"No Risk Factors" Doesn't Mean "No Risk"

Contributed By Melissa

I'll never forget that night.

It was just before Christmas 2006, and I was standing at my laptop in the kitchen when I felt back pain, like lightning flashes, shooting down my shoulder blades to the center of my back. I turned to my husband, Scott, in the living room and said, "I'm having strange pains that I've never felt before." The pain didn't go away when I changed position, and I was starting to feel scared. Just to be on the safe side, we called 911. At the emergency room, doctors gave me baby aspirin and ran tests, including an ECG, chest x-ray, and blood work. All of the test results were normal, and after a few hours, I was sent home with the diagnosis of "back spasms." I was prescribed ibuprofen and told to follow up with my primary care doctor in the morning. In the meantime, the pain had disappeared. Everything seemed fine.

Of course, everything was fine. It couldn't possibly be anything serious. After all, I was under a lot of stress -- between fighting a bad cold, being busy at work, getting ready for the holidays, and chasing after my two-year-old son, Aidan. I was 37 years old, in excellent health. I'd never smoked, never taken any illegal drugs, and didn't have diabetes or any medical condition. My blood pressure and weight were normal (I'm 5'4" and 122 lbs.). My total cholesterol was 105, and I limited the saturated fat in my diet and regularly exercised at a gym several times each week. Since I'd managed our employee wellness program at work for several years and considered myself educated on how to stay healthy, I'd earned the reputation of being a "skinny health nut." There's no incidence of early heart disease in my family and all of my grandparents lived to age 90 or beyond. And most interestingly, since I'm a participant in the Framingham Heart Study (my grandfather was one of the original research subjects in 1948), I'd had a complete Heart Study exam in 2003, which included a cardiac CT scan that can detect early calcification in the arteries -- a medical test few people my age receive. All normal. I was probably healthier than most of my peers.

So, I assured myself, I could rest easy. After coming home from the ER, I went to sleep thinking the pain I'd felt was indeed back spasms from putting up the Christmas tree earlier that day.

Imagine my shock when a strong wave of pain shook me awake five hours later. I sat upright in bed and grabbed Scott's arm. The pain was back, but now it was changing -- it was more intense, it was migrating to my chest, and I had broken out into a sweat. Scott was reluctant to call 911 again, but I begged and pleaded. Something was definitely wrong. I returned to the ER, where the same crew of doctors re-ran the same tests. But this time, one of them came into the room and said "We think you're having a heart attack." After that, everything moved in slow motion. I was stunned, to say the least. I thought for certain that I would die, and all I could think about was how I'd never see my little boy again.

Upstairs in the cardiac catherization lab, the team found significant left main stenosis with occlusion of the proximal LAD artery and diagonal branch. (I found out later that stenting was not possible due to the location and unstable nature of the blockage. The type of blockage I had is sometimes referred to as "the widow-maker," and many folks don't even make it to a hospital.) When a surgeon appeared at my bedside soon after, the pain medication being pumped into me could not dull the rising fear as I struggled to grasp his words. Through the haze, I thought I heard him say "I'm recommending we do an emergency cardiac bypass -- probably a triple bypass."

"A bypass -- like you do on elderly men?" By now, I was crying hard and gasping for air. I knew that a bypass was major, risky, open-heart surgery. On me -- the skinny health nut! I thought, this cannot be happening to me. One minute, we're putting up the Christmas tree -- and the next minute, I'm here?
"Yes, it's the same procedure," he said.
"I guess I have no choice?"
"Not really," he replied gently, and he handed me the waiver to sign.

The surgery was performed the next day, and I was released from the hospital a week later, on Christmas Eve.  My postoperative course was predictable, and I recovered from a medical and physical perspective. But in some ways, my ordeal had just begun.

One of the most difficult things about my heart attack was the identity crisis that followed. I felt as if I'd suddenly been thrust into a demographic I didn't belong in -- my identity as a young person, a healthy person, even my identity as a woman -- it was like my identity disappeared in an instant. While I knew several people my age who had battled cancer (three in my neighborhood alone), I knew no one else who'd had a heart attack in their thirties... not a soul. And I personally knew no women who'd had a heart attack, let alone bypass surgery!  I felt defective, like a freak of nature... it was a confusing, frightening, incredibly lonely time. Cardiac rehab only added to my sense of isolation. It was intimidating and strange to find myself among men thirty and forty years older than me. At first, the group thought I was a visiting medical student -- I couldn't possibly be a heart attack survivor! -- and I almost dropped out that day. Somehow, though, I stuck with it and over time, rehab helped me to tap into a network of caring professionals who supported me and helped me put my life back together.

I realize that having a heart attack in your thirties is unusual. But with heart disease now epidemic, my story is one that women need to hear -- especially young women, because they think it can't happen to them. Some lessons I learned:

- Of course, manage your cardiac risk factors if you have them. But just because you have no known cardiac risk factors doesn't mean you have no risk for heart disease or heart attack. I assure you: if someone with my medical profile can have a heart attack, ANYONE can. Don't be lulled into a false sense of security.

- Don't ignore symptoms. Any strange pain that doesn't have a clear cause should be evaluated by a doctor. Recognize that women absolutely do have heart attacks, and we may have atypical symptoms, like back pain (as I did). Not all heart attacks look or feel like the so-called "Hollywood heart attack" (where the person clutches his chest and collapses in agony).

- Don't be dismissed at the emergency room. It might not be just anxiety, and you're not necessarily overreacting. You may have to advocate for yourself in a medical setting if you don't "look" like a typical heart attack patient or you don't have risk factors. Doctors may not believe you; insist on a cardiac workup if you feel something is wrong. I'm certain of one thing: if I had been too embarrassed to return to the ER the second time ("what will the neighbors think?"), I would surely be dead now.

Several months later, we learned the likely cause of my heart attack:  a common over-the-counter cold medicine triggered a coronary artery spasm, which produced a blood clot in my artery.  I'm still amazed that this chemical, pseudoephedrine, is still widely available while an identical substance, the weight-loss drug known as ephedra, was banned several years ago for causing heart attacks and stroke in healthy people.  Pseudoephedrine almost killed me, and its dangers are well-known and well-documented.  I'm angry that it's still on the market in this country, because no one else should have to endure the hell I've been through.  This "skinny health nut" is now a "heart patient" for the rest of her life -- and all because of a cold medicine I bought at the drugstore for five bucks.

Since my heart attack, I've resumed my life and I don't take a single day for granted.  These days, when I'm keeping up with my busy schedule at work, doing somersaults with my son at his tumbling class, or powering through a workout at the gym, I often think "I made it... I'm alive... I'm a survivor." As you can see from the photo of me, Scott, and Aidan, I have a lot to live for -- and I plan to be around for a long time!

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