From the Guidelines
Dizziness and palpitations after percutaneous coronary intervention (PCI) with cardiac stent placement are most likely caused by stent thrombosis or the discontinuation of dual anti-platelet therapy (DAPT).
Causes of Dizziness and Palpitations
- Stent thrombosis: This is a life-threatening condition that can occur when the stent becomes blocked by a blood clot, which can happen if DAPT is discontinued too soon after stent placement 1.
- Discontinuation of DAPT: Stopping DAPT too soon after stent placement can increase the risk of stent thrombosis, which can lead to dizziness and palpitations 1.
- Bleeding complications: While bleeding complications are a risk of DAPT, they are less likely to cause dizziness and palpitations compared to stent thrombosis 1.
Management of Anti-Platelet Therapy
- Continuation of aspirin: Aspirin should be continued perioperatively to reduce the risk of stent thrombosis 1.
- Timing of non-cardiac surgery: Elective non-cardiac surgery should be delayed for at least 4-6 weeks after bare-metal stent placement and ideally for up to 3 months after drug-eluting stent (DES) placement 1.
- DAPT duration: The duration of DAPT should be individualized based on the type of stent and the patient's risk factors, but generally, DAPT should be continued for at least 4-6 weeks after bare-metal stent placement and for at least 12 months after DES placement 1.
From the Research
Causes of Dizziness and Palpitations after PCI with Cardiac Stent Placement
- Dizziness and palpitations after percutaneous coronary intervention (PCI) with cardiac stent placement can be caused by various factors, including hyperperfusion syndrome 2, transient ST elevations and polymorphic ventricular tachycardia 3, and tachyarrhythmias 4.
- Hyperperfusion syndrome is a rare condition that can occur after stent placement, leading to dizziness and other symptoms due to increased blood flow to the brain 2.
- Transient ST elevations and polymorphic ventricular tachycardia can cause palpitations and dizziness, and can be diagnosed using Holter monitoring 3.
- Tachyarrhythmias can also cause palpitations and dizziness, and can be treated with antiarrhythmic drugs 4.
- Other possible causes of dizziness and palpitations after PCI with cardiac stent placement include coronary artery spasm, coronary arterial wall stretching, and non-cardiac origin 5.
- Post-procedure chest pain after coronary stenting can be a predictor of clinical restenosis, and may be caused by micromyonecrosis and vessel stretch 6.
Possible Mechanisms
- Hyperperfusion syndrome may be caused by increased blood flow to the brain after stent placement, leading to dizziness and other symptoms 2.
- Transient ST elevations and polymorphic ventricular tachycardia may be caused by coronary artery spasm or other cardiac conditions 3.
- Tachyarrhythmias may be caused by abnormal heart rhythms, and can be treated with antiarrhythmic drugs 4.
- Coronary artery spasm and coronary arterial wall stretching may cause chest pain and other symptoms after PCI with cardiac stent placement 5.
- Micromyonecrosis and vessel stretch may cause post-procedure chest pain after coronary stenting, and may be a predictor of clinical restenosis 6.