4. SCAD Heart Attacks - WTF just happened to me?

Published 1st August 2021

So the troponin blood tests proved that I’d had “1 if not 2” heart attacks.
The angiogram proved they were caused by a tear in 1 of my heart arteries.
It also showed that I did NOT have ‘furry’ arteries - always good to hear!
Then, to everyone’s surprise, I was discharged at 21:30 on the day of the angiogram, with only a bag of medication that included:

• Ramipril - to lower blood pressure

• Clopidogrel - an anti-platelet med, i.e. reduces developement of blood clots

• Asprin - another ‘anti-blood clotting’ medication

What the Hell Just Happened?

Whatdaya mean “you’ve had a heart attack?”

And forgive me but, how can I possibly have a “beautiful healthy heart” AND have a random and spontaneous heart attack
(or 2)?

Me being me, I needed answers but first recovery.
The post heart attack exhaustion was debilitating but as I began to recover I could tell that the meds were not helping.
If one does not have high blood pressure, taking medication to lower it results in too low blood pressure.
Cameron had to support me whilst I did some leg curls to pump the blood around -especially in the mornings.

In the discharge letter it does state that although I have been prescribed the above, the “dual antiplatelet therapy for 3 months, can actually be discontinued as there is no evidence of benefit from this strategy”.
So then the patient is confused! What do you want me to do?
6 weeks later, in desperation to reduce the severe dizziness and lightheaded-ness, I phoned cardiology. A few days later, I received a letter saying that I could stop the Ramipril- and I began to feel more ‘normal’ .

“You were under my care when you were, although we did not meet each other”
Prof. Neal Uren
(Cardiologist)

I find it fascinating whilst also disconcerting that medical advice is given to a patient
that the clinician has never even met.
That’s how data driven the medical profession is.
Be aware of this fact.

(and it’s not my typo btw, I assume they meant, ‘when you were in/in hospital/admitted’

So am I off the drugs because I’m a healthy individual?
Or because of the type of heart attack, this SCAD thing?

So Cameron and I begin googling SCAD. Once we got past the results for Savannah College of Art and Design… we came across a charity website Beat SCAD
An excellent resource that explained what Spontaneous Coronary Artery Dissection actually was.
What I found interesting was that:

So.
Average age around 50….?…. and most of us are female?…. and what happens to women around this age then?
It’s not rocket science really is it?
Perimenopause or menopause.
Average age of menopause for a white UK female is currently 51 - which is classed as 1 year after her last period.
Perimenopause is the time running up to that ‘1 year after last period’ date and can take 4-10 years.

Also, SCAD used to be thought of as a condition only of pregnancy - P-SCAD. My theory is that it’s easier to ‘pick up’ that something is wrong during pregnancy as women in the UK are monitored regularly during and just after pregnancy.
Whilst the rest of us will only be seen by the medical profession should we choose to go.

So the above was very interesting.

I was 1 month off 51, at the time of SCAD and most definitely perimenopausal.
I know!
As if!
No way!
Surely not! 
Really?!
(FYI, yes, flattery will get you everywhere)

Ariel bodywork - it felt amazing!

For the past 12 months, I had been experiencing severe ‘heats’ and sleeping through the night was a thing of the past.
I say ‘heats’ not ‘flushes’ as the word ‘flushes’ suggests sweating. I had stopped sweating completely, even whilst exercising.
It was also 2020, Covid times, and, as a massage therapist in Scotland, I was not allowed to work for the majority of those times.
The positive?‍ ‍
I was entitled to full financial Government support and was having my 1st ‘allowable’ downtime in nearly 30 years.
My cat was loving having me around and I was enjoying being in a new happy, healthy relationship with a wonderful man.
I was coping with the heats and sleep deprivation.
The negative?
Around July/August 2020, I was allowed back to work but…
It was definitely very stress- inducing dealing with the inordinate amount of work that that was now involved in the private healthcare sector, due to Scottish Covid regulations -I won’t bore you here but washing the walls and the bathroom after every single patient, to name but a few, gives you an indication.

Plus, the psychological impact of switching from STAY 2M AWAY FROM EVERYONE
to
“Welcome patient!  It is a total pleasure to be in your personal space, for nearly an hour”, was a tad discombobulating.
My heats became more frequent, more noticeable, but still manageable and I put the increase in their frequency down to the challenging work environment that I now found myself in.

Then, my menopausal symptoms became much worse.

From January 2021, going to bed at night was a nightmare. Sleep was illusive, a fleeting concept that my brain only toyed with.
I knew there’d been a big change in my sleeping habits when the cat stopped sleeping on the bed. Previously, Smudge and I would remain in the same position ALL night. 

But, after a month or so of coping with me flinging the bedding about, tossing and turning, constantly getting in and out of bed, she'd given up - she didn't need to put up with this nonsense, and she toddled off to find a more peaceful place to kip. She was not happy.

I felt quite sad that Smudge and I weren’t sleep buddies anymore.

I also had to begin to use cool pads on my pillows, every night all night.

The relief of laying my boiling hot head on the ice cool pad was heavenly!  A fan had been set up beside my bed too. 
God… have I reached that stage….. how awful do I feel now? How old am I?
This. Is. Hell.

