women’s heart attack symptoms

Maybe life is like a traffic signal. When the light is red you stop. When it’s green you go, when it’s yellow, that means caution. You have choices and choices have consequences.

Ten days ago I landed at the yellow. Let my story be a cautionary tale.

Over this last pandemic year I have spent more time sitting on my butt in front of the computer than ever before. For days I wouldn’t even go outside and outside around here is really pretty. Exercise? Puleeese…

A friend suggested that right after rolling out of bed, I do some kind of physical something. This is how it started for him and now he’s a jock. So I commit to a whopping ten minutes of weights or yoga every day and this particular Friday morning I am doing aerobics, dancing hard to my funky music playlist. When the ten minute timer goes off I’m a little winded but, stick a fork in me, I’m done.

Then I plop down at the kitchen counter to clean my computer keyboard. I’ve talked about the “spraying thing” in my classes. When we sing, we share our juices. Yeah it’s gross and every once in a while I have to clean off the grody. With alcohol pads and Q-tips at hand, a steaming mug of tea and honey nearby, I’m reveling in the early morning quiet. Aah…

Until a vague feeling of heartburn creeps into my upper chest and grabs my attention right away since I haven’t eaten anything for hours. I swallow a few times but it’s still there. This feeling is almost in my neck which is now beginning to tighten, just a little, along with my jaw. And shoulders. I keep cleaning the keyboard but believe me, my attention is laser-focused on this unfolding constellation of sensations. Then my right arm starts to throb. And get this, just my bicep. I danced this morning, but it’s not like I punched a hole in the wall. Then my left arm begins to ache too. In the same place.

“Walk it off Cali,” I tell myself. But when I stand up I feel a little woozy and nauseous. I’m wondering how much of this is anxiety or a panic attack because I’m really good at twisting myself into a great big knot with one frightening thought. But the sensations are not going away and now the heartburn feeling is moving into my chest. I also have a ukulele class and music show today on Zoom. “How am I going to make it through?” I ask myself. “Come on…you can do it.” That’s the workaholic talking.

Another voice pierces the conversation: “Take an aspirin!” I quickly swallow the pill, reconnect my keyboard to the computer and Google heart attack/women.

I already know that lady symptoms can be subtle, low-drama, and we can talk ourselves out of believing “this is happening to me.” I also know that my mother had at least two heart attacks, my father had triple bypass surgery and both my grandmothers died of a stroke. But hey, I’ve got things to do today…okay?

I’m driving towards the yellow light and wobbling mightily between denial and acceptance. My primary care doc would tell me later that this is what happens and the sooner you come to acceptance, the sooner you get help. Too many people freeze in denial.

My Google search lands at heart.org and this sentence grabs my attention:

“Many women I see take an aspirin if they think they are having a heart attack and never call 911…But if they think about taking an aspirin for their heart attack, they should also call 911…”

OMG, I didn’t just think about taking an aspirin. I actually did it. But there is no way in hell I’m calling 911. I’m feeling fine. Sort of. I’m talking. I’m walking. I call my husband Craig instead, who is having breakfast at his regular hangout.

“Honey please come home, I may be having a heart attack and need to get to UCLA.”

“CALL 911…”

“No-no-no, I’m okay, let’s just drive there.” La-dee-da. I later learn the restaurant staff is really worried for him as he dashes out, white as a ghost.

So what do I do next? Take a shower. Remember I’m still at the yellow light—yeah this stuff happens to other people. Not to me. BUT if I’m going to the hospital, at least I’m going to start off clean.

Afterwards I throw on some clothes, grab my backpack, take a last look at our living room, wonder if I’ll ever see it again, lock the door and meet my husband downstairs. He is a nervous wreck and right now I’m just trying to breathe—in, out, in, out.

 

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We live close to UCLA and get there quickly. It’s early morning and these are Covid times. No visitors in emergency. My husband drops me off and I won’t see him again until that night. The triage nurse greets me at the door and I go into my spiel, which in itself reveals the complexity of the moment and how I’m processing all this. “Hi. Nice to see ya. I feel like an idiot being here…but I think I may be having a heart attack.” Then I rattle off the symptoms. The nurses whip me back to an examination room lickety-split, hook me up to an electrocardiogram and ask me to stop talking. You gotta love that…

Something is up with the first test and they put me in another room with a different ECG. “Is it me or the machine?” I chirp brightly. No answer. Until the ER doctor tells me there is a problem and barrages me with questions. A nurse promptly starts an IV line. Blood is drawn immediately. Chest X-rays and an ultrasound of my heart follow in quick succession. The tiny nitroglycerin pills they pop under my tongue don’t do squat.

