SCAD leads to cardiac arrest for mother-of-two

Trudy was doing chores at home when she felt weird sensations in her arms and pain in her chest. As she arrived at hospital Trudy went into cardiac arrest and was later diagnosed with spontaneous coronary artery dissection (SCAD).

Trudy and her husband, James, have lived in Whangarei for 13 years while bringing up their two children, Jayden (13) and Hannah (8). The young family like to play sports, spend time at the beach and enjoy an active lifestyle.

“We all like to keep fit and healthy.” said Trudy.

However, things changed for the family one Sunday afternoon in April 2018, when a spontaneous coronary artery dissection (SCAD) caused Trudy to go into cardiac arrest.

“We were at home chilling out, doing a few things around the house,” Trudy remembers. “I’d just finished cleaning the outside of the windows and I suddenly felt this really weird sensation down each one of my arms and I felt a little bit odd.

“I told my husband I didn’t feel very well, so we came in and I sat down. It got a bit tight across my chest, which felt like indigestion but higher up.”

Trudy initially refused to go to hospital, but as the pain worsened, James got the family in the car and drove to the local emergency department (ED). 

The trip to ED

“I was feeling pretty awful by that stage and the feeling in my arms was really horrible. I don’t remember part of that journey – I lost consciousness and passed out. My husband said that I flopped over onto him and so he tried to prop me up, while trying to drive as well.”

On arrival at the ED entrance, James jumped out of the car and called for help.

“The nurses came out they just grabbed me and dragged me out of the car. I was unconscious, I wasn’t breathing, and I had no heart beat, no nothing. So they started doing CPR on me, right there on the concrete at the main entrance to the hospital beside the car.”

James took the children aside while the doctors and nurses tried to revive Trudy.

“Eventually they got me up onto a bed and I was defibbed three times in the end. They took me into ED and the team worked really hard to get me back, but I wasn’t trying to breathe or anything by myself, so they made the decision to intubate me and put me on life support and transferred me to ICU (Intensive Care Unit).”

Looking for a diagnosis

The doctors were unsure what had caused Trudy’s cardiac arrest and spent some time with James and the kids to find out her symptoms. Trudy didn’t have any of the usual risk factors for a heart attack. She had experienced an anaphylactic reaction to a bee sting previously, therefore the doctors suspected her collapse could be related to another bee sting. However, she had no symptoms of an anaphylactic reaction.

That night Trudy had a CT scan to check for an aneurysm or brain bleed, and several blood tests, which identified raised troponin levels. This had increased from a normal level to approximately 750 and then to 1,500 – this type of increase indicates a cardiac event.

Early the next morning, an echo ultrasound confirmed her heart was the cause of the problem. Trudy, who was still on life support, was helicoptered to Auckland Hospital, where she was admitted to the intensive care unit (ICU) and had an angiogram.

“Once I’d had the angiogram the doctors realised I had a SCAD. I was kept on life support. They tried to bring me off it a few times, but I wasn’t able to breathe on my own.”

Coming off life support

The following night, Trudy started to breathe by herself.

“Because I’d been out of oxygen for four to six minutes during the cardiac arrest, the doctors told my family that they didn’t know if I would ever wake up, and if I did, what kind of state I would be in.”

Trudy can’t remember that night she first woke up, but her mum and James told her she was dazed and confused.

“I kept repeating myself, so they were really nervous that maybe it wasn’t the normal me that was there. They let me sleep all night, and by the next morning I was making more sense.”

Recovering in hospital

Trudy was transferred to the coronary care unit (CCU), where she stayed for three weeks while her heart was monitored.

“I didn’t get out of bed for nearly a week and when I did I could hardly walk I was so weak. I had lots of tests and scans done. The doctors had different theories about what happened to me, how and why, etc. so they wanted to clarify them. The main reason though was to make sure my heart was healing. They needed me to have bed rest so that my heart could heal and for me to be ok.”

“Being in hospital in Auckland away from home for so long was really hard. I always had someone with me whether it was my husband or my Mum and someone would bring the kids down in the weekends which was lovely. I had other visitors as well but there was lots of down time too, which was good for my heart recovery, but they were long days and nights in hospital. I missed being around everyone and that was really hard and sad for me."

Medication and side effects

Finding the right medication for Trudy during her recovery proved difficult.

“The first 10 days after I woke up were really awful. My ribs hadn’t actually cracked during the CPR, but I had hairline fractures, which were extremely sore, but it was obviously great CPR as I’m still here! Also, when I’d had the cardiac arrest I’d had what they call a pulmonary oedema, where you have fluid in your lungs, so I had a whole lot of pink frothy stuff and blood that I had to cough up, this was incredibly painful to do with the damage to my ribs.

“I was on so many drugs and pain relief, which was awful because I’d feel really sick from it. And you’d have all the side effects from one drug, so you take another one to combat that, so you take something else, then you have another side effect. Eventually they changed my pain relief drugs. I went from morphine to fentanyl and then finally they tried ketamine which was the best one for the pain and gave the least side effects.”

Trudy was also given different medications to reduce her risk of another heart event and to control and steady her heart rate, including aspirin, diltiazem, and metoprolol.

