Dear Carolyn: “My husband’s heart attack was treated differently than mine”

~ Carolyn Thomas

by Carolyn Thomas  ♥  @HeartSisters

As part of my Dear Carolyn series of posts featuring my readers’ unique stories about becoming a heart patient, this one involves a plot twist that, sadly, sounds maddeningly familiar.  It also involves a remarkable coincidence: a married couple who have their heart attacks eight days apart! Today’s tale focuses on one of my favourite themes in women’s heart health: being misdiagnosed with acid reflux during a heart attack, and it stars my longtime reader, Kathleen:

“Dear Carolyn,

“I arrived in the ER at around 9:30 p.m. on a Friday with pain in my chest, arms and back. The ER physician told me my EKG was ‘normal’, in a tone that suggested I was wasting his time.

“I received a GI cocktail* (Carolyn’s note: see glossary at the end for translations of some terms in Kathleen’s letter) followed almost immediately by nitro. My chest pain was relieved, and the physician asked which remedy I thought had made the difference. I told him they were given back-to-back, so how was I to know? (I was also currently on Omeprazole for ongoing heartburn, and aspirin having had breast cancer in the past; I’d read that it can slow tumor growth, which the doctor was aware of.)

“Fast forward two hours. The ER director stopped in to see how I was doing. I told her I was fine and waiting for discharge. She asked if my cardiac enzyme blood test results were back. I said no, as no labs were done. Within five minutes, they were drawing my blood.

“Shortly after that, the ER doc came back in and said, very irritatingly, ‘Your troponin level is elevated!’ (In my head I was like, ‘I’m sorry?’)  Suddenly, there was a cardiologist along with seven people around my bed asking where my husband was because I was having a heart attack. Luckily, he was able to get there quickly just as I was being loaded into the elevator. Like you, I had the ‘widow maker’ heart attack, caused by a 99% blocked artery.

“Fast forward to Saturday. My husband came into the house complaining of arm and jaw pain. I immediately called 911 (much to his chagrin). I asked which ER doc was on duty, and, thankfully, it wasn’t the same one. Again, his EKG was normal. But this doctor repeated the test every 10 minutes and his blood tests were drawn immediately. Within an hour, my husband was in the cath lab. He ended up with a stent and will be monitored.

“Another interesting note: My husband and I had two different cardiologists. My attack was on a Friday, I was discharged on Sunday and was told I could return to work the next day.

“My husband had his attack on a Saturday and was released on Monday. His cardiologist told him to take five to six weeks off work. (My husband works at a desk job, like myself).

“I have worked in hospitals for over 25 years and know enough to question things that don’t seem quite right. Most people don’t.

“Please continue your Heart Sisters work – we need more women like you!”

                                  Kathleen

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NOTE from CAROLYN:  This story helps to illustrate what can too often happen when women’s first cardiac diagnostic tests come back “normal“, as Kathleen’s EKG was (and as mine was as well in 2008). But unlike Kathleen, when her husband’s EKG was at first interpreted as “normal” too, his cardiac enzyme blood levels were immediately and repeatedly tested. Had the ER Director not stopped to chat with her two hours after her arrival at the ER, she would have been discharged home in mid-heart attack.

Women should NOT have to count on a coincidental accident to get appropriate testing and diagnoses. And don’t even get me started on the preposterous differences in back to work readiness advice!

Thank you Kathleen!  ♥

*Definitions, in order:

  • GI cocktail – a mixture of medications often given in a hospital’s Emergency Department to help doctors diagnose (or rule out) a gastro-intestinal problem
  • nitro (nitroglycerin) – a medication used to address cardiac chest pain
  • Omeprazole – a medication used to treat symptoms of gastroesophageal reflux disease (GERD) or other conditions caused by excess stomach acid
  • troponin – a type of cardiac enzyme found in heart muscle, and released into the blood when there is damage to the heart (for example, during a heart attack). A positive blood test that shows elevated troponin is the preferred test for a suspected heart attack because it is more specific for heart injury than other blood tests.
  • widowmaker – a type of heart attack attack involving a blockage in the left main coronary artery or in the left anterior descending coronary artery, preventing adequate blood flow to large areas of the heart muscle. If blood flow through these arteries is abruptly and completely blocked, it can cause a massive heart attack that can lead to sudden death. The archaic word itself implies that only men experience widowmaker heart attacks; they don’t, after all, call it the ‘widowermaker’ when they happen to women, do they?
  • For more helpful translations of cardiology terms, visit my patient-friendly, jargon-free Heart Sisters glossary.

