Corsicana Daily Sun, Corsicana, Texas

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January 31, 2013

‘Walking Miracle’: Ignoring warning signs of heart trouble foolish

Fridays in February, we celebrate American Heart Month: Friday, Go Red for Women Day

Corsicana — Publisher’s Note: The Daily Sun will spotlight American Heart Month on Fridays in February. We kick it off today, the American Heart Association’s Go Red for Women Day, with a personal story, the one of my wife, Tanya, and a first-person account of her recent heart attack, open heart surgery and recovery.

You just never see something like this coming. How can someone so healthy, someone who works out regularly and someone so young have a heart attack?

The signs developed quickly.

“I felt like something might be wrong, but I didn’t want something to be wrong,” said Tanya Linex, a first-grade teacher at Mildred. “I made believe it was something else, something not so bad, like indigestion.”

Within a seven-day period, “indigestion” turned into a heart attack, and life as we knew it changed. On Dec. 18, Tanya — my wife of 21 years and only 40 years old, had open heart surgery at Baylor Hospital in Dallas, about 12 hours after a third episode of severe chest pains and extreme sweating.

After the first episode on Dec. 11, which lasted about 10 minutes, we wrote it off as simple indigestion. The second episode, on Dec. 15, was a little more severe, and a lot more alarming. Tanya, home alone at the time, later took to the Internet to research her symptoms.

“That’s when I really started thinking something was wrong,” she said. “If it was indigestion, I wouldn’t be sweating. That was a big sign it was a heart attack.”

But again, she overcame it, and had a typical Saturday. Without a primary physician anymore, we discussed finding a doctor that night. We’d do it Monday, we told each other. But we didn’t, and it was almost too late.

Monday night, the third episode came on with a fury.

Tanya never went into full cardiac arrest, but she did go through a time of being unresponsive before paramedics and our neighbor, Dallas paramedic and firefighter Shane Farmer, arrived to assist. To say it was a scary time would be underselling what goes through your mind. I remember telling her, “You’re too young for this. Hang on, baby.”

“I don’t remember the third time, other than saying it’s happening again,” she said. “I don’t remember the pain. I do think I checked out for a little bit. I don’t remember anything until Shane walked in the door.”

By the time Corsicana medics arrived, Tanya was coming to, still very pale, still sweating, but talking. Initially, she refused to go to the hospital. But once in the ambulance, and after an EKG, PHi’s air ambulance was summoned. Tanya was having a heart attack.

Before liftoff, she seemed to be fine. Her color was back. She was alert. It’s amazing what a baby aspirin and fluids can do.

At Baylor’s emergency room, Tanya joked with the nurses. Said her pain was at “zero” on a scale of zero to 10. She answered all of the questions on her own.

Hours later, Dr. Jeffrey Schussler, a cardiologist, found a tear in her main artery through a coronary angiogram. The young mother of three was destined for open heart surgery. The news, coming at 1 a.m., stunned me.

Not her.

“Once I got in the ambulance, I wasn’t scared. I think that’s because so many people had begun to pray, and God had given me peace,” she said. “When they told me I was having open heart surgery, I think I already had it in my mind that might happen.”

Tanya had been diagnosed with a rare, sometimes fatal condition called “Spontaneous Coronary Artery Dissection,” or SCAD. The inner-lining of her main artery had torn, and peeled, and was restricting blood flow, which led to the heart attack. Her left artery was also affected, but her right artery was fine.

One of the first things we read in the hospital after she left ICU was much of what was known about SCAD came from autopsies. That’s no longer true.

“I can assure you we’ve learned a lot more from our live patients now,” said Dr. Marysia Tweet, a cardiology fellow at the Mayo Clinic in Rochester, Minn.

Tweet works closely with Dr. Sharonne Hayes at the Mayo Clinic, forming the country’s foremost body of researchers of SCAD.

“Things are changing,” Tweet said. “We’ve learned a lot the last two years.”

After the early-morning diagnosis, doctors performed a double bypass on Tanya. Her surgeon, Dr. Themistokles Chamogeorgakis, had never seen a SCAD case before. He had operated on dissections of the larger aortic valve, but never a coronary artery.

 “It’s a more delicate surgery,” Chamogeorgakis said.

