A Matter of the Heart
Many factors can play into a heart attack, including genetic predisposition, lifestyle, and excessive stress. Here is one local woman’s firsthand account of the path that led her to a heart attack, and the road back.
I had a heart attack on Feb. 9, 2018. It scared the you-know-what out of me, but it also annoyed me no end! I was so busy — doing things for everybody and being everywhere. My days were planned to the max with no wiggle room for delays. I was irritable with stress and now peeved because things didn’t go my way. How inconvenient! I was in the middle of a late-life career path — teaching writing, publishing a book, running a writer’s group, and tons of other social stuff. My to-do list was a mile long, and I liked my busy lifestyle. But something wasn’t right. I was ridiculously tired to the point of fatigue. I couldn’t get through the day without lying down, and if I didn’t get an afternoon rest, I was uncharacteristically cranky in the evening. I was getting up at 5:30 in the morning to tackle that to-do list, thinking I was just sleeping poorly. I blamed everything from my pillow to the full moon. Unbeknownst to me, that nagging pain in my collarbone and the occasional lightheadedness were common signs of heart attacks in women. Women experience a heart attack differently than men. Men typically have the “Hollywood” attacks we see in movies. You know the kind: pain in the left arm, clutching the chest, collapsing. But I had none of those. However, the day before my heart attack, I had nine symptoms in total and still refused to go to the emergency room — fatigue, cold sweats, heart palpitations, lightheadedness, pain in my collarbone, cold/numb fingers and toes, shortness of breath, dizziness, and feeling faint. I believed I could be just having an anxiety attack. I was too busy and “didn’t have time” to have a major health issue interrupt my full schedule. On Thursday, Feb. 8, I was the spotlight speaker at one of my networking groups. This meant I had 10 minutes to stand before the group and give a presentation. That morning my fingers and toes were icy cold. I was tired and hadn’t been sleeping well, but I chalked it up to one of any number of things: a poor dinner choice the night before, a case of nerves, or maybe sleep apnea. My collarbone ached like someone was pinching it. As I wrote my speech notes onto blue note cards, I felt like I’d been holding my breath. While loading the supplies into my SUV, I noticed I was winded even from that effort. At the restaurant, I took an end seat so I could get up easily to do my presentation. When it was my turn to speak, I stood at the front and grasped the microphone for dear life. I talked easily for 10 minutes, though I realized I was getting short of breath. Then my heart started pounding, because (I thought) I was probably holding my breath — until it pounded faster, and I mean really pounded. It took everything I had to appear calm and composed. Then I started feeling lightheaded to the point of dizziness. At the end of my time, I took a few questions and sat down just before the room started to spin. Immediately, sweat formed at my hairline and trickled down my forehead like a menopausal hot flash. I dabbed at my forehead with a napkin, desperate to be “fine.” A friend noticed that all the color had drained from my face. She brought me water and the waiter gave me a Sprite. They wanted to call 911, but I resisted, saying, “NO! I’m fine, just feeling a bit woozy….” I sensed I might pass out, and wanted to lie down, but there was nowhere I could do that. So, I just kept saying, “I’m fine. Honest, I’m fine.” Finally, after lots of water and napkins to mop up the cold sweat pouring from my scalp, I felt somewhat recovered. Knowing I couldn’t drive in this condition, I called my husband Tomas to come and take me home. Once there, I lay on the couch, very still, and Googled my symptoms. Voila! It’s an anxiety attack. That explained everything! Somehow that made me feel better, even though I couldn’t imagine what I might have been anxious about — but anxiety had to be it. On Friday, Feb. 9, I awoke with a head full of plans and a long to-do list. In the shower, raising my arms to wash my hair seemed like such an effort. I was quickly out of breath. So, with a towel wrapped around my head, I put on my robe and lay down on the bed until my breathing returned to normal.