♥

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And if you too have a personal heart disease story with a plot twist that you think should be shared with the world as a “Dear Carolyn” feature (or at least the part of our world that reads Heart Sisters each week), please share your own by contacting me here.

♥

#2 NOTE from CAROLYN:   I wrote much more about the cardiology gender gap in Chapter 3 of my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local library or bookshop or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the code HTWN to save 30% off the list price).

 

Q: Has your hubby been treated better/quicker/differently than your own similar medical problem was?

See also:

Dear Carolyn: “I went into labour during my heart attack”

Dear Carolyn: “Breaking up is hard to do”

Dear Carolyn: “I had both acid reflux and a heart attack at the same time!”

Dear Carolyn: “I’m having the time of my life!”

Dear Carolyn: “I was never one to complain. . . 

Dear Carolyn: “Did I have a ‘real’ heart attack?”

“It’s not your heart. It’s just _____” (insert misdiagnosis)

Misdiagnosis: is it what doctors think, or HOW they think?

Misdiagnosis: the perils of “unwarranted certainty”

Seven ways to misdiagnose a heart attack

Stupid things that doctors say to heart patients

Cardiac gender bias: we need less TALK and more WALK

Unconscious bias: why women don’t get the same care men do

When you fear being labelled a “difficult” patient

The sad reality of women’s heart disease hits home

How can we get heart patients past the E.R. gatekeepers?

How does it really feel to have a heart attack? Women survivors answer that question

 

Published by Carolyn Thomas

20 thoughts on “Dear Carolyn: “My husband’s heart attack was treated differently than mine””

  1. There is a gender bias when doctors treat women ( especially young ones) in the ER. My girlfriend went to the ER for chest pain. The doctor apparently spent little time with her and diagnosed her with heartburn. She was sent home to resume her life. But in the parking lot, the chest pain became worse along with vomiting. Her husband called 911 but by the time they got her back to the hospital, she was dead! My friend was only 49.

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  3. Hi Carolyn,
    It’s been a while, but Kathleen’s treatment is something that still goes on world wide. I was hospitalized mid August, I was sweating profusely and vomiting at a neighbor function. Paramedics were called and I was rushed to the hospital with an unreadable EKG. They kept me for two, stopping all of my medications and putting me on IV fluids for dehydration. Their first statement that I shouldn’t be on two anticoagulants to which I told them that I was taking a blood thinner and an anticoagulant and that my platelet level was in the high levels of normal. Then checking switched my heparin shots from twice a day to three times a day. They also found out that I now have both hyper and hypotension. But was told I couldn’t be released until an echo and nuclear stress test was done. When done, they released me saying that it wasn’t a heart problem but they set appointments with both my PCP and cardiologist.

    I pulled my medical records when I got home and the new diagnoses is; Chronic systolic congestive heart failure (acute); Idiophathic hypotension; Near Syncope; Syncope; and Anemia of a chronic disease. In short my heart has taken a hit to the front wall and I’m having cardiac seizures in which the heart quivers and not beat causing my bp to bottom out, my going into a cold sweat with severe diarrhea and vomiting. EF reading was 30% on my echo and 41% on my nuclear. I have active ischemic cardiomyopathy and an EF that will never go up, it was holding at 39% for nearly two years. My cardiologist has confirmed it to be 30%. I have an appointment to see an Electrophysiologist for a possible ICD so that when the rhythm stops it can be shocked back into beating. My cardiologist was angry because he wasn’t notified.

    I have even seen news programs over the past two months that stated that women are not given the same treatment as men, but the question is what can we do to change it?

    Robin

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    1. Hello Robin – I’m sorry to hear that you’ve been through all this, and now have a list of new diagnoses. I am not a physician but it does appear however that you WERE taken seriously, underwent an appropriate range of diagnostic tests, kept in hospital for observation, and given follow-up medical appointments – including an EP. That’s the good news. The bad news is that it sounds like you now know you have a range of medical issues that do need attention. Good luck to you…

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    2. My opinion is that every single time we are dismissed we should notify, in writing, the state medical commission.

      My heart attack was written off as shortness of breath due to being overweight. I got *salad recipes* in my checkout paperwork. I was discharged in less than two hours. The nurse got pissy because they wanted me to swallow some junk (GI cocktail) which I declined because I’m gluten free and dairy free (gluten reaction is seizures), so the doctor scolded me and sort of said it was like chutes and ladders. they couldn’t order further testing until I drank their crap to first rule out GI problems.