The tear was also worse than expected, likely progressing through the morning after her arrival, Chamogeorgakis said. He called the surgery a technical challenge. In a sense, the arteries have layers, and blood flow can get between the torn layer and the next level, creating a “false lumen,” or channel for the blood to flow through. Chamogeorgakis said he had to sort out the false lumens from the actual channels, then make sure he reconnected them properly.

“If you graft in the false lumens, the heart won’t beat,” he said.

There is always pressure with these types of surgeries, Chamogeorgakis said.

“When you’re dealing with a young patient, a family, children, a husband and wife, it’s a different situation,” he said. “You’re responsible for what happens. ...

“You carry on the happy memories, and the bad memories.”

When she finally came to, more than 24 hours after saying good-bye before being wheeled in, Tanya looked at me, whispered “I’m alive,” and smiled.

Tanya’s a happy memory.

Neither Chamogeorgakis nor Schussler had an explanation or a cause for this to have happened to Tanya. She fits most of the SCAD profiles, though: 80 percent of patients are female, 30 to 50 years of age, physically fit, and often a participant in intense workouts. Tanya and a few fellow teachers had been doing the “Insanity” workout for about a month.

“We saw a good number (of patients) who were doing extreme exercises,” Tweet said of Mayo’s research. “And a lot of them were in a setting of extreme stress.”

It’s still too early to say if the exercise was an actual cause in Tanya’s case. As Schussler told us in the hospital, millions of people do workouts similar to the “Insanity” program and don’t suffer from SCAD.

There is a SCAD profile Tanya did not fit: 30 percent of the female patients were either in their last month of pregnancy, or had recently delivered.

“She is a remarkable case,” said Schussler, who is now Tanya’s cardiologist.

He compared looking for a dissection in a patient like Tanya to looking for zebras. “You’re not going to see any,” he said. “I’ve seen coronary dissections in drug abusers and I have seen it in pregnant women, but I’ve not seen it in a patient like this.”

The fact she refused to believe she was having heart issues is not unusual, Schussler said. People who don’t fit the profile for heart trouble often reason it away.

“It’s not just patients, it’s physicians too,” Schussler said. “If a young woman comes in with chest pains, the vast majority of the time it’s not a heart problem.”

Still, doctors often start with an evaluation of the heart, he said, and rule out potentially life-threatening issues before moving on.

In the days and weeks after her surgery, the realization existed that Tanya would eventually be close to “normal” again physically. There are still times of soreness, still times of fatigue, but she gets stronger every day. Her direct cardiac rehabilitation ended Thursday after only three weeks. Doctors and therapists have advised her not to do high-intensity workouts again, however.

There are emotional battles.

“Some of the emotional part is when you’re 40 years old you don’t want limitations. You don’t expect to have them,” she said. “It’s sad when someone tells you that you can’t do something like (high-intensity workouts). If I wake up, and I want to do that, I can’t now.”

Going back to work helped. Visits from friends, both in the hospital and in the early days back at home, and since, have helped. She’s getting out more, trying to become as normal socially as she is physically.

It’s a slow process, but at least she’s here ... going through the process.

Occasionally, Tanya asks a lot of questions, perhaps to no one other than God. Why? Why me? Why I am still here? What am I supposed to do as a survivor?

“On the good days, I realize how blessed I am, and how it could have been different,” she said. “On the bad days, I also realize how blessed I am, but I ask why was I saved? I don’t know what I should be doing differently with my life, and I feel overwhelmed.”

“That’s very common in patients with heart disease,” Schussler said. “... Part of it is adjusting to major change, especially in younger people who have previously had no health problems.”

The emotional recovery is the most challenging, Tanya said. Yet she forges on.

She’s a lucky one, she’s been told. A walking miracle. If nothing else, she has a message for anyone who even thinks the signs of a heart attack, or heart trouble, are there:

“Don’t wait to go to your doctor,” she said, emphatically. “If you don’t have a doctor, go to the emergency room.

“Don’t assume it’s nothing. Get it taken care of.”

———

On the Net:

http://www.spontaneouscoronaryarterydissection.com/

http://www.mayoclinic.org/spontaneous-coronary-artery-dissection/

http://www.baylorhealth.com/

http://www.mayoclinic.org/spontaneous-coronary-artery-dissection/medicaledge.html#3507  (click here for a short video on SCAD from the Mayo Clinic)

—————

Raymond Linex II is the publisher of the Corsicana Daily Sun. He may be reached by email at rlinex@corsicanadailysun.com. Want to “Soundoff” on this story? Email: soundoff@corsicanadailysun.com

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