report was approximately as follows:
Coronary Angiogram Note:
- LM: patent
- LAD: patent with distal aneurysmal change
- LCX: OM1 stenosis
- RCA: Mid total occlusion with collateral from LCA
The day after the procedure, I still felt chest tightness and slight discomfort in the upper left chest, raising concerns about the possibility of thrombosis.
Therefore, another coronary angiogram was performed, and the second report was approximately as follows:
Coronary Angiogram Note:
- LM: patent
- LAD: patent, distal aneurysm formation
- LCX: OM2 40% stenosis
- RCA: NO thrombosis
There was no thrombosis found, but there was a 40% blockage in the LCX.
At that time, I still felt some discomfort in my chest, but it was much better compared to the symptoms of the acute myocardial infarction.
The doctor mentioned that it might be due to the foreign body sensation from the stent and reassured me that it should be fine, so I was discharged six days later.
After returning home, I continued to experience intermittent discomfort in my chest, even experiencing strong pain.
About a week later, I returned to work, and the chest pain seemed to worsen, particularly after noon.
During a follow-up appointment, I reported this to the doctor, who explained that the previous acute myocardial infarction might have caused some myocardial damage, and the pain I was experiencing was likely part of the recovery process.
I was advised not to worry and to return for a follow-up in two months.
I adhered to my medication regimen, quit smoking, and returned to my normal work routine.
However, the chest pain persisted, sometimes requiring me to take nitroglycerin (NTG) for relief.
Unable to tolerate the pain any longer, I returned to the outpatient clinic about three weeks after my last follow-up.
I reported my symptoms again, and the doctor arranged for a myocardial perfusion scan and prescribed Sigmart.
My condition improved, with less severe pain, but I still experienced occasional tightness and discomfort in my chest, which was much better than the previous severe symptoms.
On February 9, 2014, the first day of a cold front, I experienced discomfort in my chest again.
If the sensation of acute myocardial infarction was rated at 100, I would rate my pain at about 40-50.
After taking NTG, the symptoms slightly eased, but discomfort returned after about 20 minutes, prompting me to go to the emergency department.
The cardiologist on duty indicated that although my blood test results and ECG did not suggest an acute myocardial infarction, my medical history and previous myocardial perfusion scan indicated hypoxia in the left atrium and left ventricle.
Therefore, I underwent another coronary angiogram, and the third report was as follows:
Coronary Angiogram Note:
- LM: patent
- LAD: mid 50% ulcerative plaque, distal ectasia
- LCX: proper-OM2 bifurcation 70% stenosis
- RCA: NO ISR
A drug-eluting stent was also placed in the LCX, and I was discharged three days later.
This is my entire medical history and experience.
My questions are as follows:
1.
What happened to the LAD? Why do the descriptions in the three angiogram reports differ, especially the third one, which seems quite alarming?
2.
Since my discharge in February, I still experience intermittent discomfort in my chest, ranging from mild tightness to more intense feelings of pressure and pain, which can be relieved by NTG.
This usually starts after noon, particularly in the afternoon.
My job is sedentary and does not involve physical labor.
Do you have any other recommendations for this situation, or is this indeed part of the recovery process?
3.
Honestly, it’s hard not to worry.
I am only 37 years old, and my family relies on me to be healthy and work to support them.
I just want to understand my current condition.
Generally, how long might this situation persist?
4.
If it’s inconvenient to reply publicly, please respond to my email.
Thank you very much for taking the time to read this lengthy message.

A Yuan, 30~39 year old female. Ask Date: 2014/03/06

Dr. He Dongjin reply Cardiology

Hello, after the second stent placement, are you no longer in pain? Your question is very good.
Why are the catheter reports different after three procedures within two months? I suggest you copy the catheter images and take them to another medical center in the northern region for a more reliable opinion.
Generally speaking, angina is not closely related to time but is associated with activity levels.
You mentioned experiencing more pain in the afternoon, and gastroesophageal reflux should also be considered.
Changhua Hospital is concerned about you.

Reply Date: 2014/03/06

More Info

After experiencing an acute myocardial infarction (heart attack) and undergoing angioplasty, it is common for patients to have lingering symptoms and concerns regarding their recovery. Your journey reflects the complexities of post-heart attack recovery, and it's essential to understand the implications of your symptoms and the findings from your angiograms.

1. Understanding the Changes in the LAD: The Left Anterior Descending artery (LAD) is a critical vessel supplying blood to a significant portion of the heart muscle. The variations in the angiogram reports you received indicate changes in the condition of the artery over time. Initially, the LAD was noted to be patent, meaning it was open, but subsequent reports indicated the presence of an aneurysmal change and ulcerative plaque. This suggests that while the artery remains open, there are structural changes that could predispose it to future complications, such as thrombosis or further narrowing. The differences in descriptions across the three angiograms can be attributed to the dynamic nature of coronary artery disease, where plaque can evolve, and the condition of the artery can change due to various factors, including lifestyle, medication adherence, and underlying health conditions.

2. Ongoing Chest Discomfort: It is not uncommon for patients to experience chest discomfort after a heart attack and subsequent procedures. This discomfort can manifest as tightness, pressure, or pain, often exacerbated by physical activity or stress. The fact that you experience relief with nitroglycerin (NTG) suggests that your symptoms may be angina-related, indicating that your heart muscle is not receiving adequate blood flow during certain activities. This could be due to residual ischemia or the presence of new or worsening blockages. Given that your symptoms are occurring primarily in the afternoon, it may be beneficial to monitor your activity levels and stressors during that time. It is crucial to maintain regular follow-ups with your cardiologist to assess your heart function and make necessary adjustments to your treatment plan.

3. Concerns About Recovery: Your anxiety about your health is entirely valid, especially at a young age with familial responsibilities. Recovery from a heart attack can be a lengthy process, and symptoms may persist for weeks to months. Factors such as the extent of heart muscle damage, the presence of coronary artery disease, and your overall health will influence your recovery timeline. Engaging in a cardiac rehabilitation program can be beneficial, as it provides structured exercise, education on heart-healthy living, and emotional support.

4. Next Steps and Recommendations: Given your ongoing symptoms, it is essential to maintain open communication with your healthcare provider. If your symptoms worsen or become more frequent, it may warrant further investigation, such as additional imaging or stress testing. Lifestyle modifications, including a heart-healthy diet, regular exercise, and stress management techniques, are crucial for your recovery. Additionally, adhering to prescribed medications and attending follow-up appointments will help manage your condition effectively.

In summary, while your symptoms may be part of the recovery process, they should not be ignored. Regular monitoring and proactive management are key to ensuring your heart health and overall well-being. If you have further concerns or if your symptoms change, do not hesitate to reach out to your healthcare provider for guidance. Your health is paramount, and addressing these issues early can lead to better outcomes.

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