heart attacks in women

Heart Attacks in Women Are Different: It Took Doctors Days To Diagnose Mine

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I guess I always knew it was coming, but I would never have banked on it being one month and one day after I turned 38!  I have a strong family history of heart disease and heart attack in my family, my Father passed suddenly at 49.  He was fit and healthy, never smoked, wasn’t a big drinker, played sports and generally lived a good life. My Aunt passed at 41 years of age. She was a big character who was full of life. My brother was 42, and like me, one of the lucky ones!

I suffer from chronic endometriosis and have had seven surgeries in eight years for this ugly disease, so I’m accustomed to pain, but the pain of the heart attack was something else!  It started unassumingly a week prior, with a horrid headache every day, behind my left eye, I put it down to hormonal changes and thought no more about it. I pushed on through.

I just didn’t feel myself on the Saturday, “off my eggs” as my Granny would say, I was so tired and out of sorts.  I was grateful when it was time to go to bed. I’d had “heartburn” and just wanted to sleep it off.  At 4:50am I was jolted awake with the searing, heavy pain in the center of my chest and an odd sensation in my throat area, like a squeezing.  “Bloody heartburn!”, so I got up and reached for more antacids and a glass of milk, and paraded around my lounge floor trying to pass wind and relieve the discomfort. After an hour it just wouldn’t relent, so I called the Healthline Service for some advice.  I was shocked when the Nurse at the other end said she was calling me an ambulance and began running through I was to do.  Feeling a bit silly, I put my dog outside, gathered my regular asthma medication and got dressed. My partner gave me 1000mg of dissolvable Aspirin. They were here pretty swiftly and had me hooked up to the ECG machine, which I though odd for heartburn.

The pain was increasing, my blood pressure was elevated (nothing unusual for me when in pain), so I was given two sprays of GTN (Glycerin Spray) which lifted the pain almost immediately; finally the relief I had been looking for.  When I arrived at the Emergency Department, I was seen quickly by the team of Doctors and Nurses.  More ECG’s were taken, and my blood pressure was checked regularly.  I was given the results that my blood test had come back clear for troponin, which would indicate a heart attack. Just to be sure, in came the ultrasound machine to take images of my heart. This was also given the all clear.  I was discharged with a prescription for Losec and Gaviscon and given a diagnosis of acid reflux. I felt so silly having been taken by ambulance and such a fuss having been made from just a bit of wind.

I was fine when I arrived home, just exhausted from being up all night in pain, but feeling reassured that my issue was gastric, not cardiac. I went about my day as normal, and headed over to see my Mum around 2 o’clock.  Just 5 minutes drive away from my Mum’s I had to stop in at a small shop and buy some milk and antacids, heartburn strikes again.  It came on quickly and intensely.  My pain increased, and all the other symptoms had come back, along with an aching in my arms and shoulders.  500mls of milk, and 5 fast acting antacids were quickly consumed while sitting in the car, and I waited for relief.   It didn’t come, and again the pain in the centre of my chest was starting to become overwhelming.  I drove quickly to the pharmacy just down the road, and asked for the strongest over-the-counter antacid, I again got back to the car and chewed my way through 3 chalky tablets praying for relief.  Still it didn’t come.  I had a sense I had to get to my Mums.

When I arrived she noticed immediately I looked off color, and I explained about the trip to hospital and the diagnosis of acid reflux, and that I had just begun feeling very uncomfortable again.  She breaks out the Eno’s powder, so I knocked back 6 teaspoons worth, even doing star jumps to cause enough of a reaction to shift this dreaded wind! Of course I burped, who wouldn’t after that, but still, no real relief. I could see that I was upsetting my Mum so I pretended that it had improved and that I was going home to prepare dinner for that night. So again I drove the 20 minutes back home. I just couldn’t settle, parading up and down, rubbing my chest until my partner arrived home from work at 5.30pm.  I had little breaks from the pain, lasting 5 or 10 minutes but it just kept coming back.  By 9pm I was starting to worry a little so I called my Aunt who has been a nurse for over 40 years. She suggested that I go back to hospital again, so in the car I jumped telling my partner to stay home as he was up early the next day for work, and it was just a case of bad heartburn.

When arrived at the Emergency Dept at 10 pm, I was assessed quickly, my BP at that time being 211/142, which was initial cause for alarm.  Quickly taken through and again the process begun.  ECG ordered, which looked clear, bloods taken, then the wait.  The pain was still coming and going in waves, until I felt as if I had been punched in the back.  I was given morphine to address my pain levels.  My next BP was 238/157, but still my ECG was clear.  My blood results came back around midnight and again they were clear, but needing a further top up of pain relief by 2 am as I sat straddled the bed in my cubicle, grunting in pain, and rubbing my chest. I had one last set of bloods taken, and sent off to have a CAT scan with contrast taken, again the scan was clear and showing no signs of any issues.  I was asleep not long after and awoken around 5.30 am with the news I had a positive result.  “Great!” I thought, “So I can go home now?” I asked the young doctor. “No, you’re going directly to the Cardiac Unit, your blood test is positive for a heart attack”.

It all happened pretty quickly from there. I was taken in to Theatre to have an angiogram, and have a stent fitted into my right coronary artery.  I’m one week post-surgery and still coming to terms with the situation.  I feel so blessed that I have had the opportunity to survive my heart attack, it certainly puts a new spin on what life means to me, and what I want out of it. There’s one thing I’ve learned from both this experience and my endometriosis, sometimes we know our bodies better than any doctor, sometimes we need to ask questions, and most importantly we are always our own best advocate, so I’m now a great believer in speaking up for myself.

I asked the doctors why my heart attack took so long to diagnose. I was told that it can take hours, in my case days, for the enzyme to build up in the blood. Even when the enzyme does finally build up, in women those enzymes are sometimes much lower than in men. My tropinin levels were only 178-243, whereas in the case of a man’s heart attack those readings can be in the thousands. Another reason my heart attack didn’t show on the ECG reading was because the damage was not in the main area of the heart, so it didn’t cause any redirection of the current.

I am grateful for the young ER doctor who recognized the symptoms of my heart attack and pushed for one more set of tests before releasing me again. I am especially grateful that those blood tests finally revealed the elevated cardiac enzyme. Had another test come back positive, I am certain they would have sent me home and I would not be here writing about my story.

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This article was published originally on Hormones Matter on February 25, 2014.

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