iRhythm "success"

On Thanksgiving 2010, I felt like I was "off" all day.  One of our cats woke me up at 5:30AM.  I have been exhausted over the last few months anyway.  

I hadn't previously shared this via the Internet, but I am pregnant for the first time.  I have only been this exhausted once before:  prior to the myocardial infarction (M.I.) I survived in 2008.  Nausea is also a common theme during this pregnancy.  My nutrition has been non-existent since becoming pregnant (I could tell early on that I was pregnant).  Excitement has carried me through the last few months of pregnancy.  I've done my best to block out the 'what if' ideas and instead think positively about having a healthy baby.  

Back to Thanksgiving.  Preparation in the kitchen kept me busy until about 10AM when I decided to take a nap.  The smell of food cooking woke me up a couple of times, but I fell back asleep unable to get up.  A little before 2PM, I made myself get up even though I still felt tired (I needed to help with the cooking, but it was already all done, hooray!).  After showering and dressing, I tried to set the table, but felt like I was about to faint in addition to palpitations.  My pulse was rapid compared to the usual rate.  I decided to use an electronic blood pressure/heart rate device.  My pulse was on average at 100 which is a high rate for me.  My shoulder blades were also extremely painful (another symptom during the M.I. I had).  Unfortunately I had walked our wild dog the day before and wasn't sure if that was the cause.  When we sat down for dinner at 3PM, I had no appetite.  After dinner, I "retired" to my recliner.  I finally asked my husband to call the on-call cardiologist because I eerily felt similar to the day(s) leading up to my M.I. (heart attack).  Soon I spoke with the on-call cardiologist who told me to record and transmit anything I felt via the iRhythm medical device and assured me that Zio Event Card/IRhythm would contact the cardiologist should something be received that needed immediate attention.  Needless to say, I later found myself at the local emergency room.

Arrival at the ER was a result of using the iRhythm.  I recorded an event later in the evening around 8pm while watching football.  The cause for the recording occurred when I felt a dull, repetitive pain below my left breast.  About an hour later, I phoned iRhythm and transmitted the recording.  I know, I shouldn't have waited.  Unlike previous transmissions, the representative asked me to record another event while they remained on the phone and then transmit the event.  After doing so, I asked why I was instructed to complete the task and was told that the event (that I recorded while watching football an hour earlier) met the criteria to notify the on-call cardiologist.  After waiting about 20 minutes, I called iRhythm back and asked if they had contacted the on-call cardiologist.  The representative stated that they were in the process and that if I wasn't contacted, that would mean the on-call cardiologist deemed the event not an emergency.  Thankful for the fact that I was wearing the Zio Event Card/iRhythm, I asked if it was okay for me to call back if I didn't hear from the on-call cardiologist.  I found it hard to believe that given the fact I had already spoken with the on-call cardiologist, that I wouldn't be contacted.  The representative stated I was welcome to call back.  Fortunately I received a call from the on-call cardiologist about 10-15 minutes later.  I was told that it was a good idea for me to go to the hospital and that the doctor would call ahead of my arrival.  


More on that later.  I'm tired and my husband just handed me a homemade piece of apple pie!  I'm very thankful for every day I have and need to go spend time with the ones I love.

Medtronic Failure

I feel I would not be a responsible patient if I did not comment regarding the recent failure(s) by Medtronic and the spinal cord stimulator I received in 2008. My spinal cord implant had been an overall happy story until a few weeks ago (less the physician form the get go). I should have listened to my instincts and at least switched to a new physician (I almost cancelled the surgery the day of, even after already receiving the I.V. I began having problems with the medical device (it had protruded); giving me the worst stinging/burning sensation at the implantation site. My 'pain specialist' doctor and Medtronic have not been helpful - they have been the complete opposite. It's as though they consider me an enemy and could care less now that the Medtronic implant is in (though failing). In addition to the shifting of the device, the battery has failed. It hasn't even been two years. I cannot impress upon others considering this life changing event to thoroughly research before going through with the surgery. I was utterly desperate after living with chronic pain for years - I would have done it differently had I known what I am experiencing now. I also had a blood clot form in my heart within three months of my surgery, thus suffering a myocardial infarction, of which I am lucky to be alive.  I am hopeful that my situation stems from an irresponsible physician and Medtronic representative. I truly hope that all who have the devices already implanted have continued success.

Retrospect: I am a Heart Attack Survivor

If you follow the news closely, and by closely I mean in a timely manner, you are aware of former President Bill Clinton's stent procedure that took place following "chest discomfort" today.  I can't help but feel heart-sick.

After reading my own post titled, 'It Hurts and It Hurts', I feel I haven't followed my own advice.  Had someone told me they were feeling the way I described in my post, I would have urged them to seek medical care.  Of course, I considered going to the hospital.  So, what held me back?  My $100 co-pay for the emergency room and the fact that the emergency room doctors never do anything.  It is a vicious cycle. Unless you are literally on your death bed (and they are able to determine so), the emergency room doctors seldom are proactive for patients.  I know I sound ungrateful.  I'm not ungrateful, however, this is my experience in the emergency room, time after time.  