Blow-drying my hair caused the same effect. Holding a brush in one hand and the blow-dryer in the other with my arms above my head was a challenge. I was again exhausted and short of breath. Back to bed I went, lying down for the second time that morning — and it wasn’t even eight o’clock. I thought, This is unacceptable. I have too much to do to be lying down every five minutes! Knowing something wasn’t right, I was determined to push through and prepare for my writing class the next morning. So, I charged off to shop for groceries. I knew exactly where to find all my favorite foods for the class, but in the cookie aisle, it hit me. I reached for a pack of gourmet cookies and they fell to the floor. As I bent down to retrieve them, I suddenly knew I’d faint if I leaned all the way down. I left the cookies on the floor and retreated to the register to check out. My legs felt so heavy, I could barely move. Thinking a jolt of caffeine and sugar would pick me up, I grabbed a cold soda from the case and gulped it down. I slowly loaded the two bags of groceries into the back of my SUV as if I were moving through syrup. I was short of breath again and recognized the pain in my collarbone as constant. After I got home, I finally gave in and called my primary care doctor. “Sorry, he’s out of town,” said the nurse who answered the phone. “Is someone covering for him? Who can I see?” I begged. Her answer was short and sweet. I could either call my cardiologist or go to the hospital emergency room. “I can’t go to the ER. I have too much to do!” I wailed. Her reply would haunt me for weeks, months, even longer: “You can’t do anything if you’re dead.” Thankfully, I had a cardiologist to call. The receptionist found my file (it had been 10 years since my last visit) and said the doctor could work me in that day. I called Tomas and we drove there together. After I was hooked up to an EKG, the tech shook his head as he watched the needle move. Cardiologist Timothy Marshall, M.D., entered the room, stared at the EKG machine, and I knew something was up. “Susan, you’re having a heart attack right now,” Dr. Marshall said. What? It can’t be. I thought he would just give me blood pressure pills and send me on my way. Terrified, I looked over at my husband who appeared terrified, too. The doctor said we had to go to the ER — now. Then things happened fast. The tech gave me a baby aspirin and had me place a nitroglycerine tab under my tongue. I heard Dr. Marshall on the phone swiftly making arrangements for me. Oh, God, I prayed silently.
Tomas dropped me off at Tucson Medical Center’s ER entrance, which was only four blocks from the doctor’s office. I was whisked inside and placed on a gurney. I winced as the attendant peeled off my brand-new black leggings and my underwear. I was allowed to take off my top and bra myself, and the hospital gown went on so quickly, nobody could see my nakedness. The medics swarmed around me. Doctors, nurses, techs, all said their names and what they would do to me. Calmly, they took some blood, put in a needle for an IV, and asked about my health history, my medications, and my nail polish. Yes, my nail polish. They wanted to remove it so they could clip a heart monitor onto my finger. They said the polish would interfere, but I knew it wouldn’t come off because it’s made of shellac. I tried to explain this but to no avail. Instead, they attached a heart monitor to my ear. I felt a breeze on my face from the speed of the moving gurney. They rolled me to the Cath Lab, explaining every movement and location along the way. But having received anesthesia, soon I didn’t care. Surrounded by nurses, equipment, and blinking monitors, the doctor threaded a tiny wire with a balloon on the end through the catheter tube in my groin. From there, he inserted a stent in my right coronary artery. It was 95 percent blocked and resistant to opening, but with the stent in place, my blood flow improved to 60 percent. Less than 20 minutes had passed since I walked into the ER. When I woke up from the anesthesia, I found myself in a private room with nurses, techs, and orderlies coming in and out. Tomas was there and so was my son Tim. I was starving, but I couldn’t eat until another round of tests were run. That night was a blur of fitful sleep, bad dreams, a dinner tray at 10 p.m. and a constant struggle to get comfortable.
