A close call

She attributed her symptoms to a combination of lack of sleep and being out of shape. When she was younger she played tennis on the weekends, but recently she simply could not find the time. Her job was very demanding but was also very rewarding financially and personally. She decided to cut back on her hours and gave some of the day to day responsibilities of running the bank to her assistant. She continued to feel tired and started to feel a little short of breath when she walked. Another strange thing started to happen. Her ankles started to swell in the early afternoon. She wondered whether menopause was getting the better of her. She recently turned 52 and had been having hot flashes and episodes of sweating for the last few years without any explanation. One week ago she noticed a weird feeling in her chest. It wasn’t quite a pain; it was more of a discomfort, a kind of pressure. The feeling would occur sometimes when she was under extreme stress or when she walked up stairs. She now started to wonder whether this was more than menopause. She has never really been ill except for the occasional cold, and has never missed work because of an illness. Although she has never been really sick, she reflected on the fact that her father had a heart attack when he was 64. But that was of course because he smoke and drank heavily and did not take care of himself. She tried to remember when she had her last physical. It must have been about four years ago. Her doctor had said that her blood pressure was a little high and that her cholesterol was at ‘the borderline’, but her EKG was fine and that she had nothing to worry about. He gave her some advice about diet and exercise (nothing new there), and that was that. She did remember him saying that she should have followed up in six months to repeat her cholesterol and blood pressure, but she had become so busy that she had forgotten about the appointment. Now she needed to see him right away.

She was able to see him the following morning. He examined her carefully and performed an EKG in the office. Her blood pressure was elevated, 160/104, higher than four years ago. He remarked that the EKG looked a little different from the one he did four years ago. He was concerned about something called ‘ischemia’. Over time, he explained, something called plaque builds up in all the arteries, causing the artery to narrow over time. Sometimes, the plaque ruptures suddenly, causing the release of several chemicals that cause platelets (the blood cell that causes our blood to clot when we get a cut) to stick together. If enough of the platelets stick together, then a clot forms. The clot blocks the artery completely, causing a part of the heart muscle to die (no blood flow, no life). That is what happens when you get a heart attack. He explained to her that her episodes of chest pain could be angina (decreased blood flow in the heart resulting in pain) and that she was right to heed the warning that her body was sending her. Now she was really frightened.

He said that because her chest pain was occurring so frequently, he felt that it was best to have her checked into the hospital to get her heart fully evaluated. That evening she was admitted to the hospital. She was given aspirin (to prevent the platelets from sticking together) and blood pressure medicines. Her cholesterol was found to be high and she was started on a type of medicine called a statin (she had seen the ads on TV). She had a stress test the following morning. She walked on a treadmill for a few minutes (putting her heart under stress) while the specialist compared her heart function at rest to her heart function at the increased heart rate. Her stress test was negative, which meant that she did not have a severe blockage of any of the major blood vessels of the heart. The doctor in the hospital explained that she likely had significant plaque formation in her heart vessels, despite the negative stress test. He recommended that she be very careful about her diet. He advised her to decrease her meat intake substantially and to have five servings of vegetables per day. He wanted her to have salmon once or twice per week to enhance her level of omega 3 fatty acids which would be beneficial in fighting inflammation. She was curious about this inflammation. She received no treatment for an infection and so wasn’t sure why the doctor was now talking to her about inflammation. The doctor explained that inflammation referred to the accumulation of certain type of cells within the plaque and that the plaque would be more likely to rupture if there was inflammation. If the plaque were to rupture, then her risk of developing a heart attack would be very high. He told her that the cholesterol medication may also help to lower the level of inflammation in her body. She had one last question: would she have to stay on these medicines forever? “That depends”, he said. “If you work really hard with the diet and exercise, your doctor may be able to gradually reduce these medicines”. For now, she should stay on the meds until she saw her primary care doctor. She was now feeling much better, and resolved to do a better job of taking care of her heart.