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Question:

Is there information about women like myself who have had an MI without risk factors present?

I guess I am not your typical 57-year-old woman. I am physically fit. And I mean FIT. I work out 6 days (cardio) a week with three of those days dedicated to strength and resistance training. I am a certified sports nutritionist and trainer and do follow my own advice as far as eating and lifestyle choices. I have a healthy BAI (body adiposity index) BMI is not as accurate. My body fat at 24, visceral fat is six, and my lipid profile, glucose and CRP (C - reactive protein), are excellent. BP 110/64 normal, no diabetes, do not smoke. The only negative in this equation is I have lots of stress and anxiety in my life.

Let me back up with some history. In 2007, I had a routine EKG. It showed I had a left branch bundle block. I quickly learned what that was and was told I could live just fine with it. Had an echo and stress test in 2007 as well and have just now requested the results (a baseline?) to see if there was damage back then, but the doctor had said it was fine. Fast forward to June 2011, I went to my primary care still complaining about anxiety and fatigue the two symptoms that can be so many things. I was also having chest pressure and my lungs would burn when I accelerated my fitness pace and would have to slow down to recover. EKG was given and I told her about the LBB but after reading it, she said I might have had a heart attack. Ended up in hospital for more extensive tests. Had the echo, which revealed my heart muscle was damaged and down to 46% function. I never had rheumatic fever. I also had a nuclear stress test, which is 96% accurate and showed no blockage. They went one-step further and catheterized me. I have a set of perfectly clear arteries pictures to show for it.

I just came from a pulmonary specialist today who started me out with a breathing test, put me on Prednisone, had me return a week later to see if there was improvement and there was not. I do not have COPD, Valley Fever, or Bird Flu, asthma and my lungs are clear. He concluded it is my heart affecting my breathing and said I MUST return to the cardiologist ASAP. I have an appointment for November for another echo but will go in sooner than later.

OK, here are my questions and I hope I am not alone. Is there any information on women like myself, who have had a myocardial infarction without the risk factors present? Are there any studies and tests on these people? They must exist! As I type this I am having chest discomfort that I have always thought for years, was anxiety. I am a bit scared and very freaked out. My life has devoted to being fit, eating well, and helping people in their quest to becoming the best they can be. Any information would be extremely helpful.  

submitted by Spongie from Phoenix, Arizona on 8/11/2011

Answer:

by Texas Heart Institute cardiologist, Roberta C. Bogaev, MD    

Roberta C. Bogaev, MDDear Spongie,
Thank you for contacting us. Your story is not atypical for many of our women who present with heart disease. Unfortunately women are often told they are anxious or stressed when their anxiety and fatigue reflect pathologic disease that should be further investigated. Anxiety is a normal symptom when the oxygen level in your lungs is low due to pulmonary edema (water in your lung tissue). Fatigue is a normal result of inadequate blood flow to your muscles during exercise. These symptoms are telling you that your body is having a problem. Please listen to your own intuition and trust yourself. Many physicians are unaware that heart disease is the number one killer of women worldwide.

Furthermore, your lifestyle and preventive strategies are commendable. You did not cause this heart disease, which is called cardiomyopathy. Common causes include a viral infection, thyroid disease, hypertension, exposure to alcohol or illicit drugs, or familial (inherited). Not infrequently we never determine the actual cause of the heart failure. However, it is important to exclude reversible forms of heart failure such as thyroid disease, tachycardia (fast heart rate), coronary artery disease, or uncontrolled hypertension. The medical therapy for cardiomyopathy is the same regardless of the etiology.  A disease management heart failure clinic, which is often run by advanced practice nurses, can teach you about cardiomyopathy, initiate standard medical therapy, and educate you about the importance of a low salt diet. Many times, the heart function recovers to normal with correction of the underlying etiology and standard medical therapy, which includes a beta-blocker, ace-inhibitor, and aldosterone antagonist. Some patients will also require a pacemaker and/or debrillator to help treat their heart failure.

You can find a heart failure clinic associated with most heart transplant programs as well as with large cardiology groups. There is a new sub-specialty within cardiology of advanced heart failure and cardiac transplantation. You can search for heart failure cardiologist in your area by contacting the American Board of Internal Medicine to see who has a board certification in your area for advanced heart failure.

Best of luck to you. Continue to exercise and live healthy. Your prognosis is good with medical therapy and education. Kind regards.         

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Updated August 2011
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