Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "

Case study ( 12096 views as of December 22, 2024 )

Wayne is a 52-year-old man with a history of high cholesterol and hypertension. He is referred to a cardiologist for the evaluation of exertional chest pain that has been worsening for 6 months. Walking only 2 blocks on the level reliably precipitated his chest pain. He had no symptoms at rest, and stopping exercise reliably relieved the discomfort.

A treadmill examination is arranged and is interpreted as being abnormal after 6 minutes of exercise. A trial of medical therapy with a beta blocker and a nitroglycerin patch is attempted, but it fails to relieve his symptoms satisfactorily. Therefore, Wayne is referred for coronary angiography to define his coronary anatomy and possibly perform a revascularization procedure. He is told that a stent may be implanted if a significant blockage is identified. He is concerned about the long-term implications of stent implantation and the need to take blood thinners for an extended period of time. He is also asking how long stents last and if they ever need to be removed.

Wayne may benefit his condition by further discussion with his cardiologist to address his hypertension and chest pain. A cardiovascular surgeon can discuss the options available to him, such as cardiac revascularization or the use of a stent. If surgery does ensue, a cardiac rehabilitation program will be needed. In the meantime, seeing a nutritionist regarding his cholesterol levels would be good, as well as searching for ways to control any stress he may be experiencing, such as yoga or massage.

Author: Dr. Graham Wong

Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "

Case Introduction

Understanding The Risks Of Cardiac Stents In Treating Chest Pain

Presented by

Dr. Graham Wong

MPH, FRCPC

Cardiologist

Treatments

Cardiac Rehabilitation Following Cardiac Stent Surgery

Practitioner help from:

Aaron English

Athletic Therapist
Understanding the Ablation Treatment Process

Practitioner help from:

Dr. Atul Verma

Electrophysiologist
Coronary Artery Bypass Graft Surgery (CABG) and Cardiac Stents

Practitioner help from:

Dr. Craig Pearce

Cardiothoracic Surgeon

Treatments

Plant Sterols To Lower Cholesterol in Cardiac Stent Patients

Practitioner help from:

Erin Meloche

Registered Dietitian
Exercising Safely In Your Later Years - Cardiac Stent Patients

Practitioner help from:

Mr. Tim Battaglia

EMBA Candidate

Kinesiologist
Cholesterol Lowering In Cardiac Stent Patients

Practitioner help from:

Dr. Amr Morsi

Cardiologist

Conversation based on: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "

Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "

Dr. Graham Wong MPH, FRCPC Cardiologist, Vancouver, BC 07 September 2018

A cardiac stent is a small, expandable metal or plastic tube that is inserted into a narrowed artery to keep it open. It can also be called a heart stent or coronary stent. To open larger arteries, your surgeon may use a stent graft made of fabric. Usually these blood vessel blockages are caused by a buildup of plaque. You may need an emergency stent if your coronary artery is blocked and/or you suffer a heart attack. The surgeon will place a catheter into the blocked coronary artery, followed by a balloon angioplasty and a stent in the artery. A stent procedure is much less invasive than coronary artery bypass surgery. Generally, recovery after a stent surgery results in less discomfort and a shorter recovery time. Your doctor will usually recommend blood-thinning drugs such as aspirin to prevent blood clots. Before getting a stent, your doctor will tell you not to take any drugs that will make it harder for your blood to clot. During the cardiac stent procedure, the surgeon will make a small incision - usually in the groin or arm - and use a catheter to guide surgical tools through your blood vessels. He or she may use an angiogram to help guide the stent to the broken or blocked blood vessel. Once the stent is placed, the surgeon will close the incision. Most patients remain in the hospital overnight after a heart stent surgery. Many patients are able to return to work after a week, however, often those who have undergone emergency stent surgery take longer to recover. Your physician will recommend no heavy lifting or strenuous activity for a few weeks after surgery.

Reply to: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "
Chantal Sayers Vancouver, BC 22 August 2017

Having a stent put in does require that the patient goes on blood thinners. My question is, does a patient have to be on blood thinners indefinitely once they have a stent??

Reply to: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "
Chantal Sayers Vancouver, BC 22 August 2017

When my 74 year old mother had a heart attack, she was experiencing pain in her neck and shoulder on the left side. She never actually had any pain in her chest at all. She thought she had injured herself gardening so didn't link it to heart attack. She ended up getting a stent put in.

