by Carolyn Thomas ♥ @HeartSisters
Part 3 of a 3-part series about pain
My initial heart attack symptoms struck me right out of the blue. I was out for a brisk walk early one beautiful Monday morning around 6 a.m. when suddenly, I experienced a pain smack in the centre of my chest. It felt like a cross between crushing heaviness and a severe burning sensation that gradually extended right up my chest into my lower throat. My left arm began to hurt. I also felt like I was going to vomit, and I started sweating far more profusely than my walking pace warranted.
But a strange realization about my heart attack symptoms hit me much later, long after I was hospitalized for what doctors still call the “widowmaker” heart attack.
This was not the first time in my life I’d felt the chest pain symptoms I experienced on that spring morning.
In fact, over a 19-year pre-heart attack stretch while I was a distance runner, I felt a virtually identical chest/throat pain at the end of my running group’s long Sunday morning training runs. Every week, as we neared the part of our route taking us back to the downtown Victoria Y (where our group runs typically started and ended), we hit the Quadra Street hill.
Quadra Street is the kind of double-whammy hill that most recreational runners dread: it was both long (4-5 blocks) and also memorably steep, leading north from the edges of Beacon Hill Park up to the Y at the top of the hill. Near the very end of the final push up that endless hill, I would start to feel those chest pain/burning throat symptoms. Every Sunday, for 19 years.
Back then, I just figured that this chest/throat pain meant my lungs were screaming for mercy while we pounded up that long steep hill. But I don’t recall thinking anything was particularly wrong with that kind of pain at the time. After all, our entire Y group was pretty much heaving and sucking wind by the time we all reached the top, so I thought everybody felt that way running up Quadra Street.
I don’t recall even bothering to mention what I was feeling to any of my running buddies all those years because I assumed they all felt it, too. And I never attributed these symptoms to my heart, but only to my lungs as I imagined them struggling for each breath under extreme exertion.
But that struggle seemed to ease up after we reached the top of the hill, during our cool-down walk and post-run stretch. I also never felt that unique combination of severe symptoms during our road races or other training runs – only while running up that one particularly long and steep hill. After each Sunday run, I didn’t give those symptoms a moment’s thought until the next week near the end of the the next run up Quadra Street.
Fast forward several years to those first severe heart attack symptoms and my first trip to the Emergency Department on that beautiful spring morning. When the Emergency doc told me that my symptoms were NOT heart-related, it made sense to me. After all, I had never before attributed those familiar chest symptoms to my heart. In fact, had it not been for the alarming pain down my left arm that spring day, I would not likely have sought immediate emergency help at the hospital.
I felt embarrassed for having made a fuss over “nothing” when I was sent home from Emergency with my acid reflux misdiagnosis. But I was also relieved! I’d much rather have indigestion instead of heart disease, thank you very much.
We know that heart disease can be 20-30 years in the making. So I now wonder: is it possible that I had been experiencing early signs of angina all those years, brought on (as stable angina almost always is) by extreme exertion?
We know that women can often experience what are called prodromal (early warning) symptoms of heart attack. As I wrote here, for example, when Arkansas researcher Dr. Jean McSweeney interviewed hundreds of female heart attack survivors, she discovered that 95 percent of the women she studied actually suspected something was very wrong in the months leading up to their attack.*
Well, that’s months – but not years – ahead of time!
While you ponder that possibility, consider what causes the cardiac chest pains of angina pectoris (translated as “strangling in the chest):
My particular type of current angina is associated with that latter diagnosis. The debilitating pain tends to be more severe and last longer than other types of angina pain, and can also occur with severe shortness of breath, sleep problems or crushing fatigue. Ironically, it’s often first noticed during routine daily activities (for me, simply walking down the frozen food aisle at the grocery store can set it off) and aggravated by emotional stress (running late for an appointment, for example, can create an avalanche of debilitating symptoms). I can generally manage the pain most days like this:
- with medications (remember, heart sisters, that “nitro is your friend!”)
