As a retired registered nurse living in Southern Minnesota, Christine Pfarr, 66, has always known how important it is for people to know their own bodies and be their own health care advocates. She just never imagined that she would have to put her own knowledge and advocacy skills to the test and convince an emergency room doctor at her local rural hospital that she was indeed having a heart attack. Unfortunately, she needed to do it not just once, but twice in 10 years. In both instances, doctors didn’t initially recognize her symptoms or take her concerns seriously and she needed to insist on being appropriately treated.
Remarkably, Christine’s situation is not uncommon, especially for women. When it comes to heart disease, women are often under-diagnosed and under-treated. In Christine’s case, at age 56 years old, she “didn’t fit the stereotype” for someone having a heart attack. She was at a healthy weight, ran up to five miles a day, participated in competitive running races, and made healthful food choices. Her blood pressure and cholesterol were well controlled and there was no history of heart disease in her family.
But as Christine eventually learned, both heart attacks were of a type that she — and many doctors — had never even heard of called Spontaneous Coronary Artery Dissection (SCAD). SCAD is different from a typical heart attack in that there is a spontaneous tear in an artery that is apparently healthy. There are typically no pre-disposing risk factors for SCAD and the causes are uncertain. SCAD occurs almost exclusively in women.
During her first heart attack in 2008, Christine explained, “I had massive chest pains and cold sweat and pain down my arm, and I knew instantly that something was wrong with my heart. I walked into the ER and told them I thought I was having a heart attack. They took me back and the emergency room doctor looked at me and said, ‘Oh, I doubt if you’re having a heart attack.’ He said, ‘You probably have indigestion … what did you eat for supper?’”
She insisted on having the doctor start the heart attack protocol. Her electrocardiogram (EKG) came back negative and he again told her it was just heartburn. But Christine wasn’t taking no for an answer. She demanded to have her troponin levels tested, which is a protein that is released when the heart muscle is damaged. Hers came back elevated and she was eventually transferred to Minneapolis Heart Institute® at Abbott Northwestern Hospital. There, cardiologists determined she had a 90 percent blockage in one of her arteries caused by SCAD, requiring treatment with a stent.
When Christine’s second heart attack happened in June 2018, she headed back to the emergency room at the same local rural hospital. She told the doctor she thought she was having a heart attack and that she’d had a previous one. The doctor did order an EKG, but it came back negative and she was told she wasn’t having a heart attack. She insisted on having her troponin levels tested, which were once again elevated, so the doctor arranged for an ambulance to take her to Abbott Northwestern Hospital but stressed it wasn’t urgent. Upon arriving at Minneapolis Heart Institute®, she learned she had experienced a second SCAD event requiring another coronary stent.
More than a year later, Christine said she was still feeling extreme fatigue, which she said is common among many of the women in the SCAD survivor group. She said she and a lot of the women also get frequent chest pains that come and go, and they are all afraid when that happens because they worry that they’re having another SCAD.
“Sometimes, you know, it seems like there’s no real answers and it’s kind of frustrating,” said Christine. “But I tell my husband, that’s the reason we need to keep sharing and, you know, communicating about it. Because that’s how we find out and they can do more research and figure things out by comparing all of us.”