Recovering at home

When the SCAD had healed, Trudy was taken by ambulance back to Whangarei Hospital where she spent a further three nights before being allowed home.

“When I came out of hospital I was on a total of 36 pills a day, which was a mixture of heart pills and pain relief. It was so nice to be home and be around my family all the time, but there’s a whole heap of things that you didn’t think of before you get there. I’d been monitored 24/7 and had nurses there if something beeped. Then you come home and you’ve got no monitors and no nurse.

“My husband was really nervous, I don’t think he got a lot of sleep for the first few nights. He was awake and checking on me all night. I was still in quite a lot of pain from the CPR, I was still being propped up with pillows, I couldn’t lie flat, it was just too hard and painful to do that and hard to breathe.

“Although I couldn’t do anything, at least when the kids came home from school I was there, and I got to see them, even if I was half asleep and feeling yuck all the time. It was just nice to feel like I was part of my family again, because I hadn’t had that for so long.

“So that side of it was awesome but it was quite worrying as well, just because it was all so new and there’s not a lot known about SCAD, so things were quite grey in the respect. There were no definitive answers as to how and why etc., and would it happen again?”

Impact on the family

Trudy’s heart event was a stressful time for the whole family and even now, she still notices the impact it has had.

“We still talk about it a lot. As soon as the kids bring it up, we just let them go and get it all out. Even now, all these months later, they’ll say something like, ‘Did you see that? Did you hear that?’. Obviously, they were petrified that they were going to lose me.

“The kids have nightmares and they’ll be screaming out and crying, it’s awful. I feel really bad that this is happening to them, it makes me so sad. They shouldn’t have had to see something like that.

“They are much more affectionate and grateful and all those sorts of things now. Jayden will often say to me “I’m so glad that you’re still here” and tell me he loves me. So, it’s still very raw with them. As much as they’re kids and they’re busy and doing things, it’s still there. I think it affected them quite a lot.

“And my poor husband, it was so scary for him. He had to drive to Auckland while I was in the helicopter, thinking the whole time about whether or not I’d ever wake up. It was his worst nightmare. He was such an incredible support and knowing that he was there for me every step of the way was so special.

“My Mum was amazing too, she was there the whole time. It was really hard for her to watch me go through that. It was so comforting to have her and James there, but their lives were totally put on hold for months.

“While I was in hospital my Dad moved into our house and looked after the kids. That was awesome as we knew the kids’ lives were kept as normal as possible at home with their routine etc., and then when they came down to see me it was so nice.

“So, the impact on the whole family has been huge, something that you never want to go through. It might be mentally and physically challenging for me but for all of them it is a huge hurdle mentally and one we still all battle with today”.

Rebuilding confidence

Nearly one year after her SCAD, Trudy is feeling much better, but it took time and determination to get her here.

“When I came out of hospital, the cardiac nurse came out and we talked about what I was going to do. I could hardly walk down the hall to the toilet without feeling tired and breathless. Slowly as time went on I started to get my fitness back – to me that is really important, it has been really hard work but definitely worth the fight to get here. I don’t have the fitness levels that I’m used to, but I’m happy with where they are at now and I’m trying hard to accept my new normal.”

An ongoing concern for Trudy and her family is the chance of the SCAD reoccurring. The chances are small but not impossible, so James and Jayden have had CPR training and Trudy tries not to stray too far off the beaten track.

“Everything happened so quickly, so I like to know I could get an ambulance to where I am. We don’t go far from town anymore and haven’t been out to our Bach at the beach since the SCAD, but there’s only a small chance it would happen again so we’re hoping that as time goes on we can work through that and maybe do the things we used to do again, sometime soon. I guess as time goes on that will get better.”

For now, life has returned to a type of normal, “the new normal”, for Trudy and her family.

“I can pretty much run the house as I did before but I am so easily distracted now, which makes things hard and things get forgotten. I go for daily walks and I also do cardiac rehab classes at the gym twice a week, which I love. So, although life now is our new normal, the worry is always, always, right there in your mind. No matter where you are, where you’re going, what you’re doing, it’s always there, sitting right there on your shoulder.”

Life after SCAD

Trudy hasn’t had to make many changes to her lifestyle as a result of the SCAD. She maintains a healthy diet, doesn’t smoke and only has the occasional drink at the weekend. Trudy still takes her heart medication but takes it at night, so she doesn’t notice the side effects as much.

She would suggest to anyone in a similar situation to listen to their body.

“At the time when I had my symptoms, being a reasonably fit and healthy 40-year-old, there was no way I thought I was having a heart attack, and neither did the doctors! So listen to your body. Take it easy. When you have such a big event like that it takes a long time for it to heal.”

Trudy is also so grateful for all the support she had from her friends and family and is more appreciative of her life.

“I’m so lucky to still be here with my kids and my husband, so I can watch them grow up. If there’s anything good to come out of it, it is just to appreciate life a whole lot more and if someone else can appreciate their life a little bit more by reading my story then that’s awesome, that’s really cool. That’s what it’s about at the end of the day.”

 

Shared August 2019

Please note: the views and opinions of the storyteller and related comments may not necessarily reflect those of the Heart Foundation NZ.

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