- regular daily exercise (as Kentucky cardiologist Dr. John Mandrola likes to say: “You only have to exercise on the days you plan to eat!”
- the portable TENS unit I wear clipped to my belt from dawn to dusk
- anticipating, preparing for monitoring and managing my daily stress levels
- ongoing care from our Regional Pain Clinic staff, an expert pain specialist, and the pain self-management programs offered there.
* Jean C. McSweeney. “Women’s Early Warning Symptoms of Acute Myocardial Infarction”. Circulation. 2003; 108: 2619-2623 November 3, 2003. doi: 10.1161/01.CIR.0000097116.29625.7C
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Q: Have you experienced odd symptoms that turned out much later to be early warning signs of a significant health crisis?
- NOTE FROM CAROLYN: You’ll find much more about cardiac symptoms in my book, “A Woman’s Guide to Living with Heart Disease” (Johns Hopkins University Press). You can ask for it at your library or favourite bookshop (please support your local independent booksellers) or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from Johns Hopkins University Press (and use their code HTWN to save 30% off the list price when you order).
See also:
Part 1 of this 3-part series: The Freakish Nature of Pain
Part 2 of this 3-part series: Brain freeze, heart disease and pain self-management
On being a (former) runner – my guest column in Runner’s World
How women can tell if they’re headed for a heart attack
Researchers openly mock the ‘myth’ of women’s unique heart attack symptoms
12 heart attack symptoms you must never ignore
Women fatally unaware of heart attack symptoms
Mayo Clinic: “What are the symptoms of a heart attack for women?”
When chest pain is “just” costochondritis
The chest pain of angina comes in four flavours
Women’s heart pain is both physical and emotional
Self-Tracking Device? Got it. Tried it. Ditched it. (from The Ethical Nag: Marketing Ethics for the Easily Swayed)
♥
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Heart Sisters 
Thank you for this post and for all of the information on this blog. I started running just a few months ago and have been preparing for my first 5K (…on my 42nd b-day). I’ve been running 4 mi 3X a week.
Every time just as I near the top of a lengthy hill on my run, I’ve been having a pain in my chest that shoots to my right shoulder. I feel quite ridiculous now to say this, but I honestly didn’t think much about it as it goes away rather quickly after I slow down or stop at the top of the hill. Only when I went to see the course I am signed up to run this weekend and saw that the entire first half of the race is up a giant hill, I started to get nervous about that pain. I mentioned it to my husband and he made me promise to get it checked out.
The Dr. found nothing on an EKG and, at my request, sent me to a cardiologist. (He was ready to send me on my way, only advising me to stop and ask someone for help if I felt that pain again! He also suggested that I was probably just feeling nervous about the hill and that was why I was having the pain.)
Today I had another EKG at the cardiologist showing nothing, and she is having me come back in for a stress test. But, after reading on here that a stress test won’t necessarily confirm that my pain is/isn’t my heart has given me great pause. I feel at a loss and like I am now overthinking every feeling in my chest. My father had a heart attack in his late 60s, otherwise no heart disease that I am aware of in my family.
Knowing what you know now, if you could step back in time what would you have done differently if you were still that runner in the distance group going up Quadra St.?
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Hi Barbara – thanks for your comments here. In answer to your final question, I wouldn’t have done anything different running up that Quadra Street hill. See the September 21st comment exchange (below) between Mary and me about this question: e.g. a heart attack is caused by a reduction in oxygen flow to the heart muscle when the heart’s capacity to pump oxygenated blood to that muscle is reduced. Exerting beyond one’s capacity is also what runners experience on those big hills. As I told Mary, my cardiologists now suspects that my 19 years of distance running actually helped my heart and likely postponed my cardiac issues for many years.
At this weekend’s run, don’t hesitate to take regular walking breaks during the first half of the course. It will slow down your finishing time, but will give you a better (and possibly safer) experience. Good luck to you – and happy birthday!
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Thank you so much for this article and your experience.