      My EKG had three abnormalities and my troponin was elevated … slightly, but it wasn’t zero.

      When the doctor asked if my left arm had radiating pain I said no. She turned to the nurse and said “no arm pain then rules this out as cardiac.” Oy.

      I did file a formal complaint and the medical commission did open an investigation of that doctor as they believe that her negligence was a matter of public safety.

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      1. Hello unicorngal and thanks for sharing that experience with us. I’m not a physician, so cannot comment on whether this was negligence or not, but I can say generally that the doctor was misinformed in her comment that a cardiac event must include the symptom of arm pain. Some do, some don’t – but heart attacks are not “ruled out” by the absence of certain symptoms.

        Misdiagnosis IS a matter of public safety. In any other profession/industry, an error would be routinely recorded, reported and discussed – not to punish the person who had made the error, but to ensure that such errors can be minimized in the future.

        Take care, stay safe… ♥

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  4. It is so ‘heart breaking’ to have to hear these stories of women not being taken as seriously as men. I had mentioned in a previous blog that I too went to see my husband’s cardiologist at Duke, who treated my husband for a partial blockage. The same doctor saw all my test results and evaluated me with acute angina (undetermined diagnosis). He told me to go home and eat plant based food and go to the gym and lift weights to strengthen my heart. He refused to believe that I had coronary microvascular disease (MVD), no matter how much I tried to explain my symptoms or provide the test results.

    On my own accord, I researched for the past year on MVD and found a woman cardiologist at Emory University. She has been doing research on MVD for the past eight years. Her name is: Dr. Pugh Metha. She thoroughly reviewed my medical records and evaluated me and diagnosed me with MVD. She was Amazing! She also found a woman cardiologist at UNC-Chapel Hill, closer to my home in NC that works with women’s heart health. The big difference was that she listened and believed in me and had advanced knowledge and understanding about MVD compared to a lot of her arrogant male counterparts.

    I updated the Duke doc when I got home and told him that Duke had much to learn about women’s heart disease and since we were half the population, they should take the time to get on board and learn to take women much more seriously if indeed they truly wanted to treat us!

    Lois Bouchard

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    1. Thank goodness you found that wonderful Dr. Metha (and also another cardiologist at UNC). I hope that Dr. Metha also sent copies of her appointment records to that Duke doc! Best of luck to you, Lois!

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  5. Frustrating read. My CADASIL is a hereditary stroke disorder – genetic microbleed, small vessel disease, genetic disease and causes heart disease without any other factors (no high blood pressure, elevated cholesterol, diabetes). It is due to autonomic nervous system dysfunction which interferes with normal heart rhythm. I had the one month monitor which proved palpitations. I have terrible angina. I have made zero progress getting a formal diagnosis.

    I should have a pacemaker, but because I have CADASIL, I am subject to increased cognitive dysfunction during anesthesia and need brain oxygen monitoring. While I understand no doctor likes patients dying on their table, I am willing to take the risk because I am being forced to live with excruciating angina without meds (I am taking medical marijuana) which I can’t control.

    St. Charles in Bend, Oregon is an AHA designated “center of excellence”… but they rejected me. Said they could take a heart biopsy but can’t process the biopsy! How crazy is that… sent my records back. Told me to go to OHSU.

    I did, last year. Their staff would not work with my auditory processing disorder and pushed me into a stroke, then told me I was having a migraine, and offered to put me in the hospital. They knew CADASIL is a stroke disorder! Incompetence! My husband helped me out of there during a full stroke caused by a cerebral infarct, since they would make the stroke hemorrhagic through their malpractice. Then they put lies in my record to cover their malpractice. Illegal!

    Still trying to find a reputable heart center which will accept me. Stanford doc recommended here on this site said she “has nothing to offer” and returned my records.

    Medicare Quality Control is planning to order my records and review. Substandard doctors and facilities receive punishment for taking federal funds for malpractice, and they said they will protect me from retaliation for reporting. I should spend my life trying to make the medical system better for everybody while I am trapped in a painful dilemma.

    Looks like I am facing an excruciating death with steadily increasing debility, and zero hope. Lucky me.