On top of the sleep issue, I was having headaches nearly every day.  'Cos 'Hell' was just not 'hellish' enough....
It became easier to note in my journal the days that I did NOT have any head pain.  
They varied in intensity.
Sometimes merely a dull, numbing ache, other days, a really impressive head pain, and sometimes debilitating migraine pain that occasionally Paramol and sleep might take the edge off.

This was a marked difference to my ‘normal’ patterns.
In the past, I'd have migraine, maybes twice a year, and I’d know what had triggered it. 
Not anymore.  Nothing would shift them completely.  I mean Kerrist... NOTHING could make me sleep, nor reduce the head pain. I just had to wait it out.

And the other 'Life Destroying' symptom? 
The heats…

They become much, much worse..... 

They were violent and extreme, appearing at any time of the day or night, not governed by what I had eaten or how I was feeling emotionally.   
They would take over my body, regardless of whether I was busy running around, exercising or just sitting watching the TV. 
(If anyone DARES to suggests that they are worse if the woman gets anxious about them, I will quite possibly do that person physical harm…..)

My head starts to ‘buzz’, to vibrate at a very low, gentle frequency.
My breathing becomes shallow and laboured.  
I have to breathe through my mouth.  
My whole body feels as if it would be happier running and preferably a marathon, but I can’t even walk.
The dizziness appears. 
It feels like my brain has somehow begun to float within my head. 
I can’t decide whether I am going to topple over to the side, faint, throw up or just pass out on the spot.  
My stomach churns as an internal fire ignites within my brain. 
Suddenly, my brain is made of molten lava, expanding within the cranium, pressure building.
There is an overwhelming desire for my chest, upper back, neck, face and head to sweat, but it doesn’t come. The heat, and the pressure inside my head, is intense.  I want to open up my head and let it out – like steam billowing out from an old steam train’s funnel.
The rest of me is a normal temperature… and my feet are freezing.

From the chest up, I. Am. On. Fire.

Remember I said that I had stopped sweating? I just got hotter and hotter. And hotter? Cameron would say, “your face is beetroot – you’re going to explode”

5-10 minutes later it’s over. I’m exhausted. But my breathing is back to normal, I no longer feel like I’m going to pass out and the temperature of my upper body (from the chest up) is reducing.

I’m not sure I could’ve coped without my man

My menopausal symptoms disappeared after the heart attacks!

From the night of the SCAD heart attack, THAT NIGHT, I had NO HEATS whatsoever. 
Now, THAT'S weird isn’t it?  How random is that?!
My sleep was better, actually it was amazing!
AND my headaches drastically improved.
Result!

As my man had unwittingly said, I looked like I was “gonna blow” when I had a heat. 
And something did blow.
A wall of one of my coronary arteries, leading to a SCAD heart attack - Spontaneous Coronary Artery Dissection. 

But are the 2 facts related?

OK, so it’s maybe a rather extreme way of reducing one’s menopausal symptoms, but hell, who cares?! They'ld gone!
* Jilly does her happy dance* "Life can get back to normal… can’t it?

Immediately after the heart attacks, I had no need for the cold packs, we put the fan back up in the loft and the packs in a cupboard.

It felt like the pressure that the heats had produced, was just too much for my heart.  As if it just could not cope with the ‘violence’ of my heats but once the pressure had been released, life became much more manageable again.

Or…. maybe the heats were so extreme because I had a compromised heart???

Who knows!  Who cares?!

And, according to the data in 2021, 90% of SCAD patients will not have a recurrence within 3.1 years. Cool! That's my new mantra, "90% don't have another in 3 years, 90% don't have another in 3 years,"‍ ‍
Not the most 'catchy' mantra I've ever used...

Summary

• Nobody knows why it happened or how

• As of 2021, the research seems to suggest a possible sex hormone link to SCAD

• 90% of SCAD patients are female

• For me, the hormonal link was definite but I needed to review my symptom diary.

• Patients will receive medication advice from clinicians that have never met them

• 90% of SCAD patients don’t seem have another within 3.1 years.

• I’d been told I had a beautiful, healthy heart - always good to hear.

• If I haven’t done anything ‘wrong’ to bring the condition on, then I can’t do anything ‘more right’ to make sure that it doesn’t happen again.

I was recovering well, all was good I couldn’t change anything, so let’s just crack on yes? T’was a random blip?

Sadly not. Everything came back and with a vengeance a few months later.

Coronary Heart Disease (CHD) kills more than twice as many women as Breast Cancer in the UK every year,
and is the single biggest killer of women worldwide.

Despite this, it’s often considered a man’s disease.
The British Heart Foundation, Women & Heart Attacks.

SCAD is when a tear or bruise develops in a coronary artery that prevents normal blood flow.
This can cause: a heart attack, heart failure, cardiac arrest
and can be fatal.
Current data indicates:
90% of patients are female with an average age of 44-53,
– many of whom have no or few heart disease risk factors.
ECGs and O2 levels may be normal.
Assess troponin levels, repeating 4 hours later.
(NB. Trop levels may be clinically insignificant)
For information:
https://beatscad.org.uk/what-is-scad/
https://academic.oup.com/eurheartj/article/39/36/3353/4885368