We're all familiar with "The Hollywood Heart Attack" — a man of a certain age clutching his chest or arm, falling to the floor in terrible pain. But for Hilary, whose heart attack happened at age 34, one year after the birth of her first child, the experience was very different.
"Suddenly, I felt this incredible pain in my chest," she told SheKnows. "I tried to sit down and relax and deep breathe, but the pain didn't let up. I broke out into a cold sweat and felt extremely nauseous. I also felt numbness and tingling in my wrists. I was convinced it was a panic attack (which I'd never had before), but my husband convinced me to go to the hospital to get checked out."
On the drive to the hospital Hilary started realizing something could be really wrong. She had been trained in CPR, so her mind kept jumping to the conclusion that it was a heart attack, which she quickly dismissed because of her age.
What Hilary experienced was spontaneous coronary artery dissection. SCAD occurs when a tear forms in a blood vessel in the heart, blocking or slowing down blood flow and resulting in a heart attack. It's a rare condition, happening to women between the ages of 30 and 50 without a prior history or risk factors for heart disease.
"I was extremely surprised," she said. "I'd had no warning signs before the SCAD heart attack. In fact, I'd been to the doctor the day before for an unrelated issue, and they listened to my heart and took my blood pressure and everything was normal."
Because SCAD is so rare, and there are no predicting factors or means of prevention, it's not the first thing doctors think of when healthy young women manifest symptoms — especially because they aren't necessarily the same as what we've come to associate with heart attacks in men. In women, SCAD symptoms include chest pain; pain in the back, arm or jaw; a fluttery feeling in the chest, shortness of breath, extreme tiredness, nausea and dizziness.
If you've ever had a panic attack before, some of these symptoms might sound familiar, but Dr. Suzanne Steinbaum, a cardiologist at Lenox Hill Hospital in New York City, urges women to be aware of what's normal for them.
"Seventy percent of women don't call 911 because they're afraid of being wrong, but if the symptoms are unusual for you, get help," Steinbaum told SheKnows.
In Hilary's case, this meant not dismissing her symptoms and being clear about what was going on for her when she got to the hospital.
"When I arrived in the ER I made the decision to open my mouth and say, 'I think I'm having a heart attack.' That got me treatment immediately," she explained.
The medical community doesn't yet fully understand what causes SCAD, but Steinbaum said it might have to do with hormonal fluctuation, high blood pressure, or autoimmune diseases that affect the blood vessels, which are more predominant in women than in men.
In order to treat SCAD, blood flow to the heart must be restored, which can happen via the placement of a stent, bypass surgery, blood-thinning and blood pressure drugs and cardiac rehabilitation, and of course, the long-term effects of SCAD are different for everyone. Some survivors endure ongoing chest pain, but for Hilary, that hasn't been the case; the physical impact has been small. She tires easily, she says, and her cardiologist has advised that she avoid stress, so she's learning to moderate activity and resist the impulse to "do it all."
"I'm definitely less concerned about what other people think and I don't feel guilty about prioritizing self-care," Hilary said.
In spite of SCAD's unpredictable nature, Steinbaum urges women not to panic.
"We can't live scared, but we can live empowered and educated," she added. "Heart disease is 80 percent preventable, so go get your Well Woman visit and know those numbers — your cholesterol, blood pressure, blood sugar. When you have a handle on these things, you are empowered."