Not Your Average Patient

By Katie Reiser | Photo courtesy Michael Lieurance Photography

Last January as Sara Lieurance, a 38-year-old school nurse and mother of two from La Crosse, left yoga class she had an unusual sensation of muscle fatigue in her arms which she attributed to tricep pushups from a boot camp class. She also noticed a fluttery feeling in her chest. While taking some deep breaths at her car, she tried to get a handle on things. An active and fit person who had just the day before run a 5K race in subzero temperatures, she was typically in tune with her body. After eliminating anxiety as the cause of her symptoms, she recalled a “silly” short video she had shared with the medical response team at her job. In the video, a busy mom suffers a heart attack and asks, “Do I look like the type of person who has a heart attack?”

Lieurance asked herself, “Could I be having a heart attack?”

She went back into her yoga classroom after a feeling of intense restlessness surfaced. She talked to her instructor who suggested she seek medical care and called 911 while Lieurance informed her husband that she was heading to the hospital via ambulance.

Lieurance was having a heart attack caused by spontaneous coronary artery dissection, or SCAD. While rare overall, SCAD heart attacks occur more often in women and may account for a third of heart attacks in women 50 and older, according to the American College of Cardiology. They more often afflict women under age 50 who appear to be fit and healthy, lacking the risk factors for typical heart attacks. Because of this, SCAD heart attacks can be misdiagnosed (or undiagnosed) until it is too late.

SCAD heart attacks share symptoms associated with more common heart attacks such as chest pain, rapid heartbeat, arm, shoulder or jaw pain, shortness of breath, sweating, fatigue and nausea. They tend to have different risk factors, however. According to the Mayo Clinic, people may be at greater risk who have recently given birth, recently participated in intense physical exercise or have suffered a severe emotional stress, such as a sudden death in the family.

Dr. Matthew Wolff, a cardiologist at Madison’s UnityPoint Health-Meriter hospital, says, “When fit-looking young women seek medical attention with vague complaints, a cardiac event like SCAD is not always recognized appropriately and that can result in a delayed diagnosis.” Wolff explained that while most heart attacks are treated with angioplasty or stents to open up clogged blood vessels, restoring blood flow for SCAD patients is more difficult. Because of the rarity of these heart attacks, more research is needed to determine the best treatments and how to prevent recurrences. Currently patients are prescribed adrenaline blocking drugs, blood thinners, baby aspirin and cholesterol lowering drugs.

Lieurance was lucky. At La Crosse’s Gundersen hospital she had the option of taking a “wait and see” approach because her vital signs were relatively normal, but her cardiologist suggested further investigation using imaging equipment to see her arteries. Those tests immediately revealed a blockage which was successfully treated with two stents.

Lieurance was released after just two days in the hospital and only missed a few weeks of work. She credits her intensive cardio rehabilitation program for “getting her back into the swing of things” both physically and emotionally.

Wolff advises that “any form of discomfort above the waist is a matter of potential concern.” He recommends being “aggressive in advocating for yourself” if you feel that something isn’t right and your concerns are dismissed.

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