Heather Elliott - What the heck is a coronary artery spasm?
Heather is a mother, a full-time manager at a primary care practice, a medical assistant for 10 years, and a college student pursuing a bachelor’s degree in Health Care Administration and just 33 years old.
While preparing for a routine day of workup, one less stressful than usual, no early morning meetings, no meetings at all that day! I was putting the last touches of makeup on for the day, and getting ready to wake up the kids when it hit me......
Let's set the stage.... I have two boys, this was June 18th, 2020, my oldest just 10 days shy of being 11 years old and my youngest, 6 years old, were both still sleeping in the early hours of the morning while mom and dad got ready for their workday. My husband was going about his business, taking the dog out, packing his lunch etc. When I was just about ready for the day and ready to move on to the next item on the agenda; get those two boys up and ready to go to grandma’s for their day.
Walking out of the bathroom in my bedroom, it hit, a sharp pain localized to the left side of my upper chest.....intense, but it must be heartburn? I haven't taken my heartburn medications for a couple of days, dang it, right? The pain continues while the boys are now up and getting ready. In passing, I mention the pain to my husband while I pop my reflux meds. Ok, once the meds kick in, I'll be fine.
Now it's time to leave, a good 15/20 mins since onset, the boys and I load up in the car to head to grandma’s for their day. The drive from our home to hers is roughly 20 to 25 minutes, there's not much traffic, no school busses in the summer and it wasn't trash day, so the drive was pretty uneventful, but keep in mind, the chest pain hasn't subsidized yet...it's still there....seems to be radiating a bit more. Ok. Let me get these kids to grandma’s, I'll get to work and have a nurse do an EKG, but first Dunkin Donuts Iced coffee, caramel, cream, and sugar, please.
The kids are now at grandma’s and I'm back on the road heading to my office, another 20 to 25 minutes, I'm sure this pain will be gone till I get to work, no worries. Well, halfway to work the pain, which feels more like burning and tightening was more intense, breathing through it, was not happening, and does my left forearm really hurt, or is it all in my head? Oh yea, I think to myself, I promised the one nurse I would bring her kids their favorite candies that day, let me stop at the gas station. Standing in line, after locating the favorite candies, things becomes a bit serious, now feeling tingly, that sensation before syncope, wearing a mask is the cherry on top and I think to myself, I need to get out of this gas station before I make a scene. Ok, items back on the shelf and I'm out to my car.
My arms weigh so much, my fingers tingling and stick straight, unable to bend them. I am thankful on my phone, I have a one-touch widget to that calls my husband directly, no opening the phone app, no going to my favorites or locating his contact, I just tap the app and the cars Bluetooth takes over. Something’s wrong, he calls an ambulance, and I remember his words, "I got to go and call 911 before it's too late." I call my boss, I'm not going to be on time, she's in shock, she knew by my voice and concern and lack of communication, something wasn't right!
My husband's calling back, I hit answer on my Bluetooth in my Grand Cherokee, an ambulance is on the way and so is he. It didn't take long for the ambulance and then followed my husband opening the passenger door and throwing my purse and work bag into the back seat. It's been an hour and a half since chest pain onset. The medics are there, and I'm starting to feel better, vitals seem normal and why go to the ER via ambulance now? Both my husband and I decide we’ll see my primary care office, which I worked at as an MA for 10 years and remember my boss I called? Yes, her main office is at this location. So, off we go.
No other walk-ins were waiting so I walk right back, I know everyone there, so they get me checked in and ready for my visit, an EKG is run by the nurse right away after she took and documented my complaints. Remember, I'm an MA, I've completed an abundance of EKGs, so when the nurse ran mine and then decides to check my leads...hmmm...something is showing on this EKG? The PA comes in, she has my baseline EKG from the year prior and the one ran today.....there's a change....I have ST depressions....but it was felt it could all be anxiety and an anxiety attack, but how? I'm not an anxious person, my morning was way less stressful than most. Ok maybe it is, overall, I'm 33 years old, could be more active but between work, my school, and kids activities, It's hard to find that time but as you can see, I keep myself busy, I don't have any major family heart history, besides the alcoholics in my family, I eat relatively healthy, my BMI is slightly higher than where it should be, but still no not where close to obese, maybe this really is anxiety. I'm offered blood work and I decline. I'm feeling better, I'll go to work now but my husband convinced me otherwise, so home we go!
That entire day, I had a twinge of pain and it would increase with deep inhalations and as the day goes on, I find it harder and harder to comprehend and admit, I succumbed to a panic attack? No, I couldn't have.
