About 10 years ago, I was watching Mad Men on TV when my heartbeat fluttered like a hummingbird, then seemed to disappear. When I felt for a pulse, I got nothing.
My husband, Greg, detected a thready beat, then bundled me into the car to speed across the Potomac River to Sibley Hospital in D.C., seven minutes from our McLean home. The ER was empty at midnight, save for a drowsy security guard who asked me to sign in. When I wrote “heart attack” in a shaky script, the place jolted awake. Within three minutes, nurses had hooked me to a heart monitor and turned off its sound, because the syncopated, 190 beeps each minute freaked Greg out.
That was my first—of many—atrial fibrillation episodes. A-fib is an arrhythmia where the heart’s normal lub-dub/lub-dub rhythm becomes a samba of chaotic and inefficient muscle contractions that can’t pump all of the blood out of the heart. An electrical glitch in the heart’s top chambers, A-fib is scary, but not life-threatening. The real risk is that residual blood will clot and travel to the brain, causing a stroke.
One moment, I’m a normal, middle-aged woman with a thing for Don Draper; the next, I’m a cardiac patient tethered to an IV dripping drugs that, two days later, finally “converted” my willy-nilly heartbeat into a predictable rhythm again.
Why was I so surprised? Heart disease is the No. 1 killer of women (men, too) in the U.S., claiming 299,578 female lives in 2017, according to the Centers for Disease Control and Prevention. “The American Heart Association has been pretty good at putting out PR every February, which is American Heart Month,” says Rachel Berger, a cardiologist in the Ballston office of the Virginia Heart medical practice. “But people are still shocked to learn that it’s the leading cause of death in women. One in every five women will die of heart disease, beating out breast cancer, Alzheimer’s and all the other ways women die.”
Heart disease doesn’t discriminate by age. The odds of having a heart attack increase as you get older, but then again, young women having heart attacks isn’t as rare as hen’s teeth. “It’s more common than you think,” Berger says. “And it’s more dramatic when it happens to a younger person who doesn’t expect it and doesn’t have the typical risk factors.” However, treatment of heart disease does discriminate by sex, according to Roquell Wyche, a cardiologist and board president of the Greater Washington Region American Heart Association.
Recognition is often the first hurdle for women. From the moment they begin experiencing symptoms to the time they arrive at a hospital, women having heart attacks wait more than 30 percent longer than men, Wyche says. Once there, women experience a 20 percent longer wait time than men, from arrival to the point at which they begin receiving care.
“In some cases,” she says, “women with chest pain were less likely than men to receive aspirin or be transported with lights and sirens. And women with cardiac arrest were less likely to be resuscitated.” This article is a cautionary tale about three area women who were active, fit and healthy before their hearts—and, in some cases, the medical establishment—let them down.
Lori Scott, 54
Lori Scott loves to ski, schussing down blue-square slopes, slicing through fresh powder and feeling winter’s chill on her cheeks. But during a Steamboat Springs, Colorado, vacation 13 years ago, she felt another sensation.
“I was in bed around 11 with a book when I felt extreme difficulty breathing, like an elephant was sitting on my chest,” says the now 54-year-old. “It took about a minute before I said to my husband, ‘I think I’m having a heart attack.’ ”
While maybe a third of women have atypical heart attack symptoms—back, jaw, even earlobe pain; nausea; maybe some dizziness—Scott’s were classic: shortness of breath; numbness traveling down her left arm; an elephant (heart attack’s spirit animal) taking a siesta on her chest.
“It was unmistakable,” says the Arlington resident, who lives off Military Road and works as the chief information officer for NatureServe, a biodiversity conservation group.
Still, the couple debated going to the emergency room, which always robs four hours from your life, no less your vacation. Scott didn’t think she was a top contender for a coronary. She was 40, in good shape, with no close family history of heart disease—at the time. (Her mother would die suddenly a year later, at 65, of what Scott believes was a heart attack.)
“You always second-guess if what you’re experiencing is worth going to the ER for,” she says.
When more cautious heads prevailed and Scott finally showed up at the mountain hospital, she was the lone heart event in a sea of breaks, sprains and dislocations. Her electrocardiogram (EKG) was normal, and her level of troponin, a cardiac enzyme that climbs after a heart attack, was just fine. Her symptoms subsided, and the docs chalked up the event to indigestion—she had eaten her first elk steak for dinner. They discharged her at 4 a.m. with, “You’re fine; ski hard tomorrow.”
The next morning dawned on Scott’s last day of vacation. She slept in, and with “ski hard” ricocheting around her brain, she slapped on the new skis she’d been eager to try and joined her husband on a lift around noon.
You can guess what happened next. Halfway to the top, she turned and said, “Guess what, Joe. I’m having a heart attack. Again.”
That realization led to a ski-patrol toboggan ride down the mountain and an ambulance assist back to the same hospital that had discharged her 10 hours earlier. This time, her EKG was abnormal, her troponin level had spiked and she was admitted. The next day, Scott was airlifted by helicopter to a major medical center in Fort Collins, where a cardiac surgeon placed two stents into her blocked arteries.
