‘I’m proof it can happen to anyone’
As a former international triathlete Anna was used to pushing her body to its limits. So when she felt chest pain during a social Frisbee game, a heart attack was the last thing on her mind.
Anna was just 36 years old and in excellent health when her heart attack occurred. She’d just retired from international triathlon competitions and was still exercising every day.
The morning of her heart event, in January 2016, Anna jogged down to the Auckland Domain with a group of friends for a friendly game of Frisbee before work. They hadn’t been there long when she noticed a tightness and discomfort in her chest.
“I felt like my sports bra was a bit too tight,” she recalls. Once the game had begun, the normally super-fit Anna had to keep coming off the field because of discomfort and breathlessness. In the end, she left the game early and headed back to work.
‘I didn’t think a heart attack was a possibility’
Ironically Anna had to walk past Auckland Hospital on her way back to work, and she paused outside to consider her symptoms.
“I kind of stood there for a little minute. I had this chest pain and my arms felt heavy. In the back of my head, I knew that they were classic signs of a heart attack. But I didn't think a heart attack could really be a possibility.”
Not wanting to look stupid, she decided against going in to A&E and continued on to work. The discomfort remained, however, so Anna called her sister, a nurse, who suggested a visit to her local doctor.
An electrocardiograph (ECG) at the GP surgery revealed nothing. “It all seemed fine. The doctor thought it was maybe some inflamed cartilage from a weights workout that I'd done the day before. But he said, ‘Just in case, go and get this lab test. We'll put it on urgent so it'll come back in a few hours.’”
An urgent trip to A&E
Anna didn’t think much more about it until the doctor called later that afternoon. Now feeling fine, Anna was surprised when he told her she needed to go immediately to the hospital. Her blood tests had revealed elevated levels of troponin, an enzyme released into the blood when damage to the heart has occurred.
Once at hospital further tests confirmed the initial blood results, and doctors told her they suspected a heart attack.
At this point Anna called her husband, who at that time worked in the Airforce and was on a two-day work trip in Palmerston North. “I rang him and said, ‘Don't freak out because I don't know the story yet. But I'm in Emergency at the Hospital and I might have had a heart attack.’"
Doctors diagnose spontaneous coronary artery dissection (SCAD)
An angiogram revealed no signs of coronary artery disease, but confirmed the cardiologist’s original suspicions that Anna had suffered a heart attack caused by a spontaneous coronary artery dissection (SCAD).
She was put on heart medication in the short term, and doctors kept her in hospital for three days to monitor her recovery.
Anna found the physical recovery relatively straightforward. After the initial discomfort that she’d experienced on the first day, she’d had no real pain and it seemed there had been no long term damage to her heart.
“Then they put me on a treadmill before they discharged me and I could still get up to quite a decent pace without there being any concerns about my heart. They didn't think there was any permanent damage to the heart muscle itself. I was pretty lucky really. It was more of a shock than anything.”
SCAD diagnosis brings uncertainty
The emotional recovery, however, was more challenging. The SCAD diagnosis brought with it a lot of concerns and questions.
“I think the main thing was, how can this happen to me? And one of the hardest things to deal with was the lack of information known about SCAD. They really couldn't give me any answers on what had caused it.”
Anna was also unsure how it would affect her future.
“There are quite a few cases of women getting it post-partum so a big question was whether I’d be able to have a family? And would I be able to exercise again, or do any kind of intense exercise? But really, the biggest question was, ‘Will it happen again?’ Because it was so out of the blue, I wondered if I was going to have to live in fear of it.”
Discharged from hospital
Anna found the anxiety particularly bad immediately after leaving hospital. “Once you're discharged, they're always saying, ‘If you feel the same pain again come straight back in.’ So then there's all the over-analysing every little chest pain that you feel.”
She was told not to exercise until her cardiology follow-up appointment, six weeks after discharge. For a former triathlete, doing nothing was certainly a challenge.
“I had to wait, which I'm not very good at. So it really felt like such a change of my lifestyle, quite a sense of loss of my lifestyle, I think. Even though I wasn't doing heavy training at the time, it was still the loss of not being allowed to go exercise, I guess.”
Anna was also told that, in the interim, she shouldn’t get pregnant.
“When I was in hospital, the advice was, ‘No, you're not to try.’ And then I did some reading on the SCAD Survivors’ Group, which is mainly US-based, and I think most people over there are told, ‘No, it's too high risk. You should not get pregnant.’ So reading that was pretty upsetting.”
Six week appointment brings relief
At her follow up appointment, Anna was given the go-ahead to exercise again, on the proviso that she did so with caution.
“At the six-week follow up the advice was to go back to normal. But, with the likes of Ironman training, don’t end up on a long cycle or swim in the middle of nowhere on your own. But I think if I had the desire to get back into long distance training I could be doing it.”
Anna, however, had other plans for the future. The cardiologist had not only given the go-ahead for exercise, he’d also said it was ok for Anna to get pregnant.
“I don't know whether it's the Kiwi ‘she'll be right’ attitude, or whether he felt that in my situation it wasn't as risky. But he basically said, ‘I'm not going to tell you not to.’”
Anna’s daughter was conceived just a few weeks later, and the pregnancy was very straightforward.
“I did have a lot of monitoring during the pregnancy and then during labour too. But everything was fine. There were absolutely no issues with my heart, or blood pressure, or anything. I had a pretty good text book labour I think, really. I was very lucky and very glad to have gone through that.”
Moving on with life
These days, Anna has a busy life juggling a job, a toddler and two step daughters. She tries to squeeze in some exercise when she can and continues to eat a healthy diet. She also takes aspirin on a daily basis, as prescribed by her doctor, which help prevent damage to the heart in the unlikely event another SCAD should occur.
Anna says she feels lucky to be a survivor. “When I read stories about people who didn't survive them, I feel very, very fortunate and very lucky that I did. And really, in the grand scheme of things, mine wasn't bad and it hasn't left any permanent damage.”
Her advice to others who find themselves in the same situation is to try not to get too anxious.
“A lot of the information out there is from the US and I feel like it’s dramatised a lot. But try not to get too caught up in it. While you need to be cautious, try not to be afraid of moving on with your life. That helped me at the six-week check, my cardiologist’s attitude was to move forward.”
She also encourages others to reach out for support and know that things will get better in time.
“My main advice is reach out on the New Zealand Facebook support group. There are plenty of people who are happy to share and support. And remember time heals – well, it did for me.”