A young woman shares how a heart attack completely changed her life.
It was an ordinary Wednesday at my new job as a 35-year-old human resources manager when I began to have chest pain unlike anything I’d ever experienced.
The pain was searing; I went from sweating hot to cold and clammy. My colleague, whom I had known only for a couple days, looked at me with concern. “We are calling 9-1-1.”
Everything in me wanted to fight this. I was a petite, healthy and fit young woman with no cardiac risks, perfect cholesterol and blood pressure, and no family history of heart attacks. I exercised regularly, maintained a healthy weight, never did drugs or smoked cigarettes, had just spent a week climbing the Mayan ruins in Mexico without issue and hadn’t even been on oral contraceptives in years.
I had no idea what this was, but I was as concerned about cardiac issues as I was about an alien invasion. And yet even as I thought my colleague was overreacting, I was experiencing the oddest pain of my life.
The shocking and terrifying events that occurred in the days following have changed my life. I suffered two heart attacks only four days apart; the second was so severe and life-threatening that I spent three weeks in the cardiac intensive care unit on the brink of death, with stents, a cardiac pump and IV medications to help my heart contract.
Spontaneous Coronary Artery Dissection
So, what happened? I suffered from a Spontaneous Coronary Artery Dissection (SCAD), which occurs when the inner lining of the heart’s coronary arteries tears, causing blood to pool and halting blood flow and oxygen to critical heart muscle, leading to a heart attack.
This is not the type of heart attack we commonly think of, the one caused by a buildup of cholesterol plaque. Because I’m not in the demographic commonly considered at risk for heart disease (namely older males, those with diabetes, those who smoke, etc.), the thought I might be experiencing a heart attack surprised even the colleague who witnessed it.
I’ve learned that SCAD is more common than we think: The American Heart Association says it is the leading cause of heart attacks for women between the ages of 35 and 50. An overwhelming number of all SCAD cases occur spontaneously in young women, with no known cause. Unfortunately, there’s no way to test who’s at risk or know when it’s happening until you have a heart attack. That’s why it’s so important to spread awareness about this dangerous condition.
SCAD remains largely undiscussed in the broader community. The first medical study wasn’t completed until 2018, even though the medical community has known of the condition since 1931. The harmful bias that only older males have heart attacks still exists, both within healthcare and the population at large. Even when I went into the second ER with severe chest pain, my sister, a physician who happened to be in town that weekend, advocated for me to be evaluated in the ER much more urgently than I likely would have. Without family support, I could have died or been left with permanent brain damage.
In my case, the entirety of my left coronary artery, which provides blood flow to the main part of the heart that drives its ability to pump, tore. This led not only to a massive heart attack, but eventually heart failure as well.
When I woke up four days later, after being intubated in the cardiac ICU, I learned that the interventional cardiology team saved my life by placing six stents in the artery and a pump in my heart called an Impella, all while my family waited for six hours in the hall wondering if I would die on the table. Even after I lived through the cath lab (no small feat, given that I coded three times and had to be put on an emergency ventilator), they gave me a less than a 10% chance of making it through the first night.
Living with the After-Effects
The first person I spoke to when I awoke was a representative from palliative care, and her first question was whether I wanted the plug pulled in the event I had to be intubated again. My medical team did not think my heart was going to last.
When I woke up in the ICU on the ventilator, I was too overwhelmed and ill to think. Once they told me how sick I was, I became terrified and desperately wanted my old life back. I could no longer stand, walk or even wipe myself, and I started quickly filling with fluid because my heart was not working properly. I became part of an alarming statistic that most young women are not even aware of — a heart attack victim due to SCAD.
Women my age are often quickly diagnosed with anxiety, esophageal spasm or acid reflux when we report chest pain. While more common, these conditions do not take away from the fact that SCAD and other serious forms of heart disease can and do happen to young women. Even when a heart attack is recognized, SCAD is still often under- or misdiagnosed and mismanaged.
If anything, I am emblematic of the importance of recognizing the symptoms. I was told if I had stayed home 10 minutes longer during the onset of my second heart attack, I would have died. I also had a massive outpouring of support from family and friends, which helped carry me through the physical and emotional stress and conjure the strength needed to begin to heal.
I’m one of the lucky ones, and I know that many are not this fortunate. The Michigan SCAD support groups call the women who have not survived “Angel Survivors.”
Every day now, I waiver between my desire to live life to its fullest and the tough recognition that my life is absolutely not the same. I’m one-year post-incident. I’m out of the hospital, but I battle ongoing fatigue due to my cardiac medications, heart failure and ongoing chest pain. I’m out of breath from simple acts, such as walking up or down stairs, and my new work restrictions limit my career trajectory. Every day I take a myriad of medications to keep my stents open and help my heart pump. Moreover, because of heart failure, I can no longer have biological children, and my future quality of life is uncertain.
When I see my cardiologists now, they remark I’m a medical miracle; most women with SCAD as severe as mine do not live or only live with cardiac assistive devices or heart transplants. This, too, may be my future, but for now I am trying to live in the moment.
I hope to raise awareness of SCAD as a cardiac emergency that requires immediate medical attention from a knowledgeable provider. More specifically, women need to know the symptoms of a heart attack and understand that younger, healthy women of childbearing age, especially those who have recently had a baby, are at risk, too. We as a community of women need to empower ourselves with knowledge and change our understanding to realize that women can be otherwise healthy and still have heart attacks.
It’s common in American verbiage to talk about self-care and “knowing your body.” Yet, when it comes to cardiac emergencies, this is so much more than a mindful slogan. It’s critical for women to know the signs and trust ourselves and our bodies when something seems wrong. While SCAD can present as mild and thus the mortality rate is low, the chance of recurrence is high.
Let’s take a moment to empower ourselves with knowledge. Let me be a warning and a beacon of hope.