Sudden cardiac death after stenting

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Submitted by Dr T on February 19, 2013 – 11:22am

Question: 
Dear Dr. T,My father recently passed away one week before his 67th birthday in January 2013. He has always been a very healthy individual throughout his entire life with a strict diet, no junk food, regular exercise, and didn’t smoke, drink alcohol, or do drugs. Very healthy person. He was a college professor with a PhD degree and owned a small business. Indian-American descent. He was very happy, lighthearted, and always cracking jokes and smiling. No one in our entire or extended family has ever had any kind of heart disease, or heart problems, so this was a surprise.Suddenly, he had 3 heart attacks all within one month in October 2006. Left Anterior Descending (LAD), Circumflex (Circ) and Right Coronary Artery (RCA) were all blocked and he had 3 stents put in immediately. He was doing very well and put on a plethora of medications, lipitor, metaprolol, plavix etc and many others. His heart and ekg’s, troponin levels, etc all were constantly monitored.In summer 2011 he had all three stents replaced I believe and was doing very well. So from 2006 – 2013 he was doing absolutely great with regular checkups. The DAY before he died, he went to the cardiologist and he checked his heart, did all the battery of tests, and the cardiologist said the heart looked wonderful and was functioning very well, no blockages, no need of a bypass or anything like that. My father was very happy.The next morning, he told me he had chest pains and lost consciousness and died a few minutes later. Paramedics, ER docs, cardiologists, surgeons everyone tried everything for 1 hour straight, shocking him continuously, but it was no use. I am shocked how this can happen 12 hours after such a positive cardiologist appointment. On the death certificate, I see that he did not die from a heart attack, it was an electrical wiring problem. The ER doc wrote that he had ventricular fibrillation —-> left ventricular systolic dysfunction. The ER doc wrote that it was due to advanced coronary artery disease.Can you explain what could have happened here, and why so suddenly, seemingly out of the blue? How can one have such a great cardiologist appointment, but die of SA/AV node failure the next morning? Why didn’t that show up in the lab reports? I’m a medical student and would like to know. My dad died a week before my USMLE exam.Thanks, 

I am so sorry to hear about your father’s death. Re: what caused what in what order – this is the sequence:

Thus I disagree with the final diagnosis on the deatth certificate.

The “battery of tests” on the preceding day most likely did not include a stress test or CTCA since your father was asymptomatic. I suspect they would have shown a major stenosis. These are the options of what could have happened:

  • Stent thrombosis
  • New disease:
    • Local disease at or near one of the stented arteries
    • A new Left Main coronary artery stenosis during the interval, rather than a recurrence in one of the previously stented arteries.

While stenting is of course not responsible for the Atherosclerosis, it causes severe local damage to the artery involved; the result an inflammatory reaction that involves the area that is stented as well as a zone up – and down stream of the artery, thus the 10-15% yearly failure rate/stent.

In essence a stent produces a new disease and to prevent the built-in complications, all those drugs are given to suppress the inflammatory response. An acute event is usually the result of plaque hemorrhage with acute occlusion of the artery involved, which is what probably happened. He died before an examination of the heart would have shown actual necrosis. 

 

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    My Dad died on 6th February this year following 11 days in hospital after being admitted with a chest infection and breathing difficulties. He was booked in for an angiogram for 8 of those days which kept being delayed due to his level of infection being too high and other cases taking priority. He was 72, of ideal body weight, a smoker and had hypertension and type 2 diabetes. He died in hospital within 6 hours of having a stent fitted in the left anterior descending coronary artery. We were informed after his death that his heart was ‘very weak’ which we had no idea about even though we had attended the hospital every day he was admitted, even seeing the consultant immediately after his procedure. A post mortem was performed which advised a natural cause of death due to acute myocardial infarction and ischaemic heart disease citing COPD, hypertension and angioplasty as ‘other significant conditions contributing to death’. He was not admitted to CCU until a bed was made available a few hours after the procedure and I was informed by the doctor who had treated him during his hospital stay that he had advised Dad that he would discharge him the following morning. I was also informed by the CCU nurse after his death that his blood pressure was worryingly low before he collapsed and I also know that he had been given tablets to help him urinate as he was struggling to…my understanding is that these are early warning signs of cardiogenic shock. The consultant thinks he suffered an arrhythmia although could not be sure and said that this had not happened to a patient in her care in her 15 years as a cardiologist. As a family, we are shocked and devastated and need to understand why this treatment was chosen if his heart was too weak and whether something else should have been done to improve his chance of survival.

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    My mom died 9 years ago because of a stent failure. My family has a history of heart diease. Hopefully technology will catch up before My sister or myself dies.

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    My husband is just 44 years old , doctors have inserted 4 stents as he has three vessel disease , they said he had 5 blocks, so can anyone guide me how to tk cr of him for a long healthy life.

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    My dad had a heart attack in feb18, 2017 and he was good with the angioplasty. But he today 8th March 2017morning he had a blood vomiting what’s the reason being this ..???

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    My husband had a stent placed in March of 2017. He complained he felt pain when they were placing the stent but was told that was impossible. He continued to have chest pain that over time was so bad he had to take nitro . He was taking almost a whole bottle of nitro a week. The cardiologist kept telling him it was all in his head. June 1st, 2017 he died. The cardiologist put sudden cardiac syndrome was the cause of death. Could. There have been a problem with the stent it self? I just feel so much unanswered questions as to why and could we have prevented this.
    Thank you
    Cindy Stinard

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