Did the operation fail? Why did the chest pain become worse after the heart stent was placed?

The results of this patient's surgery made his family full of "doubts":

The older brother is in his 50s and has had intermittent chest pain for a month. The doctor suspected coronary heart disease and recommended cardiac angiography and stent implantation if necessary.

The angiography results showed that the main vascular lesions were diffuse, with the heaviest stenosis being 90%! Three stents needed to be implanted. Due to the large number of stents implanted, the operation became complicated. The patient experienced chest pain symptoms similar to a seizure during the operation, which gradually disappeared half a day after the operation.

The family members were nervous and confused: "Why did the chest pain get worse after the heart stent was placed? Was it a failure of the operation or something else?"

This type of chest pain is normal

This is because during the stent implantation process, the balloon needs to be expanded multiple times at the location of the stenosis of the blood vessel, relying on the squeezing effect of the balloon expansion to expand the narrow lumen. This process can cause temporary blockage of the blood vessel and symptoms of myocardial ischemia. The thicker the blood vessel, the longer the lesion, and the more operations are performed, the more obvious this reaction is.

With the successful implantation of the stent, the blood supply to the myocardium returns to normal, and the chest pain symptoms will disappear quickly, but may last for about a day. This is a normal surgical phenomenon and there is no need to worry.

In addition, some surgical complications can also cause chest pain, such as:

1. Branch vessel blockage

Due to the squeezing effect when expanding the stent and balloon, the stenotic plaque may move or break, which may damage or even block the opening of the branch blood vessels and cause severe myocardial ischemia.

At this time, doctors will often implant stents in the damaged branch blood vessels to restore blood supply, but the difficulty and cost of the operation will also increase accordingly.

2. No improvement in coronary blood flow

Although stents can solve the problem of stenosis of main blood vessels, microcirculation such as tiny blood vessels and even capillaries may still be damaged. Especially for patients with acute myocardial infarction, microcirculation disorders may occur after stent implantation, leading to slow coronary blood flow, which is the "no reflow" phenomenon.

This phenomenon will not only aggravate myocardial ischemia and induce severe ischemic symptoms, but also increase the risk of recurrent myocardial infarction and even death. Doctors will use drugs to improve microcirculation during and after surgery to treat it.

I am Dr. Zhang from the Department of Cardiology. If you like my popular science articles, please like them! You can also share them with friends in need! Follow me to see more health knowledge about heart disease!