When I had my heart attack, one of the responding Emergency Medical Technician's (EMT) tried to persuade me that I was fine and probably just overworked (I told the EMT I had been at the gym prior to calling 911).  Add that knowledge to the fact that I was overweight and only in my early thirties and it's plausible that the EMT felt I was someone older (in his opinion!), who was out of shape and had overexerted herself at the gym. I told the EMT (along with the 911 operator) that I felt I was having a heart attack.  

When I arrived at the emergency room by ambulance at the local hospital I was left on the gurney in the hallway.  The pain in my shoulder blades (a heart attack symptom in females) increased and I began yelling at any personnel who passed by, that I needed help and thought I was having a heart attack.  They looked at me like I was crazy.  I kept yelling (truly, this only went on for a few minutes, but situations like that feel like hours).  I was not about to be quiet.  They moved me into a room where they tried to calm me.  Finally they hooked me up to an electrocardiogram (EKG).  I kept asking if I was having a heart attack.  Suddenly the small room filled with people.  A man walked in, dressed in golfing attire (it was a Saturday afternoon).  When I saw him I immediately knew I was having a heart attack.  He took my hand and confirmed that I was having a heart attack; he was the cardiologist who saved my life and I will forever be thankful for him.  

I have never had any ill feelings towards the medical personnel who originally lacked reaction when I said I thought I was having a heart attack.  Heart attack in women is consistently misdiagnosed.  It is the numero uno killer of women.  Number 1!  Both medical personnel and we as patients have to be diligent about heart disease education; knowing the symptoms and better diagnosis on the part of medical professionals, to change the way that heart attack is overlooked in women.  I am a heart attack survivor, and it needs to remain that way, as it does with other women.
  
February is American Heart Month.  Please familiarize yourself with the differences between male and female warning signs of stroke and heart attack.  Second, make lifestyle changes if you haven't already done so.  Lastly, find out as much as you can about your family medical history:  there should be no question so uncomfortable as compared to saying goodbye too early to a loved one.

Are Heart Attacks More Deadly for Women?

Age or Illness May Cause the Gender Gap in Heart Attack Survival Rates, Study Shows

By LAUREN COX and COURTNEY HUTCHINSON

ABC News Medical Unit

Aug. 26, 2009—

Doctors have long known that women are nearly twice as likely as men to die in the first month after a heart attack. But a new study published in the Journal of the American Medical Association looked behind this statistic to discover that gender may not directly influence survival outcomes after a heart attack heart attack outcomes.

Theresa Volpe, 40, barely survived a massive heart attack two years ago. She said despite ongoing symptoms of dizziness and fatigue, when her chest pains struck, many people thought she had indigestion.

"I was so dizzy and light headed -- my arms felt heavy and weighed down," said Volpe. "The paramedics came and looked me over and said, well your heart rate is not so high maybe it's just anxiety."

But once a cardiologist saw her, she was immediately airlifted to a specialist center where it was discovered one of Volpe's major arteries was 90 percent blocked by plaque.

"I was lucky because a lot of women don't survive a heart attack," said Volpe, who is now a spokeswoman for the Go Red for Women campaign of the American Heart Association.

Investigating Why Women and Men's Heart Attacks Differ

To discover more about the difference in heart attack survival rates between the sexes, Dr. Jeffrey Berger and his colleagues at the New York University School of Medicine analyzed the medical records of more than 130,000 heart attack patients (72 percent men and 28 percent women) that were part of 11 international studies between 1993 and 2006.

Among all the studies, women died at a 9.6 percent rate compared with a 5.3 percent rate for men in the first month after a heart attack. Yet the study pointed out key differences between men and women in these statistics.

Women were having heart attacks at an older age than the men. Women were also more likely to have diabetes, high blood pressure and heart failure while men were more likely to smoke, to have had a previous heart attack and have a previous bypass surgery.

Once the researchers compared men and women of the same age and health status, then the gender difference in survival rate disappeared.

How Gender May Not Matter in Heart Attack Survival

"[In our study] you see that women have almost a twofold increase risk for death after 30 days, which was found before, but the beauty of our study is we're able to look at reasons why this is," said Berger. "If you account for age, clinical risk factors that differ like hypertension, high cholesterol and numbers of arteries are blocked, there is not a difference."

"It's not being a man or woman that puts you at higher risk, it's these other factors," said Berger. Rather than focus on treating men and differently, Berger hoped doctors would start looking at treating older heart attack victims with specific health complications differently than other heart attack victims.

Indeed, Berger's study led some cardiologists to wonder if some of the differences between men and women in heart disease have been overblown.

Gender Differences in Heart Attacks

"The so-called 'gender differences' in heart disease have been hyped to a large extent," said Dr. Steven Nissen, director of the Joseph J. Jacobs Center for Thrombosis and Vascular Biology at the Cleveland Clinic Foundation in Cleveland, Ohio.

