Ines Hernandez, 46, was having a heart attack for nearly four days before symptoms worsened enough for her to seek help at her local emergency department.
Common symptoms of a heart attack include pain in your left arm and heartburn, but being a middle-aged female and an exercise fanatic, Ines thought nothing of it when her symptoms presented.
“I thought it was muscle pain,” says Ines about the “annoying pain” that radiated throughout her left arm while she was exercising. “I took some over-the-counter pain killers and continued my workout.”
When heartburn set in, she assumed it was side-effects of the drugs. It wasn’t until three days later when she felt a strange sensation in her chest while at work that colleagues called 9-1-1.
“It was a mix of nausea, pain, and like someone punched me in my chest,” says Ines. “The paramedics said I was probably having a panic attack but took me to the emergency department anyway.”
She was in the emergency department at a local hospital for 12 hours, as doctors ran several tests and gave her morphine to manage the pain that waxed and waned. But around midnight, her symptoms worsened, and she was sent to Sunnybrook for an emergency coronary angiogram to check her heart. The angiogram confirmed that she was having a heart attack caused by spontaneous coronary artery dissection, otherwise known as SCAD.
What is SCAD?
SCAD is an uncommon emergency condition that happens when a coronary artery tears or there is bleeding within the coronary artery wall. The bleeding can block blood supply to the heart, causing a heart attack.
SCAD predominantly affects women in their 30s, 40s and 50s, although it can sometimes occur in men as well. It causes up to 35 per cent of heart attacks in women 50 years of age and younger.
“Patients who have SCAD are often given an unclear explanation of their diagnosis and uncertain prognosis,” says Dr. Mina Madan, an interventional cardiologist at Sunnybrook’s Schulich Heart Centre and the medical director of a specialized clinic for patients affected by SCAD.
Unlike traditional risk factors known to cause heart attacks, like smoking and high blood pressure, SCAD can be triggered by severe emotional distress or exertion. It can happen spontaneously in young, active, and otherwise healthy individuals.
The importance of listening
“I heard many times throughout my journey that day that I was having a panic attack,” says Ines. “The worst thing that can happen to you is the uncertainty or the fact that you feel that no one understands what is happening to you. You feel hopeless.”
“When you’re young, it can be challenging to get people to listen to your medical concerns, even when experiencing symptoms like chest pain and shortness of breath. You can be misdiagnosed as anxious or neurotic,” says Dr. Madan, who admits several of her patients from across Ontario visited emergency rooms multiple times before being taken seriously.
While knowledge of the condition among the medical community is improving, Dr. Madan encourages her patients to advocate for themselves: “If you experience chest pain and have had SCAD, go to the emergency room and say, ‘I have chest pain and I’ve had a SCAD related heart attack.’ ”
She adds, it’s equally important to listen to yourself: “It’s easy to get caught up in the craziness of life and we forget to prioritize ourselves. Don’t ignore what your body is telling you.”
“Here’s the thing: If my husband tells me that he’s having a left arm pain and heartburn, I’d take him to the hospital right away and he will be treated as a heart attack,” says Ines. “I know what the symptoms are for a man, but it was happening to me and I never, ever thought that I was having a heart attack.”
At Sunnybrook, Ines received an emergency angioplasty where a catheter (thin tube) with a guidewire was fed up an artery near her groin and into her heart. A small balloon was then inflated to open up the artery and restore blood flow to the heart. During the procedure, patients are awake but mildly sedated.
“Instantly, I felt like an elephant was lifted off my chest,” says Ines.
Now, more than one year later, Ines says she is grateful to be alive.
“I used to associate strength with being able to do whatever I want to really challenge my body – run faster, grab more weight, work longer hours. I had to learn that it is OK to be tired. It is OK to take a break. It is not because you’re weak or incapable. You have to be aware and listen to your body.”
For more information about SCAD and the SCAD Clinic at Sunnybrook, visit Sunnybrook.ca/SCAD.
