‘Diary of a SCAD Heart Attack Survivor’ will continue soon, but for now…. RESEARCH..

My last post, “Shit..its happening again“ ended as I was wheeled away for a scan. However, they can see nothing wrong with my heart. So I’m left feeling not only confused, but a total fraud.

After the scan and a night on a ward, the final doctor that I see says, I can’t possibly have had anything serious due to all my ‘vitals’ being fine and there’s nothing to see on the scan.
“So, if it happens again, I’ll just chew my 4 aspirin and all will be well?”
“Oh no,” he says, “you must come in if it happens again!”
Damn.

Next, the cardiac registrar, who does seem more interested in my case than the others. 
He actually seems to listen.
I asked him, “I completely understand that there is ‘nothing-to-see-here’ but…

a) everything felt exactly the same as the 1st time.

b) when the pain hits, it hits HARD, I end up on my knees unable to breathe –
surely that’s not the sign of an ‘normal’ heart?

c) although my troponin levels were negligible there was still a curve – they increased whilst in A&E, then decreased back to ‘normal’ – surely that’s not ‘normal’ either for a healthy heart?

d) If I have not needed any treatment whilst in hospital, does this mean that I don’t need to come in, if it happens again then? I’ll just chew my 4 aspirin and all will be well,” I repeat.

He is also not into the idea of me not bothering to come in.
“You’ve possibly had another SCAD but right at the most distal end of an artery, the very end, where the arteries are super thin and small.  Based on what you have told us, seeing as we can’t actually see anything”.
Dear God, he really has listened!

So I leave, with a prescription for aspirin and a GTN spray, a ‘reliever’ spray for angina. 
Although nobody has mentioned angina to me. 

Maybe the Registrar has ‘registered’ that I will do anything & everything to avoid coming in to hospital.
Maybe he has registered that I am not leaping to call 999 every time I have chest pain.
Maybe he believes that my symptoms are actually real and not in my head (!)
And maybe, just maybe, he has given me a GTN spray, as a kindof ‘get-out’ clause, an escape route…? 
If the ‘BANG type chest pain happens again,  I can take the spray 3 times, with 5 minute intervals in between, and, then if the pain and breathing don’t improve, I promise I’ll call 999.

I think I like that Registrar. Clever guy.

There will be a post coming soon in the ‘Advocate for Yourself‘ section, but, for right now…

…… then, not only will having some clarity, make me feel better but,
I could save A&E staff a hellova lot of time and free up a precious NHS bed as well.

I begin with:

My Chest Pain Symptoms

Level	Feeling	Pain Level	Result
Red Alert Pain	Direct BANG as if a hockey puck has been fired at my chest.	8-9/10	Inability to breathe, collapsing onto hands and knees. Intense, ‘breath-taking’ pain.
Yellow Alert Pain	Sharp, sudden bang as if a small, soft, bean bag has been gently chucked at my chest.	5-7/10	Sharp intake of breath at the sudden, sharp pain, as my hands clutch my chest.  After breathing through it for about 10 mins, it passes within 30mins.
Night-time breathing issue	A gentle pressure pushing against my chest. Laboured, fast breathing, dizzyness.	3-4/10	Awareness something is not right, very uncomfortable.
Post injury pain	Sharp pain on movement around area of heart.  Eases at rest.	7/10	A reminder my heart has had an injury, take it easy! Common after confirmed SCAD and 2nd ‘event’.  Improves as heart recovers.

My Red and Yellow Alert Pain had happened every month; March, April, May then June.
The Night-Time ones happened most nights but did wane somewhat for about a week or so.

But this isn’t freakin’ normal, surely??? All these types of chest pain? At regular times of the day or month….
WAIT A MINUTE… MONTHLY!
WAIT, WAIT, WHAAAAT? Whilst going through my diary, in preparation for my appointment at The Newson Health Clinic, I could see, in black and white:

My more major chest pain ‘events’ have happened MONTHLY!
Oh, I am SO on it now…
Monthly chest pain.
I’m like a dog with a bone to get to the bottom of this. 

As described in “Hot Flushes and Heart attacks” my ‘hot flashes’ were extreme,
Well, until my SCAD Heart Attack that is, after which they completely stopped.
Now? …
hmm..
As well as my cardiac stuff, my ‘hot flushes,’ (and I use that phrase very loosely)
had not only returned but were even more extreme and
definitely involved my cardiovascular system:

As well as becoming warm, my breathing becomes shallow, fast and laboured, I have to breathe through my mouth. 
My whole body ‘buzzes’ as if fuelled with adrenalin, whilst my brain floats about inside my head.
I become dizzy and have to close my eyes, feeling like I’m going to pass out.
These episodes began to happen at least twice a day, intensifying as the weeks pass.  They last about 2-3 minutes, then, I ‘wake up’/recover and can re-join a conversation as if I’ve never ‘been away’.
I had to avoid driving on motorways, I couldn’t imagine going back to work and I worried about it happening whilst on public transport.

Now surely that’s not normal?!

Plus, a similar thing was happening as I fell asleep at night. I wasn’t having sweats or conventional hot flushes, but weird heart/heats/breathing symptoms.
I would finish reading my book – Barack Obama’s autobiography (so not exactly a ‘thriller’) place it on the beside table and cozy down to sleep. 
All being well in my world. 

Initially resisting Cameron’s suggestion to try the GTN spray,
“It’s only for the BANG chest pain, and I don’t have that, just a light pressure and weird breathing”, but,
after 2 weeks of sleeping sitting up, I tried it and guess what…..
it only goes and bloody works doesn’t it?!