Reply to: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "
K. Michael 14 December 2015

What is chest pain ? Is it just tightness in your chest ? What should one watch out for ?

Reply to: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "
- Michelle Kaarto, BScK, CSEP CEP 18 January 2016
  
  @K.Michael - absolutely. Chest pain can come with various descriptions and sensations. The important thing to remember too is that men and women can experience chest discomfort differently. Oftentimes, women can have very different symptoms of cardiac issues or heart disease.
- K. Michael 15 January 2016
  
  Thanks @MichelleKaarto. So basically any abnormal painful feelings in the chest would be categorized as chest pain.
- Michelle Kaarto, BScK, CSEP CEP 16 December 2015
  
  @K.Michael - chest pain doesn't necessarily have to be described as tightness. It can be crushing, dull, throbbing, sharp...
K. Michael 27 July 2015

What happens during a revascularization procedure ?

Reply to: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "
- AllieS 27 January 2016
  
  During a revascularization procedure, blood flow to the heart is re-established. I believe there are a variety of ways to accomplish this, depending on other surgical procedures that need to be done or the condition of the patient.
Dr. Graham Wong MPH, FRCPC Cardiologist, Vancouver, BC 13 April 2015

The characteristics that make for a good stent is that it has to be flexible, and yet radially strong enough to be able to be passed into a vessel and yet strong enough to not collapse and to keep the artery open

Reply to: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 24 November 2016
  
  My Mother has been experiencing chest pain lately. I suspect I should get a referral to a cardiologist from my family physician.
- K. Michael 17 August 2015
  
  On television shows they use 3-D printers to make stents. Is that technology actually true and available to heart patients ? Or just Hollywood magic ?
Dr. Graham Wong MPH, FRCPC Cardiologist, Vancouver, BC 13 April 2015

Smoking is an incredibly powerful risk factor for developing blocked arteries, and that's what leads to heart disease.

Reply to: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "
Joy 06 April 2015

A Registered Dietician or Nutritionist would be very helpful too as diet would play a large role in his recovery.

Reply to: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "
- AllieS 08 June 2016
  
  Absolutely - a dietitian would be an excellent resource for navigating Wayne's health problems. I agree with @KMichael - making lifestyle alterations can be overwhelming, so a dietitian would be able to work with Wayne to make dietary changes little by little to make things more manageable. In his case, understanding his current dietary habits is key in order to effectively address his high cholesterol and hypertension. Introducing more fruits/vegetables and considering eating more plant-based proteins (legumes, tofu, etc) may be appropriate.
- K. Michael 02 September 2015
  
  A dietitian or nutritionist would be helpful. Often people who have had major medical incidents find the required changes overwhelming. A dietitian or nutritionist can help navigate the required changes
Bernadette van der Boom-Bebb 04 February 2015

Upon the approval from his physician, this man may also want to consider starting an exercise program.

Reply to: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "
- K. Michael 13 April 2015
  
  Aquarobics and walking are commonly recommended to cardiac patients
- Joy 06 April 2015
  
  Yoga would be a good start.
- Joy 06 April 2015
  
  Yoga would be a good start.
- ShirleyG 02 March 2015
  
  What sort of exercise program would someone with this condition perform ? I understand a they would need to be followed by a physician so they would not put more strain on themselves.
ShirleyG 30 January 2015

When dealing with chest pain and heart trouble, how common is the use of a Cardiac Stent ?

Reply to: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "
Yuan Lew, MSc MBA 23 December 2014

What kind of stents are used now? Are they coated with small molecule drugs or biologics?

Reply to: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "
K. Michael 22 December 2014

Yoga would help reduce his stress levels as well as improve his overall health. He would be wise to work with a personal trainer while waiting for his angiography to make sure he is keeping his heart condition in mind

Reply to: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "
Yuan Lew, MSc MBA 21 December 2014

I was encouraged by my physician to exercise more to control my cholesterol levels.

Reply to: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "
- ShirleyG 30 January 2015
  
  Have you found with exercise your cholesterol levels have improved ?
- K. Michael 28 January 2015
  
  What benefit does exercise have on cholesterol levels - aside from weight loss ?