The early morning ushered in more nurses drawing blood, bringing pills,and taking my vitals. My breathing was still labored, and my collarbone pain had moved to my chest. Three doctors visited and determined I wasn’t better, so they ordered a few tests. They gave me something for the pain and to get the fluid off my lungs, then sent me off for a chest x-ray. After that, I was wheeled out on yet another gurney for an echocardiogram, a test that uses ultrasound to evaluate one’s heart muscle and heart valves. Hours later, the hospital’s cardiologist Dr. Thomas Waggoner told me he was taking me back to the Cath Lab to fix another artery with a stent. I trusted him. I knew something had to be done because I felt so bad — constant chest pain, shortness of breath, fitful sleeping and non-stop sweating. And I saw how the nurses frowned with concern when they took my blood pressure and peered at my monitors. After receiving a second stent, I improved dramatically. The second stent opened up the left circumflex artery, improving the blood flow along with oxygen to my body. My test results improved. Everyone noticed! This fix marked the beginning of a slow recovery as my heart began to grow stronger.
My brain was on overload trying to take in every face, test result, and procedure explanation. I had three cardiologists, four nurses, a dietician, a pharmacist, a physiologist, and a hospitalist who managed my case. One nurse was a counselor who had a soothing voice and wore a fuzzy cardigan. Dr. Juan Pena, my hospitalist, visited me every day. He’d squat down to look me in the eye, hold my hand, and ask if I knew what happened to me. His soft voice calmed me. He made sure I knew I’d had a heart attack and then stent surgery procedures. Whatever the circumstance, he took care to explain the details to me. Sarah, the nurse with the fuzzy cardigan, told me, “Because you almost died, you’ll find yourself feeling depressed. Just expect this to happen at some time.” A kid in blue scrubs (a cardiac rehab intern) said he’d walk me down the hall to see how far I could go. This excited me! I wanted to prove I was strong enough to be released. He offered his arm, and we started our walk. Yet I could only make it a few steps out the door of my room before I was so winded that I had to stop. My ankles felt wobbly, my legs weak.
Then came Debbie, whose job it was to explain how to use a defibrillator life vest. She opened a color brochure describing a contraption I was supposed to wear 24/7 for the next six weeks. The vest, like a fabric sports bra with metal paddles in the back, would shock my heart if I should have a heart attack while wearing it. It’s also full of sensors to monitor everything about my heart and transmit the data to a far-away location via modem. Because it was a Sunday, though, I wouldn’t get the actual vest until Monday. A dietician wearing red scrubs was sweet as she launched into long explanations of what I should be eating for the rest of my life. I was especially intrigued with her visual of the desired salt intake. “Just make a little mound about the size of a dime in the palm of your hand,” she said. “That’s how much salt you can have in a day. Not just from the salt shaker but from everything you eat.” Then she showed me how to read labels on food products, especially the sodium content. At one point in our conversation, my eyelids drooped as I cradled the stack of brochures she’d brought. “This is a lot to take in!” I declared. Before I drifted off, I heard Tomas and my doctor talking about the “ejection fraction” or EF numbers. EF is a measure of how well the left ventricle is pumping blood to the right ventricle, and my EF was low at 15 (with a normal heart putting out 35 to 55 EF). This explained the need for wearing a defibrillator vest. That afternoon, I ordered heart-healthy chicken soup for dinner, but it tasted like dish water. So I ate the saltine crackers, I craved salt so badly! I dozed off again and heard the clicking of heels come into my room. I opened my eyes and saw my best friend bearing a vase of flowers. ”Happy birthday,” she said. “I told you not to come!” I blurted. “I had to see you with my own eyes to make sure you’re okay,” she replied. That’s when I started to cry. I didn’t want anyone to see me so debilitated — oxygen tube, catheter bag, tubes and needles in both arms, bruises on every visible surface. I wanted to tell her I almost died and how scared I was, but my breathing was so labored, I couldn’t get out any more words. We simply hugged.
Finally, Monday morning came and so did a flurry of activity. A young man in gray scrubs went through my discharge papers. One by one, he explained what they meant so I could knowledgeably sign the papers. Most important was getting the long list of drugs, their names, dosages, and what they would do for me. It felt like a barrage of instructions: Do this, do that, make an appointment for this doctor, that blood test. Then a chipper nurse dressed in brown corduroy came in with a lot of enthusiasm and a defibrillator life vest. She showed me how to put it together by inserting the paddles into the slots and the round sensors with their skinny black cords. I noticed a two-and-a-half-pound battery pack was attached with a cord on the side. “Put on the life vest and get me out of here!” I wanted to shout. But no, I’d have to prove to her I could put it together as she did. The vest already was complicated, and it came with a long list of things to do every day. I knew that no slacking off was allowed; wearing this vest was serious, life-saving stuff! The kid in scrubs came to walk me again. This time, I made it farther than before. I wanted to jump for joy, but my arm wouldn’t let go of his.
