CHEST PAIN AFTER ANGIOPLASTY AND CORONARY ARTERY BYPASS GRAFTING(CABG)

Coronary Angioplasty:

A coronary angioplasty is also referred to as PCI or percutaneous coronary intervention. It is performed in order to open up heart arteries that are clogged. This procedure may be accompanied by the placement of a stent to help keep the artery open. A stent is a small metal coil that may or may not be treated with a coating of medication to aid in the function of the stent.

Chest pain after angioplasty with stent is a common occurrence. It can simply be part of the healing process or something more serious.

Causes of Chest pain after Angiolasty

Ischemia Following Angioplasty with Stent

Ischemia is the condition in which the blood supply become restricted, usually due to blood vessels being blocked or having some other problem that inhibits blood flow.

When ischemia occurs after angioplasty, it may be called “silent ischemia”. One of the ways ischemia is treated is with angioplasty with the placement of a stent. When ischemia follows angioplasty with stent placement, the procedure may be performed again.

Restenosis Following Angioplasty with Stent

Restenosis is the name given to the condition in which the artery treated with angioplasty begins to close. This can happen even when a stent is in place. Restenosis can cause chest pain in the patient when the patient exerts himself or herself.

The treatment for restenosis is usually a repeat surgery.

Management of Chest pain after Angiolasty

Chest pain following successful percutaneous coronary interventions is a common problem. Although the development of chest pain after coronary interventions may be of benign character, it is disturbing to patients, relatives and hospital staff. Such pain may be indicative of acute coronary artery closure, coronary artery spasm or myocardial infarction, but may also simply reflect local coronary artery trauma. The distinction between these causes of chest pain is crucial in selecting optimal care.Management of these patients may involve repeat coronary angiography and additional intervention. Commonly, repeat coronary angiography following percutaneous transluminal coronary angioplasty (PTCA) in patients with chest pain demonstrates widely patent lesion sites suggesting that the pain was due to coronary artery spasm, coronary arterial wall stretching or was of non-cardiac origin.

Please Note

If the chest pain increases or is at the site of the procedure, the doctor should be contacted immediately.

If chest pain is experienced after angioplasty with stent placement, the treating physician should be contacted in order to determine whether it is due to recovery or something else.


Coronary Artey Bypass Grafting(CABG):

Coronary bypass surgery is a procedure that restores blood flow to your heart muscle by diverting the flow of blood around a section of a blocked artery in your heart. Coronary bypass surgery uses a healthy blood vessel taken from your leg, arm, chest or abdomen and connects it to the other arteries in your heart so that blood is bypassed around the diseased or blocked area. After a coronary bypass surgery, blood flow to your heart is improved. 

Coronary artery bypass graft surgery (CABG) is performed in patients with stable angina and acute coronary syndromes to prolong life or to treat angina refractory to medical or percutaneous revascularization therapies. Angina may return after apparently successful CABG. 

Causes of Chest Pain after CABG

The cause varies with the time when symptoms are first noted after surgery: 

Recurrent angina during the early postoperative period is usually due to a technical problem with a graft or with early graft closure. This is indication for prompt coronary angiography with percutaneous coronary intervention (PCI), if feasible.

Recurrent angina after the first few months, called late recurrent angina, can occur with the development of stenosis in a bypass graft or with progression of atherosclerosis in non-bypassed vessels.

Management

Chest wall pain after cardiac surgery may normally last 3-6 weeks, but may last as long as 12 weeks on rare occasions.This pain has a different quality from angina and most patients know the difference without question.  Post-op pain is also related to movement, coughing, and normally can be reproduced with palpation of the chest wall, none of which occur with ischemic pain (angina).It’s extremely rare to have angina following CABG (coronary artery bypass grafting), and differentiating between angina and post-op pain should be simple with just a physical exam.

Please Note

The discomfort you feel following coronary bypass surgery is typically related to motion and coughing.Don’t let chest pain, that follows coronary bypass surgery, alarm you, even if you’re experiencing it weeks after. However, it’s important to note concerning discomfort to your surgeon and cardiologist.