4. Shit. It’s Happening Again…

Diary of a SCAD Heart Attack Survivor –
4 Months On

Spontaneous Coronary Artery dissection – a rare heart condition that can’t currently be predicted or prevented. Yet.

The sudden, sharp, breath-taking chest pain has hit me.
Like being shot, I imagine, having never been shot, but not by a bullet, by something much bigger. 
Like a clay target, in Clay Pigeon shooting or, wait, yes, an ice hockey puck. These hurt!
Well.
It feels like one of either of those has just been fired at my chest.

BANG!
And I’m out of breath. 

When I call on Big Tall Baldy Guy (or Cameron, as most other people call him)
I speak through gritted teeth, the pain all-consuming as I force my breath, clutching my chest,
bent double as I hobble towards the front door, where he is working in the garden.

I cannot believe it. 
This CANNOT be happening again.
Remember I said in my last post that my new mantra, had been,
“90% never have another. 90% never have another. 90% never have another.”

(OK, yes, so it wasn’t the most ‘catchy’ mantra I’d ever used…)
And my thinking had been

“if I haven’t done anything ‘wrong’ to bring the condition on,
then I cannae do anything more ‘right’

so I may as well just get on with life!”

And now.
Bollox. 
This feels exactly the same.
Damn and damnation.

Now.
To any cardiologists, medical professionals or
just those who think that they know better…..
PIN YER EARS BACK!

I was NOT worrying.
I did NOT feel a ‘slight chest pain’ and immediately ‘panic’.
For the record, I am NOT a hysterical female who is panicking and rushing to get in to A&E. 
I mean, REALLY?
Who the hell wants to go to A & E?

It was about 10am on a Saturday morning and Cameron and I had been up about an hour. 
He was starting to do some work in the garden for me, whilst I was getting ready to go to a medical appointment. 
My first ever breast screening appointment. 
(Oh yep, the fun of reaching a certain age for a woman, just keeps on coming, eh?!)
And, to be honest, I was quite looking forward to a wee jaunt out! 
Lockdown has a lot to answer for.

As I sat in front of the mirror in my little dressing area, I remember thinking how lucky we are in the UK that we get all these cancer screening appointments FOR FREE!  I mean!  Just how privileged are we?
OK, so I can’t say that I was exactly looking forward to having each boob squeezed between 2 plates,
but hell, I’ve experienced a gastroscopy and colonoscopy in the same sitting,
by a doctor who seemed hell-bent on ripping my intestines apart, so this?
T’will be a walk in the park. 

Oh yes, and I’ve had a heart attack too, so yeah, this will be fine!

I check the clock, 10:05.  Good, I’m on time.

As I begin to apply some mascara – bang, with a small ‘B’, in-between my shoulder blades.

Whaaa…. whaaat?  What was that?”
My Conscious Brain questions my Body, looking for more information.

My Body replies,
“um…. kinda felt like the same thing
that happened in March to be honest”..

Hmmmmm……..

Conscious Brain, “really?  But 90% never have another, have you not got anymore info to send me?”

My Body, scans itself, looking for more clues.  “Hmm… nope, nothing else to report Conscious Brain”

Well, this is annoying…

I continue to apply my mascara.  There is no bloody way I am going through this again. 
Nope! Not me!
I am just going to ignore it. 
I know that many SCAD patients have ‘ongoing intermittent chest pain’ post SCAD event,
and I have had….  but not like this.

And anyway, I have an important appointment to get to.
A precious, free, NHS appointment for preventative health care. 
I sure as hell ain’t gonna muck that up.

I finish my (limited) make-up routine to find my jacket and handbag, half listening to my Body,
“anything else to report Body?”
“Nope” it replies, “just well, you know, this pain in-between the shoulder blades.  It’s still there….”
“Well,” I tell it, “it can just DO one.”  I refuse point blank to have any more ‘unexplained pallaver’.
I am healthy, I’m feeling great!
And I am out of my ‘lounge-wear’ ready to go to …

OH. BLOODY. HELL..

NO!

UUgh

BANG! WITH A VERY CAPITAL ‘B’, the pain hits me in the chest.

Suddenly.

Painfully.

Right in the centre of my chest.

BANG


Kerrist.

But you know what?

I still absolutely refuse to believe that the same thing is happening again and pick up my bag and make my way down the stairs.
Deny! Deny! Deny!
The power of the mind can overcome EVERYthing…

Um.. apparently not.

Once downstairs, I jack-knife in 2, collapsing onto the sofa .
My breathing is now laboured, and I’m feeling faint, dizzy.
Bollox, bollox bollox.

