“I never thought it would happen to me…”

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“I work out—hard. I don’t smoke or drink alcohol. I watch what I eat and keep my blood sugar in check. But that Friday afternoon in May I knew something was terribly wrong.”

“It began with a sensation of indigestion and within ten minutes had moved to the center of my chest with a pounding that went through to my spine,” Trish Acton described. Emergency responders rushed her to the emergency room. Her troponin, or cardiac enzyme, levels continued to rise through the night, indicating a heart attack.

“After the episode, I felt fine but was admitted. I questioned the hospitalist; could this have been takotsubo cardiomyopathy? His response was to wait and see what the cardiac catheterization showed.” Takotsubo cardiomyopathy is also called broken heart syndrome; it can occur after a sudden emotional or physical stress. Ninety percent of all cases occur in women. It has the same symptoms as a heart attack but is not caused by underlying cardiovascular disease. The main symptoms are chest pain and shortness of breath; the left ventricle balloons so that it looks like a Japanese octopus trap, or tako-tsubo.

“I have certainly had extreme stress recently,” Trish continued. “But during the catheterization, I heard the radiologist gasp, ‘Well, look at that!’ and the cardiologist leaned into my face and said, ‘I’m so sorry; the blockages are too big to stent.’”

One open heart surgery, three bypasses, seven weeks of cardiac rehab and eight months later, Trish is feeling more like herself. “Thinking back, I had a little fatigue, some shortness of breath while working out and sometimes some nausea. Otherwise, I considered myself physically fit.”

In July 2019, a 17-year study of women under 55 who were diagnosed for the first time with coronary artery disease published in the Journal of the American Heart Association reported that the rates of heart disease remained flat for younger adults instead of decreasing. Dr. Liam Brunham, the study’s senior co-author said, “This is in stark contrast to the rates of heart disease overall, which are actually coming down quite significantly because of improvements in education, diagnosis and treatment.

A May 2019 report from the Centers for Disease Control showed heart disease death rates in the U.S. among those 45 to 64 declined from 1999 to 2011, but then increased 4 percent from 2011 to 2017. The study indicated women had higher rates of obesity, diabetes and high blood pressure than men. The takeaway from these and other studies is that women need to see a physician sooner, have their cholesterol checked earlier, and focus on exercise and eating healthier food.

Since family members share genes and environments that can have an impact on their health and risk for disease, it’s important to recognize that heart disease can run in a family. The risk can also can increase based on age, race and ethnicity. Trish is my sister. We have discussed the effects of genetics on our future health. She recalls that our maternal grandmother had cardiac problems, and a maternal uncle had a heart attack when he was in his late 40s. He was also a chain smoker, so we weren’t surprised when he had a fatal stroke at 61. As a result of her experience, I discussed what changes I should make in my lifestyle with my primary care provider.

As we reviewed life events and blood work over the last year, my doctor pulled up the ASCVD Risk Estimator Plus app on her phone. It’s a tool developed by the American College of Cardiology to estimate a patient’s ten-year risk of having a nonfatal myocardial infarction, coronary heart disease death or stroke. The initials stand for atherosclerotic cardiovascular disease. It’s best used to establish a reference point, forecast the potential impact of different interventions on patient risk, and reassess ASCVD risk at follow-up visits. The result of the formula, which incorporates factors such as age, sex, race, weight, blood pressure readings, total blood cholesterol, history of diabetes and smoking, places the patient in categories of low risk, borderline risk, intermediate risk and high risk. “You’re at just over 5 percent without factoring in that you have a first-degree relative who has had a myocardial infarction. At 7 percent, we have to treat with a statin to stabilize any plaques that might be present,” she said.

It’s our hope that all readers, female and male, will maintain regular medical care provider appointments, cholesterol checks, blood sugar checks, stay active, put down the cigs and other forms of nicotine and eat right. Trish adds, “My advice from experience is that if you have an episode, don’t ignore it, because you will have another and that could very well result in sudden death.” Please take this information to heart…no pun intended. ■

Sources: cdc.gov, heart.org, health.harvard.edu, tool.acc.org.