I am a 35 year old male. I started running in my late teens (19ish) and took off a lot of weight that I had put on growing up in a family that enjoys eating for just about every event. I had gotten to 345 lbs. by age 19, and finally decided (and had the willpower for the first time), to lose the weight. I got down to 200 healthy lbs. by age 21. That weight, despite sounding high, looked really thin on me. I continued running for enjoyment and to maintain the weight – usually on the order of 10-15 miles per week with no issues.
Sometime when I was around 26 or 27 years old, on occasion while running, I would experience pretty severe chest pain (behind the sternum) about 1-2 miles into the run when my heart was under what I would generally call “full exertion” – probably pushing 165 to 170 bpm). It would go away completely and quickly if I stopped running. Having had cramps of different sorts through the years, I chalked it up to my lungs or rib muscle, or whatever.
I’ve probably had 2 dozen episodes like that in running over the 5-6 years between age 26 and 31. It’s really hard to peg. Over that time my weight has fluctuated much more than I would like it to. My wife and I became foster parents to special needs children when I was 32 years old, and it pretty much ended my ability to run – there was just no time. But our stress level surged, and I put on a lot of weight again – up to around 290 lbs.
I have since switched to a mostly whole foods diet and have been working to get 10,000 steps a day – walking at a vigorous pace but definitely not a jog (probably realistically around 3.5 mph and no more than 4 mph. My heart only gets to around 110 – 120 bpm.)
As I’ve gotten older, I’ve been thinking back on those “pain attacks” while running. I never really got them figured out, and I would love to jog again and get my heart pumping in the 140s or 150s…
But then it occurred to me, and after talking to friends, that maybe these pains are a sign of something bigger. My dad has Hypertrophic Cardiomyopathy (HCM). I was tested for this when it was diagnosed in him (he was 60 when diagnosed, I was only 25 at the time). And the cardiologist said I didn’t have it. (Relieved). I’ve also had a regular EKG, ECG, and a stress ECG that got my heart up to 160bpm, but didn’t “hold it there” for an extended period of time to simulate an actual 1-2 mile run.
In my 20s, I used to smoke a bit – not a lot – a cigar on a weekend night – cigarettes at clubs here and there. Not a daily thing, but a weekly thing. I largely gave up smoking in my 30s, maybe a pack a year. I gave them up altogether last September and am going to stay off of them – just seemed like the risk wasn’t worth it.
Anyhow, I’ve made an appointment with a cardiologist. I’m nearing my 36th birthday and I figure it’s time I need to figure out what that pain was telling me back in my late 20s and early 30s, and your post confirms that it’s a good idea for me to get checked. So I wanted to thank you for that – because sometimes doctors see someone who looks healthy (as I did in my 20s – with a rest HR of 45 bpm (no exaggeration!)) and they just assume it couldn’t be heart related. Had they seen me in my late teens at 345 lbs, they might have suspected heart damage based on carrying so much weight.
Anyhow, my advice to anyone who comes along to this comment in the future is to get tested. It can’t hurt.
Thanks again for this post. It’s a great warning to heed.
Fred
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Hi Fred – thanks so much for sharing your story here. Runners typically chalk up every ache and pain to being “just” a running issue. Right now, you don’t know if your previous symptoms were heart-related or not (as opposed to signifying a reduction in oxygen flow to the heart and lungs due to exercising beyond capacity) but given your other past health issues, it might be a good thing to consult a cardiologist again. Best of luck to you…
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In the months (year?) before I had to retire due to severe heart disease, whenever I wasn’t moving I felt the need to sit down. When I sat down I only felt comfortable when I had my feet up – to the point that I stopped going with my colleagues to the cafeteria & ate in the “break room”, alone but with my feet up. I didn’t understand why others who brought a meal bothered to eat in a place where they had to sit at a table with their feet on the floor when we all worked so hard and were exhausted by meal time. After all, were were all nurses working on the same unit.
After I was diagnosed (totally unexpectedly) with congestive heart failure, my perspective changed completely. I realized I was the only one so exhausted, and I had to sit down with my feet up because my heart wasn’t able to pump sufficiently to support my walking, standing, or working.