For years, nobody could figure out why her arteries had been blocked. Then, a decade later, on a hunch, Scott’s cardiologist sent her records to the Mayo Clinic, where Scott was diagnosed with SCAD.
Spontaneous coronary artery dissection (SCAD) is a rare and emergency condition that occurs when a tear develops in the heart blood vessels of, most commonly, a woman in her 40s or 50s who is otherwise healthy. The tear can slow or block blood flow to the heart and cause a heart attack, heart arrhythmia or sudden death. Research suggests SCAD is responsible for 40 percent of heart attacks in women under age 50. The recurrence rate for SCAD is estimated to be 20 percent.
Scott, who is now enrolled in Mayo’s SCAD registry and research study, sips a glass of ice water and waggles her right foot subconsciously as she talks about how lucky she feels to be alive with no major heart damage. Her skiing days now behind her, she walks for exercise and tasks her husband with shoveling snow.
“I don’t want to be melodramatic, but I do try to use this as a lesson to appreciate what I have,” she says. “I try not to put things off, like visiting friends and enjoying the life we have. I care more about treating myself right.”
Elizabeth McKenzie, 34
Spelling tests give many fourth-graders the jitters, but not Elizabeth McKenzie. She remembers being a go-with-the-flow kid who prepared for weekly quizzes and didn’t stress much about getting A’s.
Still, her teacher, school nurse and parents attributed it to test anxiety when, one day in the mid-1980s, the 9-year-old’s chest suddenly tightened, her heart raced and her head felt light as a cloud.
“I’ve probably had ventricular tachycardia my whole life that was misdiagnosed as anxiety,” says McKenzie, an Arlington speech and language pathologist.
Ventricular tachycardia, aka V-tach, is a fast heart rate created by abnormal electrical signals in the ventricles, the heart’s lower chambers. Typical symptoms include dizziness, shortness of breath, lightheadedness and feeling like your heart is racing. Unfortunately, panic attack symptoms also include dizziness, shortness of breath, lightheadedness and feeling like your heart is racing.
It’s no wonder that women having panic attacks often think they’re having a heart attack; and women with heart disease often think they’re having—and are frequently diagnosed with—panic attacks.
McKenzie wears a weekday ponytail and a resigned smile when she talks about all the decades her doctors got it wrong. In junior high, when she was often short of breath, doctors called it exercise-induced asthma, even though she wasn’t exercising before, during or after the gasping spells.
When, as a 30-year-old new mother, her heart played Red Light/Green Light, constantly racing and stopping, her GP said parenthood was stressful, urging her to relax and breathe deep.
And when she became pregnant again in 2018, and her Apple Watch showed her heart seesawing between 75 and 175 beats per minute—a dozen times a day—the obstetrician in rotation talked about her “beautiful” blood pressure, she recalls, then gave her a physiology lesson about pregnancy and blood flow and blah, blah, blah.
“I knew I wasn’t crazy,” says McKenzie, eyes still glistening with frustration, remembering how her concerns and complaints were diminished or dismissed. As in space, no one could hear her heart scream.
Until someone did.
Kathy Wolf, who heads an OB-GYN practice in Annandale, has compassionate brown eyes, straw-colored bobbed hair and a quirky sense of humor. Her YouTube channel is titled, “Dr. Kathy at Your Cervix.”
“We’ve been through a lot together, trying to get me pregnant,” says McKenzie, who’s seen Wolf for fertility issues since 2012. Regrettably, scheduling conflicts during her second pregnancy kept doctor and patient apart until McKenzie was 28 weeks along.
“As soon as she saw me, she said, ‘You don’t look like you feel well.’ ”
McKenzie recalls choking back tears as she spilled out her symptoms and fears. How her heart galloped a dozen times a day, how she obsessively counted her heartbeats on her smartwatch, how she didn’t want to seem dramatic, but she feared she was crazy.
Then, for the first time in 20 years, a doctor said, “Let’s get you to a cardiologist.”
In a perfect world, that would end the story. The hero cardiologist would instantly diagnose and treat McKenzie’s heart problem, and she’d live her life knowing she wasn’t nuts, just a young woman with a super-fast heartbeat.
But McKenzie’s EKG was normal, and the cardiologist, who wasn’t accustomed to treating pregnant women 40 years younger than anyone else in his waiting room, was stumped.
McKenzie sensed he, too, believed anxiety was the culprit.
Then, like the spectral whisper in Field of Dreams—If you build it, he will come—she recalled Wolf’s advice: “Push for a heart event monitor.”
A cardiac event monitor is a cellphone-sized device with electrodes that attach to your chest and measure and record heart activity. A patient typically wears it for a day. Sometimes a monitoring staff remotely keeps an eye on readings in case the device detects something weird or dangerous.
Two weeks passed before McKenzie was fitted for the monitor by a technician who waved her goodbye with, “If you don’t hear from us, bring it back in 24 hours.”
She made it three hours.
“My phone rings, and it’s the remote tech saying, ‘Are you okay? Are you safe? You need to go to the emergency room!’ ”
McKenzie demurred, saying she wanted her doctor to see the wild heartbeats that were panicking the monitoring staff.
