Heart Contractions: Insights for Seniors with Stents

Regarding heart palpation?

Hello Dr.
Lee, the following questions are from a 73-year-old man, and I am writing on his behalf (actually, his symptoms are quite similar to mine).
Three years ago, he had two stents placed.
A year after the procedure, he began experiencing sudden heart contractions intermittently.
These episodes are often accompanied by nausea and dry heaving; if nausea is absent, the heart contractions will persist until nausea and dry heaving occur, at which point the heart contractions gradually lessen and resolve.
(There is no burning sensation or acid reflux during the dry heaving.) The elderly man has asked his doctor multiple times about this issue, and the responses have indicated that all tests are normal, there are no new blockages, and no signs of hypoxia, only mild arrhythmia.
He has been advised not to worry too much.
However, the aforementioned symptoms continue to occur unpredictably, especially after meals, after climbing stairs when he feels slightly short of breath, or after squatting for too long (he has a stocky build).
The elderly man is concerned that if the contractions become too intense, it could lead to a complete stop of heart function.
Recently, his aspirin regimen was changed to after meals, and he has noticed a reduction in symptoms and frequency over the past three months.
Currently, he is taking the following medications: aspirin, Carvedilol, Concor 1.25, and Digoxin.
The Concor 1.25 was prescribed because after stopping Concor 5 mg, he reported experiencing increased heart rate, shortness of breath, and more frequent episodes of sudden heart contractions.
Therefore, the doctor adjusted the dosage to 1.25 mg.
I hope this information is not too verbose, and I look forward to your insights and guidance, Dr.
Lee.

Li Yuan, 50~59 year old female. Ask Date: 2015/08/09

Dr. Li Han reply Cardiology

Hello Mr.
Lee, regarding your inquiry, the sudden onset of constrictive pain and shortness of breath after meals or when climbing stairs, without similar chest pain occurring, are likely not typical manifestations of angina.
If non-invasive cardiac stress testing shows no evidence of inducible myocardial ischemia, you can probably take a more relaxed view of this matter...
Take care, Changhua Hospital, Ministry of Health and Welfare is concerned about you.

Reply Date: 2015/08/09

More Info

Understanding heart contractions, especially for seniors with stents, is crucial for managing their health and addressing any concerns they may have. In the case of the 73-year-old patient described, several factors are at play that can contribute to the symptoms he is experiencing.

Firstly, the installation of stents is a common procedure for patients with coronary artery disease (CAD) to restore blood flow to the heart. However, even after stenting, patients can experience various symptoms, including chest tightness, palpitations, and nausea, which may be indicative of underlying issues such as ischemia or arrhythmias. The patient’s description of sudden heart contractions accompanied by nausea is particularly noteworthy. While the medical evaluations have indicated no new blockages or significant ischemia, the presence of mild arrhythmias can still lead to sensations of discomfort or abnormal heartbeats.

The symptoms occurring after meals or during physical exertion, such as climbing stairs or squatting, could be related to several factors. After eating, blood flow is redirected to the digestive system, which can sometimes lead to a temporary decrease in blood flow to other organs, including the heart. This can exacerbate feelings of discomfort, especially in individuals with a history of heart disease. Additionally, physical exertion increases the heart's demand for oxygen, and if there are any underlying issues with blood flow or heart function, this can lead to sensations of tightness or contractions.

The medications the patient is taking, including aspirin, beta-blockers (Katyxin), and a calcium channel blocker (Conkan), are aimed at managing heart function and preventing further cardiovascular events. The adjustment of the Conkan dosage seems to have had a positive effect, reducing the frequency of the symptoms. It’s essential for patients to communicate any changes in symptoms to their healthcare provider, as medication adjustments can significantly impact their quality of life.

In terms of the patient’s concern about the heart "stopping," it’s important to understand that while the sensations of tightness or contractions can be alarming, they do not necessarily indicate an imminent heart failure or cardiac arrest. However, it is crucial to monitor these symptoms closely. If the patient experiences worsening symptoms, such as increased frequency of contractions, severe chest pain, or shortness of breath, it is imperative to seek immediate medical attention.

For seniors with stents, regular follow-ups with a cardiologist are essential. These visits allow for ongoing assessment of heart health, medication management, and lifestyle modifications. Lifestyle changes, such as a heart-healthy diet, regular exercise (as tolerated), and smoking cessation, can also play a significant role in managing heart health.

In conclusion, while the patient’s symptoms are concerning, they are not uncommon among individuals with a history of coronary artery disease and stenting. Continuous communication with healthcare providers, adherence to prescribed medications, and lifestyle modifications are key components in managing these symptoms effectively. If symptoms persist or worsen, further diagnostic testing, such as an echocardiogram or stress testing, may be warranted to ensure that there are no underlying issues that need to be addressed.

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