Heart Palpitations After Stent Placement: Causes and Concerns

The heart is contracting?

Hello Dr.
Lin, I have had a stent placed for one year and eight months.
During this time, I have frequently experienced chest discomfort or sharp pain in the middle of my chest.
However, subsequent follow-up tests, including several electrocardiograms (both resting and 24-hour) and three echocardiograms, have shown no abnormalities, including one perfusion scan.
Recently, I have noticed that my heart seems to suddenly contract, mostly occurring in the evening, and this is accompanied by dry nausea.
This situation has also occurred occasionally since the stent was placed, but it was infrequent.
(All previous tests have shown no abnormalities.) This has been happening continuously for two weeks now, and my doctor has prescribed Kankun 1.25 for me.
(During the month I took Cardizem, my heart rate was fast and heavy, ranging from 80 to 110, with blood pressure maintained at 145 to 160/95 to 120.) Currently, my heart rate is stable at 60 to 80, and my blood pressure is maintained at 120 to 130/70 to 90, but the sudden contraction of the heart accompanied by dry nausea still persists, although it is milder now.
I would like to ask Dr.
Lin if this condition could be a type of arrhythmia? I am very worried that one day it will contract severely and stop! Thank you.

Mr. Zhang, 50~59 year old female. Ask Date: 2015/06/01

Dr. Lin Wenpei reply Cardiology

It's great to hear that your symptoms have improved.
Please stay in close contact with your original medical team for follow-up.
Wishing you well.

Reply Date: 2015/06/01

More Info

Heart palpitations after stent placement can be concerning, especially when accompanied by symptoms such as chest discomfort or nausea. Given your history of coronary artery disease and stent placement, it's important to understand the potential causes of these symptoms and when they might warrant further investigation.

Understanding Heart Palpitations
Heart palpitations are sensations that feel like your heart is pounding, fluttering, or beating irregularly. They can occur in healthy individuals as well as those with underlying heart conditions. In your case, the palpitations seem to be associated with a history of coronary artery disease (CAD) and stent placement, which adds a layer of complexity to your situation.

Possible Causes of Your Symptoms
1. Post-Stent Placement Changes: After a stent is placed, the heart and blood vessels undergo changes as they adapt to the new device. This can sometimes lead to sensations of palpitations or discomfort as the heart adjusts.

2. Medication Effects: You mentioned that you were prescribed medications such as Kankin (likely a beta-blocker) and previously Kadyshyn (possibly a calcium channel blocker). These medications can affect heart rate and rhythm. While they are often used to manage symptoms and reduce the workload on the heart, they can also lead to side effects, including changes in heart rhythm or palpitations.

3. Anxiety and Stress: Emotional factors can significantly influence heart rhythm. Anxiety, especially related to health concerns, can lead to increased awareness of heartbeats and sensations that might otherwise go unnoticed.

4. Electrolyte Imbalances: Medications can sometimes lead to changes in electrolyte levels (like potassium and magnesium), which are crucial for normal heart function. An imbalance can lead to arrhythmias or palpitations.

5. Underlying Arrhythmias: While your previous tests (ECG, echocardiograms, and perfusion scans) have shown no abnormalities, it is still possible to have intermittent arrhythmias that may not be captured during routine testing. The sensation of your heart "suddenly shrinking" could be a sign of such an arrhythmia.

When to Seek Further Evaluation
Given that you have experienced these symptoms consistently over the past two weeks, it is advisable to consult your cardiologist for a thorough evaluation. Here are some considerations for further assessment:
- Holter Monitor: A 24-hour Holter monitor can help capture any intermittent arrhythmias that may not appear during a standard ECG. This device records your heart's rhythm continuously, providing valuable data.

- Electrophysiological Study: If arrhythmias are suspected, an electrophysiological study may be warranted. This invasive procedure can help identify the source of abnormal heart rhythms.

- Medication Review: Discuss your current medications with your doctor. Adjustments may be necessary if side effects are contributing to your symptoms.

- Lifestyle Factors: Consider lifestyle modifications such as stress management techniques, dietary changes, and regular exercise, which can all positively impact heart health and potentially reduce palpitations.

Conclusion
While your symptoms can be concerning, they do not necessarily indicate a life-threatening condition, especially given the normal results from your recent tests. However, the persistence of your symptoms, particularly the combination of palpitations and nausea, warrants further investigation to rule out any underlying issues. It is crucial to maintain open communication with your healthcare provider and report any new or worsening symptoms promptly. Your health and peace of mind are paramount, and addressing these concerns will help ensure your ongoing recovery and well-being.

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