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Heart attack warning signs for women: I nearly missed all of them

Natasha Johnson Editor of ABC Backstory describes her patient story:

I thought the doctors were over-reacting, which in hindsight, seems stupid.

If not for their caution, I mightn’t still be here.

I was convinced the dull ache that came on during exercise across the top of my chest and shoulder blades, occasionally spreading to my neck and jaw, was just more strain and pain from slumping over my computer.

It never crossed my mind there could be anything wrong with my heart.

I’d only just turned 50. I’m fit and active, I eat well, I don’t smoke. I have healthy cholesterol levels, normal blood pressure. No diabetes, no family history of early heart disease — no risk factors.

But three weeks after this odd ache appeared on the walk up to Byron Bay lighthouse which I usually do easily on my annual holiday, I was in a coronary care unit recovering from a life-saving operation.

An angiogram X-ray revealed a 95 per cent narrowing of the most important artery and a stent was put in immediately to open it and restore proper blood flow.

Why me?

My cardiologist told me a lesion like this is very rare in a woman my age but in men they call it the “widow-maker”.

As a close friend so aptly put it, “What the f—?!”

WTF, indeed.

It was the second time in four years I’d dodged a bullet, having had breast cancer in 2013 at the age of 46. A year of treatment left me physically and psychologically spent and now, after carefully putting myself back together, reclaiming my health and my life, my body betrayed me again.

Why had it happened?

I thought I was doing everything to avoid clogged arteries. The rest of my heart, thankfully, was in top condition with no sign of any other coronary disease.

There was no obvious explanation. Just unlucky, I guess. Or lucky, actually — very, bloody lucky.

Initially, I was high with the elation of a narrow escape, feeling a bit like you do after getting off a roller coaster at a theme park — “Whoa! That was scary, now let’s go get ice cream.”

I was diagnosed, treated and released from hospital within 24 hours.

Physically, I felt great, but my head was spinning.

No chest pain for almost half of women

The before and after photo of my heart was chilling.

What I’d thought was muscular-skeletal pain was, in fact, angina that comes on when your heart is deprived of blood and oxygen.

I’ve since discovered it’s common, particularly for women, to miss the warning signs.

While men commonly experience crushing chest pain, less than 40 per cent of women have chest pain during a heart attack, according to the Heart Foundation.

Women often experience more vague symptoms, like pain, tightness or discomfort in the back, jaw, shoulder or neck, which can easily be confused with something else.

I later met heart attack patients who thought they were suffering indigestion or a pulled chest muscle, others who thought their angina symptoms were neck strain or a toothache.

My blood ran cold recalling the things I’d done in the weeks before — hours of boogie-boarding in the surf with my teenage daughter, horse riding in the country, a high-energy Zumba class.

Doctors have since asked if I’d been experiencing breathlessness.

I didn’t recognise it at the time but looking back I did feel more puffed than usual — I just thought I’d lost a bit of fitness.

‘Your heart’s not normal’

Over the course of my week’s holiday the chest ache had gradually become worse and when I felt slightly nauseous after a stroll up a small hill I went to the local GP.

The areas where I was feeling the ache had spots that were sore to touch, which pointed to a muscular-skeletal issue, but the GP explained that doctors treat chest pain as a potential heart attack until proven otherwise.

I had an ECG, which was slightly abnormal, so he advised me to take some aspirin and see my GP when I returned home the next day to arrange a stress test, where the heart is monitored while exercising.

A doctor at my local clinic looked at the ECG and sent me to a hospital emergency department for further tests.

As I didn’t have any chest pain at the time I was, quite rightly, triaged as a low priority.

Six hours later, blood tests, chest x-ray, blood pressure, heart rate all normal — a second ECG slightly abnormal.

Heart attack or cardiac arrest?

The ED doctor said it might just be my version of “normal”, but I still needed to have a stress test.

But I didn’t even get to finish the test before the ache came on.

“Your heart’s not normal,” I was told.

Alarm bells were ringing now.

I saw a cardiologist immediately and two days later had the angiogram which found the ticking time bomb in my chest.

Heartbreak came after

You can go back to work and return to gentle exercise in a few days, I was told on leaving hospital.

Which I did, playing it down and getting on with things.

But in the weeks after, my emotions lurched all over the place.

I went along enthusiastically to cardiac rehab, keen to get back running, and walked into a gym full of frail, grey-haired people on walking frames and in wheel chairs.

I was the youngest person there, by about two or three decades. Later, thankfully, a couple of younger people turned up.

During my second week at rehab, after a session on healthy eating during which I wanted to scream “I have been doing all this for years!”, I burst into tears.

What was wrong with me? I knew people who’d had no warning and dropped dead. My heart was now fine. I am grateful, so grateful.

But I’d been here before and the emotional scar tissue was sliced wide open.

Love and cancer at 28

From cancer to anxiety

When you’re diagnosed with a life-threatening illness the shock is seismic and it reverberates for years afterwards.

It shatters your belief and trust, however naive that might be, in the way your life will unfold.

I’d covered enough tragedy as a reporter — the Port Arthur massacre, the Black Saturday bushfires, numerous interviews with the dying and the grieving — to know about the fragility of life.

But you don’t really get it until it happens to you.

At 46, four years from the recommended age for screening mammograms, I had a tumour and no idea it was there.

I’d only booked the mammogram because my pro-active GP suggested starting a bit earlier because she’d seen a few patients in their late forties with breast cancer.

Unlucky, but so very, very lucky.

During the gruelling days in the chemo ward, feeling increasingly ill as the red poison seeped into my bloodstream, I would think about everyone outside — going to work, cleaning the house, doing the shopping — and I’d long for the days of just worrying about daily life.

Eventually those days returned, but cancer continued to shadow me.

It was a psychological menace lurking in the back of my mind and leaping to the fore with every twinge or ache in my body.

I thought of myself as a strong and capable woman but now I lived with an emotional undercurrent of apprehension and vulnerability.

As I cleared the check-ups in the years after, it subsided but here it was rising again.

You can’t live in fear

Now, I was jumpy about my heart — waking in the middle of the night to check my pulse, second-guessing muscle twinges, nervous about going on a walk on my own, worrying about what might go wrong next.

Such anxiety is common among people who’ve had a life-threatening experience, we were told in rehab, which is why such programs exist — to help people regain confidence. It worked for me.

Fear can be debilitating and paralysing.

But as a colleague once reminded me, “A life lived in fear is a life half-lived.”

I don’t believe in doing things by halves.

And, thankfully, I’m still here to appreciate what living life to the full really means.

  • To know more about the heart attack warning signs, visit the Heart Foundation website.
  • Just a little heart attack starring Elizabeth Banks is a great video about warning signs of heart attack in women.
  • The Heart Foundation encourages women to know the warning signs and call triple-0 if they think they may be having a heart attack, as it’s important to act quickly.
  • Natasha Johnson is editor of ABC Backstory, which gives an insight into the making of ABC radio, TV and digital content.
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