Mary's Story
What?! I had a heart attack?
by Mary Woo Sims (Former Chief BC Human Rights Commissioner)
Days before Christmas 2017, I was getting ready to have fun singing karaoke with friends. I had just brought the ironing board up from the basement, set it up and plugged in the iron. As I started to iron my shirt, I felt tightness in my chest. I thought I had heartburn and that it was the two huge vitamins that I had taken just before getting the ironing board. I drank some water thinking that would help flush the vitamins down but then I felt nauseous. I thought I might need to throw up except when I tried to, nothing came up. Meanwhile the tightness in my chest became more painful and I started to feel my jaw clench but it was involuntary. I told my partner I wasn’t feeling well and that I was going to lie down. While resting in bed, I recalled reading in a friend’s social media posting that women had different heart attack symptoms than men so I checked the internet. I discovered I had three of the six symptoms – chest pain, nausea and jaw clenching. I asked my partner if she remembered her first aid training and right after she answered yes, she said she was calling 911. I didn’t argue.
The first responders, fire fighters from the station just up the street came within minutes followed by paramedics. Conscious throughout the experience, I remember a verbal confirmation that my symptoms mirrored that of a heart attack, being given aspirin to chew. It was a surreal experience as I struggled to understand what was going on, one of the paramedics, I think to take my mind off what I was going through joked with me about the Star Trek “onesie” I was wearing. I was glad for the levity during what was a frightening experience for me. The paramedics drove me to Vancouver General Hospital. Once at the emergency department, one of the paramedics inserted an intravenous catheter into my arm and administered drugs. I can’t remember now what they injected but I remember feeling a lot more relaxed after. Blood tests were taken, an electrocardiogram or ECG administered followed by an ultrasound or echocardiogram of my heart. Both tests showed my heart was operating within normal parameters. I was starting to wonder if I had had a heart attack.
My hope for a different diagnosis was dashed when the emergency department doctor treating me told me the results of my blood tests confirmed the heart attack. She told me that I had elevated levels of an enzyme called Troponin. She explained that in a heart attack, there is heart muscle damage and the damaged muscle releases an enzyme, Troponin into the blood stream. I was told I’d be transferred from emergency to the Cardiac Care Unit (CCU) for further assessment.
The CCU cardiologist confirmed everything that the emergency department doctor had told me. He said that the next step in dealing with my heart attack was to investigate further what was going on in my heart through an angiogram. He explained that in an angiogram, a needle is inserted in an artery of the groin or wrist, a catheter is threaded through the needle, up through to the aorta. Dye is then injected through the wire and an x-ray is taken as the dye is injected. The cardiologist performing the angiogram can then view the coronary arteries and see if there are any blockages in the heart. I was told that if blockages were seen, they could immediately perform angioplasty (place a stent in the blocked artery and creating space where the blood could flow normally again). In the worst case scenario, I might need a coronary bypass or open heart surgery. In that instance, they would discuss the surgery further with me and the recovery process.
Was I scared? Other than an out-patient procedure, I had never been admitted to hospital before let alone for heart related procedures, each with their own inherent risks. So yes, I was scared but I knew that the angiogram was the next step in the finding out what has happening with my heart. I signed the consent forms including one for organ donation should the very, VERY worst should happen.
When I recovered from the angiogram, the CCU doctor reported that I had no signs of heart disease. No signs of plaque or any blockages so no stents were needed. The angiogram showed that I had likely experienced a “spontaneous coronary artery dissection” or SCAD. I was told that I had won the “lotto” of heart attacks as I had now joined an exclusive group of about 4,000 Canadians across the country that had had this type of heart attack. He added “this is the type of heart attack that an otherwise healthy person has”. He told me that because this condition is relatively new, I’d be asked to join the “SCAD Cohort Study”. He also told me that of all the places in the world to have had SCAD, Vancouver was the best place and VGH had the world renowned expert in SCAD, Dr. Jacqueline Saw. I would now be referred to her for further treatment.
If you’ve never heard of SCAD prior to a diagnosis, don’t be surprised. Neither had I. According to information available on line through the UBC Faculty of Medicine, SCAD accounts for only up to 4% of total heart attacks. SCAD patients do not have the typical risks for heart disease such as diabetes, smoking, or obesity. Historically, SCAD affects mostly young women, but some more recent studies have shown that older and postmenopausal women could also suffer SCAD, even though the majority are under 65 years old. I fit into the latter group.
Subsequent to the initial angiogram diagnosis in December 2017, I underwent another angiogram in February 2018, this time under Dr. Saw’s supervision. Since she is the expert, she wanted to confirm the earlier diagnosis of “suspected SCAD”. Dr. Saw told me there were two tears in my heart. The tears were in different locations in my heart. One tear had completely healed and the other was healing. Typically, a SCAD tear heals after 5 weeks. Post heart attack and diagnosis, I now attend the SCAD clinic of Vancouver Coastal Health’s Cardiac Rehabilitation program as well as take preventative medication. I’ve joined the SCAD support group and am so thankful to the holistic approach the rehab program takes and to the women and a few men that have shared their SCAD experiences with me so I don’t feel so alone in what I’ve been going through.
You might ask, what is that? What have you been going through? It hasn’t been easy coping with the fact that I’ve had a life-threatening event. It is even harder to accept that I’ve had a heart attack when I’ve done all the right things to look after my health. After all, knowing that I had a family history of heart disease, I religiously monitor my blood pressure, eat well, don’t smoke, drink alcohol very occasionally, and exercise regularly. As well, after my brother died suddenly of a massive heart attack in December 2016, I had gone for a full heart check in early 2017. The heart stress test showed my heart was operating normally.
Why did I have the heart attack then? One of the questions I was asked on the questionnaire for the SCAD cohort study was about stress. I’ve thought about this a lot since my SCAD diagnosis. I’ve lived with stress my whole professional life. I’ve lead a very public life as a human rights advocate. I have run for civic office and for the Parliament of Canada. I have been subjected to hate mail and public vilification. I have cared for a father who was suffering from Parkinson’s related dementia and had gone through a marriage break up, but that was over a number of years. When I took a look at the eighteen months that preceded my heart attack, I realized that there were a number of stressors that contributed to my heart attack. My companion dog of ten years suddenly developed an aggressive form of cancer and died within a relatively short time. Two months after that, my youngest brother died suddenly and in the midst of it all, I was dealing with two drug and alcohol addicted relatives who came to me for support. There were other stressors including a very hectic international travel schedule just a month before my heart attack. In retrospect, so much stress and grief over two significant losses in my life in a short time took its toll.
Five months after my SCAD diagnosis, life is different for me now. I don’t go anywhere without my nitro spray. I pay attention to every little twinge and change in my body. I’m more aware of the role that unhealthy stress and grief can play in my physical health. I have taken up meditation and learned ways of recognizing and dealing with unhealthy stress. I’m so grateful for the support group of other SCADpatients/survivors who have shared their stories and healing strategies with me. Like them, I am determined to make my first SCAD event my last SCAD event.