In November 2021, I woke up with a sharp tightness that felt as if someone was slowly pushing a knife into my chest. The pain lasted 15 to 30 minutes before it eventually went away. At first I thought it was just a strange, one-off event. Until it started happening more and more frequently. I didn’t know it at the time, but those morning chest pains were actually early warning signs of an impending heart attack—and symptoms doctors dismissed as “anxiety”.
At the time, I was a 45-year-old president of a health marketing agency. And aside from dealing with migraines my entire life, I thought I was in good health. I reached out to my primary care doctor the first week I was experiencing chest pain for a virtual visit, and he told me it was just anxiety and panic attacks.
He prescribed anti-anxiety medication such as benzodiazepines and clonazepam. But I knew it wasn’t anxiety. My ex-husband experienced anxiety, so I know the signs—and I’d never been an anxious person.
If you were to scroll back in my online patient portal, you would find several messages of me telling my medical providers, “It feels like I’m having a heart attack” and getting the same answer. For three months, I experienced chest tightness and pain if not every day, every other day.
I have an 11-year-old daughter, and I didn’t want to worry her. So I put on a brave face and tried to push through the 20 minutes of pain so I could move along with my day.
My chest pain got even worse
On January 5, 2022, I took my daughter to school and hopped on a video call for work. Then I experienced the all-too-familiar chest pain. But this time, it felt different. It was more intense and lasted longer. I was sitting on the call trying to act normal, but the pain got to the point where I had to take myself off camera. I felt like I just needed to do something, so I began pacing. As I did, I felt pain shoot down my neck into my left arm and was sweating.
The incident lasted about 45 minutes before it went away. After it did, I went about my day and finished up my last work call at 4 p.m. in the urgent care parking lot. When I went in, they told me if my symptoms were anything like what I was describing, I needed to go straight to the emergency room. When I made it to the emergency room and told them what was going on, they thought it was COVID. Still, they admitted me and did an EKG.
The doctor said my results appeared a little strange, but not to the extent of signaling a cardiac concern. They decided to run a blood test called troponin, which helps diagnose heart attacks by checking for a protein that can damage cells when it leaks outside of your heart. I wanted someone to say, “You’re fine. It’s all in your head again.” But that little voice that knew something was going on since my symptoms started was still there.
When the doctor came in, he was white as a ghost. My troponin test showed a reading that had skyrocketed. He said, “You’ve had a heart attack.” The doctor told me I was going to the cardiac unit of the hospital and would likely not get out for a few days, so I should let my daughter know.
In that instant, a mixture of fear and relief washed over me—relief that the doctors were finally taking my symptoms seriously, but an even stronger fear that I might have to say goodbye to my daughter.
The signs of a heart attack looked different for me
When you see images of people having a heart attack, they’re clutched over in pain. Although I felt like I was having an out-of-body experience, in my case, after the incident subsided, so did my pain. In fact, I was in the ambulance on my way to the cardiac wing of the hospital, talking to the technician about getting a tattoo of my EKG printout.
When my team of doctors came in, they told me they expected to place three of four stents in my heart as my troponin levels continued to climb. Even though I wasn’t feeling pain, my heart was continuing to experience damage.
Eventually, the interventional radiologist came into the room, and he and the other radiologists were huddling around the screen studying my test results. I finally learned the cause of my heart attack—I had something called spontaneous coronary arterial dissection or SCAD.
Instead of placing stents, doctors prescribed a mix of medications, including one to lower cholesterol (atorvastatin), one to prevent blood clots (clopidogrel), a nitrate to help with chest pain (isosorbide mononitrate), a beta-blocker to regulate my heart (metoprolol tartrate) and a daily aspirin.
What is spontaneous coronary artery dissection (SCAD)?
“SCAD is a sudden tear and separation of the layers of a heart artery that results in diminished or stopped blood flow to the heart artery,” says Ellina C. Feiner, MD, Associate Chief of Quality Cardiology and Director of the Spontaneous Coronary Artery Dissection Program at Lehigh Valley Heart and Vascular Institute, part of Jefferson Health.
Insufficient blood flow to part of the heart muscle can cause cell death and damage, potentially leading to a heart attack, continues Dr. Feiner.
“SCAD is [the cause of] 1 to 4 percent of all heart attacks. But it’s the most common type of heart attack in women under 50, [contributing to] nearly one-third of all cases,” says Dr. Feiner. But SCAD can impact both premenopausal and postmenopausal women.
“SCAD occurs in association with sex hormone changes in women,” adds Dr. Feiner. “Multiple previous births and fertility medications may be a risk factor for SCAD that happens many years later. At the time of pregnancy and right after delivery, [a] SCAD heart attack may happen because of hormonal effects [that] weaken the coronary arterial wall.”
Aside from hormonal changes, Dr. Feiner says SCAD heart attacks also happen in people with blood vessel abnormalities, such as fibromuscular dysplasia.
Symptoms of SCAD
My SCAD heart attack was brought on by my underlying condition fibromuscular dysplasia—a condition I didn’t even know I had until my heart attack. Aside from the interventional radiologist who identified my SCAD, there was only one other person in the entire cardiac wing who’d seen the condition before.
It’s a rare blood vessel disorder that can cause my blood vessels to become weaker and less elastic, which makes me more prone to artery damage, high blood pressure and SCAD. It’s one of those conditions that primarily impacts women and is under-diagnosed.
While chest pain was the symptom that tipped me off that something was wrong, it’s not the only potential warning sign. Dr. Feiner says a person with SCAD may experience:
- Chest pressure or pain
- Shortness of breath
- Nausea
- Tightness across the chest
- Pain in the upper arm or jaw
Why advocating for my health is so important
My heart attack taught me the importance of living life to the fullest. Three months after getting released, I booked a trip to France with my daughter. The heart attack also gave me first-hand experience of how women are routinely gaslit in the medical industry. Some doctors either don’t believe you’re in pain, think you’re exaggerating or don’t think you’re smart enough to recognize the difference between minor health issues and something more serious. Teaching my daughter to advocate for her own body has become a passion project for me.
Fibromuscular dysplasia is a lifelong condition, and today, at 48, I manage it by taking a blood thinner pill, carrying a medical ID card, using an Apple watch to monitor my heart rate (I try to keep it under 130 bpm), using a blood pressure cuff if I feel something is not right and seeking medical intervention if I have intense chest pain. If I seek medical intervention I also advocate to see someone who is familiar with SCAD and fibromuscular dysplasia.
I’m also a member of the greater Midwest group of the SCAD Alliance, an organization that has provided me with a community of people saying, “Look, we’re here for you.”We remind each other that there’s life after a SCAD heart attack, and you can still lead a normal life.
Bio: Katherine Juergens, 48, is a 20-year veteran in marketing and communications with senior leadership roles in the healthcare industry. She believes in using marketing as a tool to educate, inspire and drive meaningful change. Beyond her professional achievements, Katherine is a dedicated advocate for women’s heart health after surviving a rare heart attack (SCAD). Through her advocacy work, she shines a light on medical gaslighting and empowers others to demand better care.
As told to Cailey Griffin
This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.