OK, OK, what we doing babe, 999?” Cameron asks, frozen, knowing but not knowing.
“NO!” I hiss through gritted teeth, “WAIT”

“Give it a few minutes, it might pass, just please, gimme me 5 mins.” He looks unsure.
“Well, just in case, I’ll get your hospital bag yea?” “Where is it?”

I’m beginning to not think straight, I can remember where it is, but cannot explain where it is to him,
“it’s ok, I’ll get it” as I begin to crawl up the stairs on my hands on knees.
“For heavens sakes Jill, STOP!” he says, realisation dawning on him,
“Get down!”

I desperately want to ‘wait it out’ but the pain is bad. Intense.
I’m doing the particularly female thing of,
‘let’s not bother anybody’,
but I can’t breathe.
And, it’s the same as before, and we know what it was THAT time don’t we.
Cam places the 999 call.
I cannot friggin’ believe this.  This is a bloody nightmare.
Although at least this time, we know what we’re dealing with….

Don’t we?

“Yeah, she had a SCAD heart attack in March”

The next 20 minutes pass in a blur.  I can hear Cameron speaking to the 999 centre but it’s weird,
it’s like my mind is all fuzzy round the edges, as if I’m in a waking dream. 
I’m definitely conscious, but maybe not for long? 
But at this point I really don’t care, I’d LOVE to lie down and go to sleep. 
Maybe then the pain will stop.
999 responder tells Cam to get me to chew 4 aspirin, which I do, hardly noticing them at all whilst Cameron looks on, squirming at the thought of what they must taste like.
I tell him later, I never even noticed.

Within about 2-3 minutes the intense pain has gone! Amazing!
Who knew chewing 4 wee aspirin could be SO powerful!
Result!
God, I wish I had done that sooner, then we might not have called 999. 
I say this to Cam, who shakes his head in disbelief, “aye right babe, you’re nuts if you think we weren’t calling them!”
Oh, ok.

If you have a rare or little know about condition, have your paperwork to hand.
Your leaflets on the condition, previous medical letters, results etc.

And remember, take a few copies with you! They will disappear in to every corner of the hospital!

We hand a leaflet to the paramedics, they’ve never heard of it and, once at A&E they hand the leaflet over to the staff there.
It made things SO much easier.  As well as causing some excitement within the department.

A nurse who happened to be walking past me, overheard an exchange between ‘nurse who admits you’ and nurse at Base B, discussing my SCAD condition, “SCAD!  I know that!  I know that!” she says across to them,
“That’s heart attacks in women, isn’t it? I learned about it that!” then,
“Ach, dinnae tell me it’s a man?” she sounds perturbed.
I understand. You don’t want to have learned all about a condition and then find out that some bloomin’ patient screws up the theory!

“No”, I say meekly from where I’m sitting  behind her, “it’s me”, so she becomes my care-giver, yeah!
However, in true Jilly style, we have a problem. 

My troponin levels are negligible, nothing like what they were like the 1st time.

I have since found out that,
for some SCAD patients,
who have had their SCAD visibly show up in an angiogram,
their troponin levels were NOT elevated.

but now this just adds to the problem that the medical staff have. 
How the hell do they treat me?

At the time, I did not know the above and I am feeling SUCH a fraud. And such a pain in the ass to the staff.
And so confused. 
I felt everything exactly the same as before and, currently, my exhausted body does not want to work.
On trying to ‘pop round to x-ray’ my legs give way. Just like last time.
I desperately need to lie down and sleep for about a year.

My nurse was so amazing and I’m SO annoyed that I cannot remember her name, she really needs a special mention.  
After our last chat, ‘Chest Pain’ nurse arrives. I know she’s Chest Pain nurse, cos it says so on her wee name badge. There’s no messing with this very capable lady.
She asks me 3 vital chest pain questions, all of which I answer in the affirmative and,
within about 5 minutes she’s got me a CT Scan. 
I don’t know who looks more shocked, her or me!


“The radiologist on duty today has a specific interest in SCAD, so she’ld love to have a look at you, and on a Saturday afternoon! she cries, “amazing!”

“Oh, thank you, thank you so much!” I say to her. 
I cannot believe that my troponin levels are not elevated, so I’m overjoyed that they are going to have a look inside. I am so lucky. And considering that I feel exactly the same as last time, at least we’ll be able to see what’s going on from the CT scan. I feel certain that that will clear everything up and then I can get some of that magic drug that they injected me with last time. God that was good!

I mean, I don’t want to have had another heart attack, obvs!
But at the very least, I would stop feeling like a total fraud, taking up precious space in A&E.

So is it ‘fingers crossed’ that they
DO find something or
‘fingers crossed’ that they don’t,
as they wheel me away for my next procedure?

Coronary Heart Disease (CHD) kills more than twice as many women as Breast Cancer in the UK every year,
and 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