If you haven’t already guessed. I am having a heart attack.

But when the cardiologist introduces himself, even he is not sure what’s going on yet because I am not “presenting” as a person in acute cardiac distress. You know how I love to ask questions and soon learn that when the heart muscle is damaged it releases a chemical known as troponin and this can be measured with a blood test. The first round comes back at .2 which is just a nudge above normal.

Talk about this modern technological world, I am getting lab results online as quickly as the doctors by just logging into my UCLA account on my phone. And believe me I am Googling furiously, trying to assimilate as much information as I can about troponin and heart attacks.

And worrying desperately about my husband. Our phones are our only lifeline to each other and I am having trouble getting through to him. He’s somewhere in the hospital or sitting in his car or the cafeteria and I would later learn, frantically texting our friends. They help him through the day. Not knowing what’s happening to someone you love is absolutely awful. And to think Covid families have been going through this for a year.

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Google says when the troponin level is above .4 there is the probability of a heart attack. The next lab is .47 and ultimately will peak at 31. They wheel me to the heart catheterization lab for an emergency angiogram, just about the time I would be doing my Friday afternoon Zoom show. I’m trying to pay attention to what I am seeing and hearing and feeling. However, I’m not taking in the big picture. How can the words Cali, heart and attack be in the same sentence? This can’t be. But I’m right there when the cath team asks what kind of sedation I’d like them to use.

“Oh nothing, I want to watch.”

How many people get to see their heart lubba-dubbing on a computer screen. In real time? No twilight happy juice for me. When I later tell one of our friends about this he replies “Holy sh-t, are you f–king crazy? I would tell them to knock me out and keep me knocked out until I’m ready to go home.”

Each team I encounter at U.C.L.A. is caring, extraordinarily competent and so kind. In the cath lab, they do everything to allay my fears and help me feel comfortable. And preserve my modesty, considering that the entry and exit point of this procedure is below the Equator. One of the nurses offers to call my husband’s cell phone personally during the procedure.

It’s not like there is a roto-rooter sensation as the catheter inches up to my heart through my femoral artery. I hear the team jibber-jabbering but can’t make out what they are saying. What looks like a flying upside-down toilet (with the lid closed) is whipping in circles over my chest, other machines are hissing and the lights in the room go on and off. You see what I mean…who’d want to miss this? I catch a glimpse of the imaging screen when the flying toilet isn’t in the way but in truth I don’t know what is going on.

Until finally the cath doctor leans into my face and tells me I have an 80% blockage in one of my coronary arteries. I will later learn, thank you Google, that the LAD, the left anterior descending, is the largest coronary artery in the heart and is also called, g-a-s-p, the widow maker. I know these doctors and nurses see this stuff every day but when it happens to you, well it’s shocking. He suggests that inserting a stent is the best option. This procedure is called an angioplasty. “Well okay,” I say, “but do you have a stent laying around so I can see what it looks like?” He pulls up a picture on his phone. First they will push through a balloon to open the blockage and then send that stent up the elevator. The nurse calls my husband again.

The symptoms I experienced earlier that morning had waned. Maybe the team in the ER had given me something for pain or to thin my blood. But when the cath doc starts manipulating the balloon, the tightness and discomfort come roaring back, WHOA, and believe me I let them know about that. The doctor says, “good, we know we’re in the right place. These are YOUR symptoms of a heart attack.” Once the stent is inserted the discomfort goes away.

Afterwards, the doctor shows me more pictures and video replays. I have other blockages but they aren’t as bad and will be treated with medication. Speaking of the new pills in my life—a blood thinner, stuff to control my cholesterol and blood pressure, baby aspirin—these medications are supposed to keep the stent and artery from closing up again. In other words, if you don’t take these pills you can kiss your ass goodbye.  Here are the facts:

Heart disease is the leading cause of death for women in the United States.