My First Night Home
Tomas and I decided I should sleep in the guest room and keep the walker nearby. I would need it when I got up to go to the bathroom — I wasn’t strong enough to make it there on my own. That night, I had a nightmare, awoke with a start, and begin to hyperventilate. My breath wouldn’t come — I was terrified. I made my way to the family room, got into the recliner, and covered up with an afghan. I realized I could breathe better sitting up. While in that chair, I had a long talk with God thanking him for sparing my life. I asked Him to help me breathe better right now! Then I asked Him what I did to deserve this and what I could do to repay Him for saving me. Over the next few months, I followed my doctor’s orders strictly. That meant attending cardiac rehab three times a week, eating heart-healthy meals, and taking my meds faithfully. The hardest order was eliminating stress from my life. Weeks passed and gradually I regained my strength. My ejection fraction or EF rose to 55, which meant getting released from the defibrillator life vest. In the meantime, I cancelled my writing groups, gave up teaching classes, and reimbursed my students for money they’d paid. I also stopped networking and posting on Facebook, plus I quit being annoyed at interruptions. Thankfully, I began feeling like a normal human being. I learned to drop the “too busy” persona and practiced my new mantra: “JUST BE.”
Six Months Later
Grief, Guilt, and Gratitude
When I had my heart attack, I almost died. I mean, I could have died, but I didn’t. Faced with my mortality in this drastic and incontrovertible way, I realized it was possible I might live a shorter life than I’d anticipated. I suffered grief for the life I’d lost. No, I didn’t die, but my old life was gone for good. I grieved over what I might have missed with my husband, my children, my grandkids, my sisters and my friends. And I grieved for all I will miss in the future when I do die. Now, I make it a priority to fill my heart with memories of love, joy, and togetherness with those I hold dear. I try extra hard to say how much I appreciate them and make an effort to spend time together. Then there is the guilt, which can take on many faces. My counselor told me these feelings are normal. That brings me to gratitude. Today, I’m so grateful God gave me a reality check and a second chance. I discovered that my busy schedule was not the most important thing in my life. I thought stress was anything that caused me great upset or anxiety. But I learned from a soft-spoken cardiac nurse that stress is more than that. “Basically,” she said, “it’s taking on too much. Doing too many things without enough time. Many women take time to take care of everybody else before they even think about caring for themselves.” “Hmmm,” I thought, “she’s describing me to a T!” I had to face facts: my stress was selfinduced. The old me always said yes to everything, never realizing it was causing stress. But I’m not that person anymore. I now can say no to things that will get done without me. I have to pull back. I know my strength doesn’t have to come from a laundry list of accomplishments. I can relax. I am very lucky I didn’t die. But my life as I used to live it? That’s over.
Heart Attack Symptoms in Women
The most common symptom is some type of pain, pressure or discomfort in the chest. But it is not always severe or even the most prominent symptom. And, sometimes, women may have a heart attack without chest pain. Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as:
- Neck, jaw, shoulder, upper back or abdominal discomfort
- Shortness of breath
- Pain in one or both arms
- Nausea or vomiting
- Lightheadedness or dizziness
- Unusual fatigue
These symptoms can be more subtle than the obvious crushing chest pain often associated with heart attacks. Women may describe their chest pain as pressure or a tightness. This may be because women tend to have blockages not only in their main arteries but also in the smaller arteries that supply blood to the heart — a condition called small vessel heart disease or coronary microvascular disease.
Susan Smith is a heart attack survivor, writer, speaker, and Mayo Clinictrained WomenHeart Champion. She is writing a book titled “My Inconvenient Heart Attack.”