So.
My cardiac ‘events’ have replaced monthly periods.
The GTN spray relieves my night-time symptoms.
I have a suspicion that the all male cardiology department are
not going to be interested in my endocrine system.
I need a menopause specialist!

(For context: as a self-employed massage therapist, I’m not driving around in an Audi R8 plus, due to Covid regs, I haven’t worked for 9 out of the last 14 months. But due to the impact that my symptoms were having on my quality of life, I decided it was time for the credit card)
There will be more on their amazing staff and treatment in a later post.
But for now…..

Within 2 ½ weeks of being on HRT,
the weird heats/breathing issue episodes
completely stopped.
Occasional mild dizziness, but
nothing like before.

After realising that the GTN spray did indeed work for the night-time issue, I had needed to use it 3-4 times per week. 

1 week after starting HRT I needed it once. 
6 weeks later,
I have not used it all.

If the majority of SCAD patients are female, I cannot be the only woman experiencing menopausal symptoms and cardiac ‘shtuff’,

to a greater or lesser degree.
So.
Back to the research…

• The vast majority of SCAD patients (∼90%) are women with a mean age of 44-53 years.
• Chest pain is the most frequently described presenting symptom,^15,44,146 an association which may be more common in SCAD than atherosclerotic ACS patients (chest pain reported in 60–90% of SCAD patients).¹⁴⁶ This may be because, in addition to pain arising from myocardial ischaemia and infarction, dissection per se is inherently painful.
• Recurrent chest pain, often with associated hospital admission, is common after SCAD.
  In some patients symptoms occur cyclically, usually pre-menstrually.²¹⁹
• Likewise it has been reported that cyclical symptoms may respond to low dose contraception (e.g. the progesterone hormonal coil).¹⁴⁵

And the fact that the GTN angina spray was working for me??
Back to the British Heart Foundation website:

Microvascular Angina

Download the full pdf from the link above.

“A type of angina that affects the many small blood vessels which supply your heart.
Sometimes known as cardiac syndrome X and coronary microvascular dysfunction.“

Below is a summary of, what I feel, are points relevant to my case:

• Condition is most common in women at the time of the menopause, which generally happens between the ages of 45 and 55.
• Microvascular angina usually develops in middle age. So, changes that happen to your body and hormones as you age, may have an effect.
• Symptoms may be triggered by cold weather, stress, exercise or other factors.
  But you may feel these symptoms when you are at rest.
• HRT may be offered to some women if they have low levels of oestrogen, as this may be linked to the condition.

Coronary Artery Spasm

Download the full pdf from the link above.

“People with Coronary Artery Spasm, experience angina symptoms such as chest pain.
Condition sometimes called Prinzmetal’s angina or variant angina.
Angina is a pain or uncomfortable feeling [in the chest]
/ usually caused by heart disease/typically develops on physical exertion.“
Below is a summary of, what I feel, are points relevant to my case:

• The pain can be severe, but usually subsides after a short time
• May occur every day at a predictable time
• Usually late at night or early morning
• If spasms last long enough, they can lead to heart attack
• For people with CAS, these [angina] symptoms can often occur at rest and come on suddenly.

My periods had stopped very suddenly, 2 months before my SCAD heart attack. Going through my journals I realised that my body had replaced monthly menstruation with monthly cardiac ‘events’.
But no-one in cardiology had asked about my cycle or the menopause……

Can this really be what is going on? Surely, I am not the only woman who has experienced this?

Given the above information, readily available on reputable websites,
why was nobody talking to me about oestrogen and the menopause?…..

I mean, I know I’m ‘unique’… !.. but really??
So now, I have more (informed) questions for my first appointment with a cardiologist.
4 1/2 months after my SCAD heart attack.

If the above ‘makes sense’, then I will be able to expedite my journey through A&E, should it happen again.

“Hey, I’ve had another chest pain event, but we think that it will likely be a monthly spasm/severe angina type event [insert as approps] so if you can just check my troponin levels?
And if all is well, I’ll go home for a few days rest?”

It does not go well.
“my main aim of this appointment is to reassure you” – I don’t need ‘reassuring’
“you leave working out what is wrong, to us”, “your symptoms will be something else”
Whilst not paying even lip-service to my questions nor offering any advice or diagnosis.
I was quite literally, patted on the shoulder (had he not heard of Covid?!)
and sent on my way, with the phrase, “you’re heart attack was really very small,” ringing in my ears.

I. Am. Raging . Angry.

Male ego?
A male dominated area of medicine that feels well within its’ rights to patronise me?
He’ld had a bad day?

A full transcript of that appointment will be in one of my next posts.

Some in the medical profession need to realise that
we do know how to use the internet,
we can read,
we can differentiate between reputable websites &
advice from well-meaning friends, family and
folk we meet in the shops…

There are women in hospitals right now, with ‘nothing wrong with their heart’,
being put on a plethora of cardiac drugs, subsequently feeling totally awful on them and I wonder…..

have they been asked about their
menstrual cycle/oestrogen levels??…….

Coronary Heart Disease (CHD) kills more than twice as many women as Breast Cancer in the UK every year,
& is the single biggest killer of women worldwide.

Despite this, it’s often considered a man’s disease.
The British Heart Foundation, Women & Heart Attacks.

SCAD is when a tear or bruise develops in a coronary artery that prevents normal blood flow. This can cause a heart attack, heart failure, cardiac arrest and can be fatal.
Current data indicates:
90% of patients are female with an average age of 44-53,
– many of whom have no or few heart disease risk factors.
ECGs and O2 levels may be normal.
Assess troponin levels, repeating 4 hours later.
(NB. Trop levels may be clinically insignificant)
For information:
https://beatscad.org.uk/what-is-scad/
https://academic.oup.com/eurheartj/article/39/36/3353/4885368