“They called back in 30 minutes, then five more times in five hours,” she says. “Finally, a supervisor was on the phone saying, ‘I must insist you go to the emergency room.’ ”
McKenzie, then 32 weeks pregnant, relented with an eye roll and drove with her husband, Evan, to Virginia Hospital Center’s Emergency Department, where the fun was about to begin.
“They hooked me to a monitor and, all of a sudden, the alarm goes off. Everyone’s freaking out. The doctor runs back and looks at the monitor and says, ‘It’s ventricular tachycardia.’ They get a crash cart and get me ready for the paddles, because they’re worried about cardiac arrest. And the doctor says to me, ‘This can cause strokes. You’re so lucky you never passed out while driving your child.’ ”
Later, Wolf held her hand and said, “You were trying to tell us this all along. And you couldn’t get anyone to listen.”
Today, McKenzie manages her arrhythmia with a beta-blocker that slows her heart to about 50 beats per minute, ironically, an overcorrection for the problem she spent a lifetime trying to convince doctors she had.
“I’m still recovering mentally and emotionally,” says the Arlington mom, who delivered a healthy baby boy, Patrick, about a year ago.
“I grew up in a house where we trusted when a doctor said, ‘You’re fine.’ Going against a doctor? I wouldn’t have done that…before. Now, I’m a much more active consumer. I’ve been on so many different medications, and if I have any side effects, I’m quick to call or text. Before, I wouldn’t want to be annoying. Now, I’m comfortable speaking up.”
Jennifer Landers, 45
Jennifer Landers easily embraces her many identities: wife; mother of two young boys; president of New Dimensions, a custom homebuilding company; Christian woman of faith.
The only identity she has trouble wrapping her head around is “heart attack survivor.”
“For a long time, I’d call it a ‘cardiac event,’ ” says Landers who, for the first time, is speaking publicly about the heart attack she suffered five years ago. “It’s still difficult to say the words—heart attack. It’s still unbelievable.”
Her new reality began early on Good Friday morning when she was 40.
“I woke up and felt some pressure in the center of my chest,” she says. “I wasn’t in so much pain. I wasn’t short of breath. But I knew something wasn’t right.”
Landers, who lives in Falls Church City, woke her husband, Paul, and told him to call 911. She asked him to instruct the EMTs to turn off their sirens because their 3½- and 2-year-old sons were still sleeping.
By the time the ambulance arrived 10 minutes later, “heaviness” had spread to her wrists, like someone was pulling on her arms.
The EMTs took Landers’ blood pressure, which was elevated to 158/100. They gave her a baby aspirin and drove her to Virginia Hospital Center, where her EKG was normal.
Some three hours later, however, Landers’ cardiac enzyme level rose high enough to win her a bed in the hospital’s cardiac wing. Around 10:30 that night, a sharp pain spread through her right shoulder.
Although nobody used the words then, the shoulder pain was the moment Landers had the heart attack, which had been revving up since morning. The nurses’ station monitor sounded an alarm, mobilizing a cardiac team.
“Within five minutes of the pain, a whole team of people were coming in, asking how I was feeling, giving me medication,” Landers says. A cardiac catheterization to scope out the problem was scheduled for Monday, the day after Easter.
Cardiac catheterization is used to locate a narrowing or blockage in blood vessels that is limiting blood flow to the heart. At 9 a.m. on Monday, doctors inserted a long, thin tube into a blood vessel in Landers’ groin, threading it through a succession of connected blood vessels to her heart. That’s when they found the “rupture.”
Landers uses a little geography and a lot of hand motions to describe where her doctor found the rupture. If you think of the main coronary vessels as the Chesapeake Bay, and lesser vessels as, say, the Patuxent River, then her rupture was hidden in a slim creek that jutted from the river that flowed from the bay.
“The pain I felt in my shoulder was when that little vessel popped,” she says. “The vessel was so tiny, that there was nothing they could do. Everything else looked good. When the cardiologist gave me the report, she said, ‘If I could order up a heart attack, it would be the one you had.’ ”
In other words, as heart attacks go, it wasn’t a bad one. Still, Landers remembers getting tripped up by those words.
“I said, ‘Wait. Order up a what?’ That was the first time I heard the words heart attack. I can’t even tell you how shocking it was.”
In hindsight, Landers—whose official diagnosis was “coronary arteriosclerosis”—says she shouldn’t have been so stunned; both of her grandmothers had survived heart attacks when they were in their 40s, so she had a family history of heart problems.
When I ask Landers how the heart attack changed her routine, she mentions the daily pills she will take for the rest of her life—a baby aspirin to thin her blood, medicine to regulate her blood pressure, and a statin to keep her cholesterol levels lower than what diet and exercise can do alone. For about a year, she carried emergency nitroglycerin pills in her purse, just in case.
The heart attack also rewrote the prayers she utters as a Sunday churchgoer and a believer. Since the event, she says, her prayers have essentially evolved from, “God, give me health” to “God, give me strength.”
“I was brought up to pray for the best outcome, pray that God will provide,” Landers says. “But today, I’m praying more for him to prepare me for whatever is to come.”
Lisa Kaplan Gordon is a Pulitzer Prize-nominated freelance writer living in McLean.