I send a picture of my EKG to another provider in the same office via text, remember, I worked with these providers for many years, I know she will respond instantly and she is off that day so she wouldn't be at the office where I just saw another provider and had the EKG. Moments later....I received the response via text, telling me she doesn't like that EKG, that those ST depressions are significant changes, and represents ischemia. So, as I mentioned I've performed thousands of EKG's over the years, I know how to read some of them, but I don't know it all. My EKG is then sent to the Dr. In the office that day, again her interpretation, suggestive of ischemia. We plan to do blood work tomorrow.
Tomorrow comes, time for work, up and getting ready feeling myself again I go about my day, leave my office around 2 for lab work, COVID has caused many businesses to modify business hours, so I have to get there early, this is a Friday. I text the ordering provider, who I had previously texted my EKG to, to let her know I just got my labs, she was going to keep her eye out for them as she was in the office till 5, but I know her, she would be at home watching the computer waiting for my results...well, four hours later my phone’s ringing, it's her, well, this can't be good, if they were normal she would have texted...I answer and you can hear her voice shaking, I have a troponin of 1.6 and that is a day later from the event, so likely already coming down from its peak. I'm off to the ED per her request, she's notified the ED, and upon arrival and checking in I waited a moment or two in the waiting room, and I'm called back for evaluation, another EKG, worse than the day before, and within moments have a room full of nurses and providers, who at this point are dumbfounded, a 33 year old with an NSTEMI? What's happening? Full workup, thankfully at this time of the pandemic, patients could have one visitor, so of course, my husband's there with me. I tell my story to multiple nurses and providers. The admitting nurse didn't believe me when I told her my troponin levels, she thought I have it wrong a normal troponin is 0.03, more lab work was done, and by this time my level continues to drop and is now 1.3, but still she was in disbelief.
I'm admitted by the hospitalist, its Friday night at 11 o'clock, so I'm staying the weekend till Monday. I have all the hospitalists stumped...cardiologist has several rule outs for the mechanism of my NSTEMI at this point, rule out plaque rapture, SCAD, or myocarditis. I have been repeatedly asked if I smoke or do illegal drugs, no and no. COVID tested, negative, which off-topic is not as horrible as people make it out to be. All right, the weekend passes hooked up to an IV drip of heparin, echo was completely normal. I have a minor IV dye allergy, so Sunday I'm premeditated for my Cath early Monday morning. Ready for my cath and laying there in the cath lab the procedure begins...entry through my radial artery and they're in, everything is up on the screen, although slightly sedated still coherent enough to pay attention. The interventionist cardiologist starts doing his thing and there it is, no signs of plaque rupture, no SCAD, but a coronary artery spasm in my LAD nearly 70% at one location and 50% further down, this could explain why my troponin throughout my stay was dropping and then going back up, I am still spasmed but overall my chest pain was no longer a thing. Nitro was administered right through my Cath and the procedures done, Cath site is compressed with strict instructions of limited movement and release of the compression over the next hours.
I'm back in my room on the 3rd floor, all is well, great we know what happened, why it happened is still a mystery. The day goes by with Netflix binge-watching and then the migraine from the nitro hits, wow no joke! The next morning - no more migraine, and after another night of premeditation for that IV dye allergy I mentioned I am ready for my last test, a CT to rule out Pulmonary Embolism, although I had a negative D-Dimer, those results return normal, no PE. It is now Tuesday and we are getting some answers.
- Cardiology gets me underway on my new daily medication regimen, Imdur, Plavix, baby aspirin and Lipitor, and home sweet home I go. After three days of intense migraines and migraine induced vomiting I start adjusting to the Imdur, I got through the adjustment of that medication and return back to work and a new normal of increased stress, a waiting game, when's this going to happen again? Is it going to happen again? Bruising like it's my job from the medications and the consuming emotional effects left behind.
I understand why it was felt from the initial EKG and visit, that my EKG had changes, but my overall health did not make sense for an NSTEMI, the puzzle didn't add up for the bigger picture of my overall health. I declined lab work that same day, not my proudest medical decision. Women's heart health presentation can be different than a man’s, but it is not something to be taken lightly, be persistent if something doesn't add up or feel right act on it.
Coronary artery spasms happen in about 2% of people, typically while sleeping or during the early hours of waking, in younger patients, and occur at rest. They are under-diagnosed or misdiagnosed. Take care of yourself, find answers, and be persistent. I look forward to one year from this event, I hear at that time something clicks and the thoughts of "when will this happen again?" go away.