"The primary conclusion of this study is that there is not a higher mortality in women than men following a heart attack (when adjusted for severity of disease and co-morbidities)," said Nissen. "Accordingly, the study does not suggest a different strategy in women with heart attack. It appears that 'what is good for the goose is also good for the gander.'"

Yet other doctors point out that the study couldn't explain why women had their heart attacks at an older age, and in worse health in the first place. Moreover, doctors wondered whether there are still important differences to note about men and women leading up to the heart attack, if not in the 30 days that follow.

"This study tells us that even in this era of highly sophisticated diagnostic and treatment modalities for heart attack that women's heart disease is different from that seen in men and that women still fare worse," said Dr. Malissa Wood, of the cardiac unit of Massachusetts General Hospital in Boston.

Sex Differences in Heart Attack Symptoms Still Exist

"I believe that the big differences start before the heart attack ever happens," said Wood. "Once a woman presents with a heart attack and is of advanced age with diabetes and high blood pressure and their associated complications (blood vessel disease, kidney disease) the horse is out of the barn."

Volpe was only 38 when she had a heart attack. Despite her young age, she experienced some of the worst troubles that seem to affect women who have heart disease. First nobody could recognize her symptoms, and then nobody believed it when she had a heart attack.

"I was very tired, I was very fatigued. I was so tired I thought I was pregnant," said Volpe.

Volpe also occasionally went into dizzy spells, she got out of breath and she would experience chest pain. Her primary care doctor performed some tests -- an EKG and an echocardiography -- but when those came up normal Volpe's doctor suggested anti-anxiety medication.

"She had thought that I was suffering from a generalized anxiety disorder -- I was thinking the only thing that I'm anxious about is that I'm having chest pains," said Volpe.

Another round of tests at a gastrointestinal specialist couldn't explain her chest pains, so Volpe tried to relax with the occasional chest pain.

Then, on March 31, 2007 at a family birthday party she had a heart attack.

"At the ER, the cardiologist said we need to get to her out of here, she's having a massive heart attack and my husband said 'are you kidding,'" said Volpe.

Volpe now lives with four stents and must take a variety of medications for life.

"I wish I had the guts to say I want to see a cardiologist earlier," said Volpe, a mother of two school-age children. "Being so young, I was afraid to say I'd like to see a cardiologist."

More, Volpe wishes she had taken better care of herself.

"That's the huge thing. I really wish that I had taken better care of myself. You always think you have time. I don't have to worry about that until I'm older, but you're back pedaling," she said. "Every time I get on the treadmill I think I don't feel like it but this is what I have to do."

Copyright © 2009 ABC News Internet Ventures

Watch Your "Own" Heart Attack

I came across a public service announcement (PSA) on You Tube about a year ago.  I believe it's from the  United Kingdom.  It reminds me of the PSA about drugs where the egg is frying in the pan ("...this is your brain on drugs").  


Okay, back to the dramatization at hand; it answers the question that people ask, 'What did it feel like?'.  If you want to know, watch this video.  My main symptoms were different:  I did not have any chest pain.  I had tightness and pain in my shoulder blades/upper back.  This is a symptom usually associated with female heart attack patients.  


The day I went to the emergency room I used the search engine Google to look up the words 'heart attack symptoms' because I knew something wasn't right within my body.  After that, recalling commercials for aspirin, I found an old bottle in my medicine cabinet.  Just as the commercials suggested, I opened it, and took a dosage.  I decided that it couldn't hurt anything and now that I had read the list of symptoms, if I had any others I would go to the hospital.  Before I knew it I was making the next decision to call 911 for an ambulance.  The actor in the PSA below is correct:  every second counts.  Why take the chance of dying?  Nobody knows your body better than yourself.


The ambulance personnel didn't think anything of it when I told them I thought I was having a heart attack.  When I was taken into the emergency room I was left in a hallway on the gurney from the ambulance.  I didn't remember much of the ride from my home to the hospital, but as I lay there on my back, I still new something was wrong.  I started asking for someone to help me, continuing to state that I thought I was having a heart attack.  A couple of staff looked at me like I was crazy.  I can't blame them, I was only thirty-three.  I wasn't about to stop asking for help though, so I was moved into a room and set up with an EKG monitor.  Within minutes the room was full with personnel; I knew I was correct when I saw a man dressed in golfing attire enter.  He calmly told me that I was having a heart attack.

I encourage everyone to not only watch this clip, but familiarize yourself with the symptoms for heart attack/stroke (differences between male and female).  Likewise, discuss with your primary care physician ways to prevent blood clots, stroke and heart attack.  For example,  a physician might recommend taking a specific dosage of aspirin daily depending on your age and other factors.  


WARNING:  This video may be upsetting for stroke/heart attack survivors and loved one's.  Please only watch if you want to know more about symptoms (otherwise refer to other sources such as the American Heart Association or a physician).