I’m on the thin side, my diet is more healthy than not, my husband and I meditate. Yes I could exercise more, get more sleep and work less. “Why did this happen?” I ask my cardiologist. Apparently, in my case, it’s mostly about genes, genes, and more genes. So here we are, you and me, taking our seats at the poker table of life in the Grand Casino of Heredity. We get dealt a hand. Some cards are good, some not so much. At least today there is medicine (and yes, lifestyle changes behind Curtain #2).

That evening I am finally reunited with Craig as I’m rolled into my hospital room. I am SO glad to see him.  At least I’ve been royally entertained all day but he’s been through the wringer and needs to go home and get some sleep. I meet the team of nurses and residents on cardiology rotation as they help me settle in. I haven’t eaten anything in 24 hours and order a cup of vegetable soup. But mostly it just sits there.

I probably would have gone home the next day except for what happened in the wee hours of the morning after I received my first dose of magic pills.  Three nurses hover close as they help me to the bathroom to pee. So far so good but when I re-emerge from that glorious experience, I tell them “I’m feeling really dizzy…really diz…” and then everything goes black.

I freaking pass out and later learn that the nurses catch me as I fall forward onto the bed, keep me from slipping to the floor and somehow get my unconscious butt back on the mattress where I finally come to. When I open my eyes, I see a phalanx of residents and nurses looking at me. And not in a good way. They don’t know why I lost consciousness and are afraid I’m bleeding internally. Some bruises on my belly are gaining acreage.

They put me through a battery of mental acuity and physical tests. What’s the date today? Can you lift your right leg? More blood is drawn and my hemoglobin has dropped a little. Now the residents are really worried and want me to have an invasive procedure to detect internal bleeding. “Good Lord. Can we just wait and see?” I ask, “I feel okay now.” In the end the cardiologist-in-charge puts the test on hold.

The advances in modern medicine are miraculous. Science is a wonder. But medicine is also an art. How many times a day do knowledge, experience and intuition intersect and pause at the yellow light. What to do? What to do?

This is a teaching hospital and teaching goes both ways.

As it turns out, one of the medications they gave me dropped my blood pressure precipitously low and that’s why I passed out. No internal bleeding.

I’d like to know how big pharma comes up with the generic names for their pills. Do they throw darts at an alphabet chart on the wall? It’s impossible for me to remember, much less pronounce these words. So I stick to the more accessible brand name. I mention this because a long time ago, in another hospital, I was given a medication for high blood pressure. When I tried to stand up, I passed out.

I remember the brand name and vowed that I’d never take THAT stuff again. Not once did it occur to me that, after all these years, I was the only one who knew this. And furthermore, I didn’t recognize the generic name when the nurse presented me with the pill that night. But it was the same medication. Big lesson. Put information like this in writing, on a card in your wallet or enshrined in the electronic medical records. These kinds of personal details can make a big difference. For you and your doctors. The medical professionals know the science but no one knows your body and your story better than you.

The day shift arrives. “I heard about last night…” they tell me, one after another. Apparently word spreads fast around here. My husband arrives too, with fresh undies and a ukulele. He stretches out, all 6’3” of him, on the comfy vinyl-padded couch under the window and gets some sleep. He’s exhausted. They are changing up my medication today, for obvious reasons, and I am “observed” by one Florence Nightingale after another. The rest of my hospital stay is blessedly uneventful.

The next morning I plop into a wheelchair and am Fed-Exed to our car by a nice transportation lady. Craig safely delivers us home where I end this “trek through heart attack land” the same way I started. With a shower. Getting to the emergency room when we did probably saved my life. I heard this more than once during my stay at UCLA. Thankfully, I have minimal heart damage. Somehow we pushed through the yellow light. So many helping hands. My heart is full.

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These are the “before and after pictures” of my heart. I suspect these images look like hundreds of thousands of others, women and men who have had blockages and were given a second chance. With a stent.

Just imagine the scientists and designers who dreamed this stent thing up, the researchers and fabricators who developed the hardware and refined the techniques for this procedure, all the teams of doctors, nurses and techs who train long and diligently to do it right. How about the countless number of people who support them, emotionally and otherwise, so they can do their work. Or the farmer in Brazil who grows the coffee beans that end up in the early morning cup of Joe that is just what the doctor needs to focus and forge ahead for the day. On and on it goes. All I can say is thank you.