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Hi Jennifer and thanks for this. In a way, I had to smile at your assumption that all your other nurse colleagues were feeling just as exhausted as you were! I’m now thinking this reaction might be a fairly common response – instead of us being justifiably alarmed by what is clearly not “normal” for us. Please take care …
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Your post about the possibility of heart related symptoms/problems decades before your heart attack and then Mary (below) wondering about “exerting beyond capacity” is something that we, I, need to heed.
I suspect that most of us when we were younger responded precisely the way you did, Carolyn – thinking the pain induced by running was felt by everyone and “appropriate” to the exertion.
Now that I’m older I still chalk it (pain) up to it being “appropriate” to my age or physical condition. When I think about it the only difference for me now is I know it can forewarn of debilitation or death. When I was younger that thought never crossed my mind.
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So true, Judy-Judith! “No pain, no gain” was our mantra back then. You just reminded me that, although my running group used to joke about how laid-back WE were compared to some of our elite running friends who used to throw up at race finish lines just to demonstrate what true effort looks like (e.g. we used to say that our motto was “No pace too slow, no course too short”) – but the reality was that once we all ran our first half-marathon together, there was no turning back when it came to ramping up our weekly mileage training. “Exerting beyond capacity” was not only normal, it was considered a goal.
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Hmmm. It would be hard to know. Chicken and egg. Why do I say this? Because running up a steep hill after a long run can bring the same symptoms of a heart attack: that being reduction in oxygen flow to the heart and lungs (cardio-vascular).
An MI brings it about by occlusion or spasm, and exerting beyond one’s heart’s capacity also brings a heart-lung that cannot keep up and supply the body to the level it needs. Does it mean you HAD heart issues before and didn’t know it, or does it mean you exerted beyond your capacity (and should have known it)? Hard to know.
We do know from autopsy reports back in the Vietnam era, that the soldiers had well established vascular occlusion back in their late teens/early 20s. Either from our SAD (Standard American Diet), or from genetic propensity, or epi-genetic triggering and/or inflammation. They all play a part. When we are declared “pristine” when our vessels are examined in catheterization, it only says they cannot see VISIBLE build-up. This is an outmoded and mostly male “standard”.
It is known that inflammation or genetics can contribute to what they call INTIMAL THICKENING WITHIN the vascular wall. What triggers the eruption of this, to cause an MI or stroke, we don’t exactly know, but inflammation and stress are considered factors. This is another major branch of the trajectory toward an MI – and not yet a standard.
It is inevitable that our bodies will sustain wear and tear. How much exercise conditions us and how much destructs is variable to the person and their particular vulnerabilities. We know we have to “use it or lose it” to a certain point. In our search for the fountain of longevity, we have to acknowledge that we are on a slow, or sometimes fast, march of entropy. We do our best and then later, when we are wiser, we wish we had done better.
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Thanks for such thoughtful and thought-provoking comments, Mary. Some cardiologists have suggested to me that my 19 years of running likely postponed my MI by a decade or so (and just think of those lovely collateral arteries that were encouraged to develop to help keep me alive during my “widowmaker” heart attack!) On the other hand, have you been following recent journal articles that warn us of the cardiac dangers of TOO MUCH exercise? I still choose to believe, every day, that exercise (mostly walking, biking, and weight-training for me these days) is as cardioprotective as docs have been telling us for a long time.
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Too much exercise ??? Say it ain’t so!!
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I was waiting for you to jump in here, JG! Yes, it just might be true, apparently: a couple of recent studies that looked at exercise intensity/duration suggest that endurance training in particular is linked with a pro-inflammatory state and higher incidence of cardiovascular disease! Mind you, this is extreme endurance exercise – another really interesting study found that prescribing regular exercise can reduce the risk of heart failure and atrial fibrillation.
Seems to depend mostly on extreme exercise duration/intensity, not my own personal moderate daily exercise – what do you make of this as a triathlete?
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