Yesterday we heard the harrowing tale of Robin Licata’s sudden, massive heart attack. But was it that sudden?
In retrospect, she wonders if the neck and shoulder pain she’d been feeling for months—“It felt like knots of tension, and a sharp pain in my shoulder blades”—really was from hunching at a keyboard on deadline.
Dr. Andrew Kates, her cardiologist at Barnes-Jewish Hospital, says it's possible there was a blockage in that area. But what he pays more attention to is the shortness of breath she experienced, and above all, the other risk factors: her cholesterol had bounced up and down, her diet was heavy on pasta, she got little cardio exercise except going breathlessly up those steps, and she was carrying extra pounds as a result.
He put a stent in Robin’s right artery, which was completely blocked, and prescribed medication to ease the risk from mild blockage in other arteries. Now she’s bubbling with energy, and it’s consistent. She’s walking, and she’s come up with “a little exercise thing” in the basement. She’s switched to decaf coffee, and she’s drinking a lot more water. “I always loved fresh fruits and vegetables,” she says, “but also pasta!” She’s cutting back on the noodles, the cheese, the cream, the bread. “My father-in-law owns a bakery on the Hill!” she moans.
But fear’s a great motivator. “For the first two weeks, I was actually afraid to fall asleep,” she admits. “But the patient education was phenomenal. They went through all that with me, told me what to expect and how to know when to call.”
She rode out one false alarm, the week before Christmas when she thought of everything she still had to do. “I almost got myself to the point where I couldn’t swallow,” she says. “I walked down the block in the cold air, drank a bunch of water and went, ‘Please go away.’”
As it turned out, it was pure panic. It’s easy, once you’ve had a heart attack, to think you’re having another. But it’s when chest pain (or tightness or pressure) persists, instead of coming and going, that you’re in trouble, Kates says. He carefully distinguishes angina, or the symptoms of coronary disease, from the signs of an actual heart attack. Angina can lead up to an acute attack, and it can let you know you’re at risk, “so you can seek attention before it progresses that far.”
Traditional risk factors, he adds, are high blood cholesterol, high blood pressure, diabetes, smoking, a family history of early coronary disease, obesity, and physical inactivity, and the newest addition to this list, depression. “Not everybody with risk factors develops coronary disease,” he notes. And the good news is, people can alleviate the risk from almost all of these variables. (You just can’t change your family.)
I ask about cholesterol, remembering news about its significance being downgraded. That, as it turns out, is dietary cholesterol. “The contribution of dietary cholesterol to one’s total blood cholesterol is not as significant as we once thought it to be,” Kates explains. “High blood cholesterol has more to do with your genes.” And it remains a risk factor.
Still, he stresses the importance of meeting with a registered dietitian. “There’s not enough time in an office visit for us to do justice to what constitutes a healthy diet,” he says, “and to the importance of exercise.”
Robin’s 51, and she figured menopause might be a risk factor, but Kates says statistically, it’s usually 10 years out from menopause that women have problems. Still, he also makes the point that statistics and “typical” symptoms shouldn’t guide you. A lot of early warning signs are incredibly variable and non-specific, and not everybody has the same pattern of chest pain on the left side, left arm tingling.
“When I think back, I’d tell other women that when it comes to warning signs, don’t expect something that could be very bad to linger on and on,” Robin says. “It might come and go. Keep track of it, and if it keeps coming back, go to the doctor. Even if you don’t have a family history. Listen to what your body’s telling you.”