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    1. More than frustrating, Juli. I’m so sorry you are going through all this, and also that the Stanford team wasn’t able to help you. My understanding is that this CADASIL is a very rare condition with few if any proven treatments available, which makes it doubly awful. I really hope you’re able to get support from family or friends through all of this…

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      1. It s now authoritatively estimated that at least 1 in 10 multiple sclerosis patients have CADASIL, that a large percentage of Alzheimer’s and vascular dementias are CADASIL, that a significant percent of bipolars are actually CADASIL (micro bleed infarcts cause emotional lability and emotional incontinence and also pseudo-bulbar palsy which is episodic).

        CADASIL, being genetic dominant, has been found on all continents and is in (one example) the Mormon population, who have very large families.

        The truth is that CADASIL is not nearly as rare as was thought. I have three published med papers which agree it is far more common than can be known, but we are fast gathering through the internet.

        Back to your comment? I feel strongly that refusal to even try to help me with pain and increasing heart-scar constriction is malpractice. St. Charles, OHSU and Stanford are despicable for their behaviors.

        I have been kicked out of medical help – yet I don’t qualify for death with dignity laws, either. I am not accepting this.

        How many readers of your blog also have coronary microvessel disease – due to CADASIL? How many have a family history of heart disease which is due to CADASIL? If they do, but don’t know it, the doctors will treat them, probably harming them in the process.

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  6. This could have been my story, if I had not had a sharp-eyed primary care physician.

    During my heart attack, I never had chest pain, just shortness of breath, tiredness, and a little indigestion. The shortness of breath came on slowly and I had it for weeks before I went to the doctor. I thought it was just a mild resurgence of childhood asthma, brought on by autumn allergies. I also had a stressful job with long hours, and was eating too much fast food. Crazy hours and no time too cook or relax? Who wouldn’t be tired and have a bit of indigestion?

    When it didn’t improve, it finally occurred to me that I should go to the doctor. My EKGs always were normal, even when I was mid-heart attack — thank God my doctor knew to order blood-work, which came back showing that I had elevated levels of troponin. When I went to the doctor, I thought I’d get a prescription for some asthma medication — instead, a few hours later when the lab results came in, I got a call telling me to call 911 and get an ambulance to the ER. I did, and the cath lab found the blockage in the artery. I just had no idea that heart attacks could come on so slowly and gradually. I always thought of heart attacks as sudden and dramatic — all of a sudden you had terrible chest pain and fell to the floor. How was possible that I was up, walking around, working, driving, cleaning, eating — mid heart attack?

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    1. You’ve raised so many good points, Lynn, reminding us that women can have “normal” EKGs and other diagnostic tests results – yes, even in mid-heart attack. And when tests are “normal”, doctors are quick to move on to some other non-cardiac possibility. I too always pictured that classic Hollywood Heart Attack as you describe – so how could I possibly be having a heart attack because, like you, I could walk and talk and work and drive – and even fly to Ottawa for my mother’s 80th birthday weekend celebrations!? There have been some interesting studies on what researchers call “slow-onset” heart attack – far more accurate in describing the heart attacks you and I experienced. Hope you’re doing well now…

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  7. Unfortunately, we are looked at differently. And I have always been the odd ball patient with strange symptons. I was always told you’re fine, acid reflux, stress. I have had a triple bypass now and my doc who I trust with my life still tells me “I don’t want to hear about anything but an elephant sitting on your chest”. Well, I have never had that and like I said I had a triple by pass two years ago.

    So what do we do? We just are all diferent.

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    1. Sandy, it’s lucky for you that somebody took your own oddball symptoms seriously! I’ve met women heart attack survivors whose only cardiac symptoms were so “odd” that few doctors would have suspected heart attack unless diagnostic tests had been ordered (and if these tests had caught the cardiac problem, which doesn’t always happen with diagnostic tests that have been researched, designed and developed for (white, middle-aged) me for decades. But as I now like to tell my women’s heart health presentation audiences, the bottom line is: you know your body! You KNOW when something is just not right! It’s why women must keep going back to seek appropriate help.

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  8. Wow, this is an amazing story. I’m kind of wondering why the blood tests for troponin levels are not just routine when someone (anyone!) presents with chest pain. Especially if that level can accurately determine that it’s a cardiac problem. I also wonder if that cardiologist that was so brusque and obviously doing a bad job with Kathleen was ever reprimanded in some way. He is in the wrong profession if he can’t treat each patient with good thorough care!

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    1. You’re right, Meghan – immediate blood tests are the correct protocol for every ER patient presenting with suspected cardiac symptoms! We don’t know if the ER doc who failed to order appropriate blood tests for Kathleen (he was the ER physician, not the cardiologist) was ever reprimanded for not following current guidelines.

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