Hindsight: The Grim Reaper's BFF

This morning, as I scanned various postings on the discussion forums for WomenHeart (The National Coalition for Women with Heart Disease), I was drawn to a plea from a young and frightened mother who shared a list of recurring symptoms: irregular heartbeat, dizziness, sharp pain radiating from her left breast through her back, a burning discomfort down her left arm from shoulder to wrist. As I read this list, my mind kept yapping, “check, check, check” as it reminded me of symptoms I’ve heard Patty describe along the way. 

This young woman’s doctor wrote scripts for anxiety and acid reflux, but these haven’t helped her turn a corner; early this morning, her symptoms had increased in severity. Reading this made me recall the day of Patty’s heart attack, when EMTs assured me Patty was having her first-ever “panic attack”.

Today, I joined a group of other forum participants in urging this woman to hurry to the E.R. At first, she was hesitant, because her husband is at work and she has a young child at home. Her first compromise was to suggest she’d “try to get in” to see her doctor today. With some additional nagging, though, the group convinced her to make the trip. As I write this, she’s had an EKG that revealed some extra beats, and she’s awaiting results from a blood draw. I secured her promise that she’d keep me posted about what she learns. [UPDATE: my new acquaintance says her tests came back normal, which made me feel like a bit of a heel for mucking with her day...but only a little bit.]

My discussion with this young mom brought back memories of the many times we made the “go” or “no go” decision about taking Patty to the hospital. Often, this involved Patty voting for “no go” and a certain chronic worrier of a husband insisting she get in the car. In some instances, Patty was stuck overnight for nothing, which won me few points; in others, the decision to head to the E.R. helped keep my favorite patient alive and kicking.

So what’s the right answer?

Few, if any, organized groups would ever suggest anything other than calling an ambulance at the first sign of any symptoms that could be heart-related—and, on the surface, the argument makes perfect sense. As the cardiologists say, “minutes mean muscle”; the sooner you get treatment, the better the odds you’ll spend the years ahead above ground.

So what’s the problem?

The problem is that the symptoms of a heart attack—and especially the symptoms of a heart attack in women—aren’t always so easy to pin down, for patients and sometimes even for doctors. For example, nausea and back pain may be indicative of a heart attack, but they may also tie directly to menstrual cycles, a bit of extra exertion or countless other things that have nothing to do with the heart. Extreme fatigue, another symptom, happens to every mom at one time or another. How many are going to call 9-1-1 for cramps or a touch of flu? Especially when an ambulance ride of mere minutes can cost four figures?

We're in no position to cast the first stone; Patty ignored important symptoms, as she shares in Pulse of My Heart:

Still, I’m letting myself off too easily; as I dismiss the pulsing ache, I recall this same sensation from the week before, while trick-or-treating with Brian and our youngest, Connor. The pain had been much more insistent, a hundred gnomes’ fists pummeling my rib cage. I’d trudged along, hoping the rough handling might pass, but soon felt my energy wane and vanish; I left the boys to their Halloween. At home, face-down on the family sofa, I ignored the incessant ringing of diminutive ghouls and princesses. Trick me if you must, but I’m not moving. Three Ibuprofen, a damp washcloth and darkness did nothing; only sleep offered an eventual and welcome respite.

Eight days later, Patty had a “widowmaker” heart attack that we may have been able to prevent had we treated her symptoms as more than “one of those things”.

I’m asking a question here for which I wonder if there are easy answers. I think the best advice is to (a) know yourself and (b) always err on the side of being overcautious. If you feel something that doesn’t seem right, don’t ignore what you’re experiencing. Pay very close attention. If there’s any doubt that what you’re feeling may be serious—any doubt at all—don’t wait. Your absence from family activities for a day or two will cause far less havoc than will planning your funeral.

If you're looking for an "official" answer, the American Heart Association suggests you call 9-1-1 within five minutes if you experience any of these warning signs:

1. Uncomfortable pressure, squeezing, fullness or pain in the center of your chest that lasts more than a few minutes, or that goes away and comes back.
2. Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
3. Shortness of breath with or without chest discomfort.
4. Other signs such as breaking out in a cold sweat, nausea or lightheadedness.
5. As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

I welcome your thoughts about this issue, and encourage you to share your experiences. What will it take (or what did it take) for you to make the call?