When the Emergency Department physician misdiagnosed my “widow maker” heart attack as acid reflux, I actually felt relieved at first. I’d much rather have indigestion than heart disease, thank you very much. His confident misdiagnosis meant I was temporarily willing to ignore the obvious cardiac symptoms that had propelled me to Emergency that morning: central chest pain, nausea, sweating and pain down my left arm.
Even I knew that arm pain is NOT a symptom of acid reflux, yet somehow that first plausible answer seemed preferable to the far more serious real answer I would receive much later. . .
Helen Akinc, a Heart Sisters blog reader in Winston Salem, North Carolina, contacted me recently about a similar experience she’d had – which turns out to be remarkably common among female heart patients: the tendency to accept the first plausible explanation for symptoms – even when it’s quite wrong.
Her own story illustrates this so well: (NOTE: for definitions* of some of the cardiology terms Helen uses, scroll down to the bottom of this page):
“For months – yes, months! – I have noticed that my left arm and shoulder started hurting about 30 minutes into my bike ride (or my rowing workout).
“My immediate reaction was ‘I must be holding the handlebars too tightly with my left hand’ – and same thing for the rowing machine.
“Imagine my surprise when I took a walk in my hilly neighborhood and the same symptoms happened.
“So then I recognized those symptoms as probably being cardiac – and yes, now I have been diagnosed with coronary microvascular disease. (which had been suspected before).
“I know you’ve written about referred pain in women’s heart disease (arm, shoulder, neck, back, throat or jaw), so I knew the cardiac connection – but since handlebar gripping was easy and plausible, I went with that cause.”
“I kind of wondered why I was always exhausted for several hours after each episode – but now I know. I think some of us may have a built-in proclivity to go with the easiest and most convenient explanation.”
What Helen was describing is called minimizing, which is a predictable response whenever we try to ignore puzzling symptoms:
- if we are afraid to take them seriously
- if we hope they might just go away
- if we don’t recognize them as being heart-related
Women’s cardiac symptoms can also come and go during longer periods of feeling “normal” between symptomatic episodes – just as Helen experienced when she wasn’t biking or rowing.
If symptoms do go away, then everything seems “fine”. If they return, we just wait for them to go away again. And sometimes women report “slow onset” cardiac events (instead of the dramatically misleading chest-clutching-falling-down-unconscious scenario we see pictured in the media). But these scenarios can be very dangerous because we tend to delay seeking appropriate treatment.
But unlike women who may try to talk themselves out of a cardiac possibility when puzzling new symptoms strike, Helen actually had good reason to suspect heart disease FIRST instead of last: she was already a heart patient.
Back in her 20s, she’d been diagnosed with high blood pressure during her pregnancy (and we now know that women who experience hypertensive complications in pregnancy are at 2-3 times greater risk of developing heart disease than women who don’t have a history of pregnancy complications).
Helen did develop a serious heart rhythm disorder that was treated with a cardiac ablation* procedure. This provided her some relief for about nine months; she then underwent a second ablation. But something went terribly wrong, as Helen explained:
“During the ablation, my heart was punctured, resulting in acute cardiac tamponade*, two cardiac arrests, and emergency open heart surgery to repair the tear. That surgery took place on a Wednesday and on Friday midday I came home.“
“I could lose my job for telling you this, but that is not normal. You need to see a cardiologist. I’ve worked in the ER, that’s not normal, get it checked out.”
“I thanked her for alerting me, and told her what had happened. But had she not taken a chance and told me, I don’t know where I’d be at this point.”
“In many ways, I’m a very typical woman heart patient, because nothing has been straightforward..“But my cardiac history now makes people pay attention. And I pay attention, too, and I ask lots of questions. What’s most fortunate is that I have a really good cardiologist who listens and pays attention, too. He is much more receptive to my ideas and questions than many doctors that I’ve seen.”
- * Cardiac Ablation: A procedure performed by an Electrophysiologist (EP), a cardiologist with specialized training in treating heart rhythm problems. It typically uses catheters — long, flexible tubes inserted through an artery and threaded up to the heart — to correct structural problems in the heart that are causing an arrhythmia (heart rhythm problem). Cardiac ablation works by scarring the tissue in your heart that is triggering an abnormal heart rhythm.
- * PVC – Premature Ventricular Contraction: An early or extra heartbeat that happens when the heart’s lower chambers (the ventricles) contract too soon, out of sequence with the normal heartbeat.
- * Cardiac Tamponade: Extreme pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle (myocardium) and the outer covering sac of the heart (pericardium).
- * Angina: A condition marked by distressing symptoms anywhere between nose and navel that come on with exertion and go away with rest, caused by inadequate blood supply to the heart muscle.
- For more medical definitions, visit Carolyn’s Patient-Friendly Jargon-Free Glossary of cardiology abbreviations, acronyms and weird confusing terms.
Q: Have you ever had an experience like Helen’s in which you believed a less scary option before your final correct diagnosis?
Image: Rudy & Peter Skitterians, Pixabay
NOTE from CAROLYN: The entire patient-friendly, jargon-free cardiology glossary (all 8,000+ words!) is also part of my book “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press, 2017). You can ask for it at your local library or favourite 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 20% off the list price).