As is the case with many women eventually diagnosed with SCAD, spontaneous coronary artery dissection, paramedics did not initially recognize the symptoms of impending heart attack that 31-year-old Troy resident, Monica Bales, was experiencing.
While shoveling snow, the single mother of then eight-week-old Isabella, Bales unexpectedly broke out into a cold sweat. Her chest ached. Her arms grew numb. Her breathing became labored. Paramedics were called but an electrocardiogram showed no evidence of a heart attack.
This result, along with Bales’ age, gender and otherwise good health, seemed to indicate cardiovascular disease was not at the root of her symptoms, which were gradually subsiding.
As Bales’ vital signs improved, paramedics recommended she take heartburn medication and get some rest.
But three days later, her symptoms returned with a vengeance.
Mom and baby were at a local pharmacy, printing family Christmas photos, when Bales became ill.
Staff gave her aspirin and called 911. Fortunately, one of the paramedics who responded the first time, was back on the job.
“This time we’re taking you to the hospital,” the paramedic said firmly.
She was rushed into the cardiac catheterization lab, where acute coronary dissection affecting multiple vessels, or SCAD, was diagnosed.
Bales’ was placed on a ventilator and an Impella device was used to keep her heart muscle pumping. Next, she underwent angioplasty, a minimally invasive procedure which opens arterial blockages. Stents were inserted to restore and maintain blood flow to the heart muscle.
“Dr. Tucciarone saved my life,” Bales said. “If it wasn’t for his quick thinking and fast actions, I wouldn’t be here. And Isabella wouldn’t have a mother.”
SCAD attacks begin with a sudden tear in a coronary artery of the heart. Blood flow is slowed or blocked entirely, causing heart attack or in certain circumstances, death.
Unlike more traditional heart attacks, which are diagnosed through blood work, electrocardiograms and risk factors, SCAD is diagnosed in the cardiac catheterization lab with a coronary angiogram - an X-ray test that uses special dye and a camera to take pictures of blood flow through the coronary arteries.
Although it is believed that only 1-4 percent of all heart attacks are SCAD-related, SCAD is responsible for close to 40 percent of heart attacks in women under the age of 50.
Additionally, the majority of SCAD patients are female.
“Our team understands that women’s health needs are special and unique,” Dr. Tucciarone said. “We recognize SCAD can occur in relatively young, healthy women. It is often associated with pregnancy or recent postpartum. This awareness has helped us save lives. Monica is a case in point.”
“Women who have atypical symptoms, without the usual risk factors that lead to heart attack, need to be taken seriously and monitored closely,” Dr. Tucciarone added.
Contributing to the challenges of diagnosing SCAD, Dr. Tucciarone said, the population who suffers from the condition “is small and every case is different. That’s why it’s so important we follow each one. More research is necessary.”
Meanwhile, Bales practices diligent self-care to fuel her recovery and set the stage for a positive, long-term outcome.
A virtual assistant who returned to Metro Detroit last September following six years in Dallas, Bales pays close attention to managing her weight, blood pressure and cholesterol through diet, exercise, medication and regular physician follow-up.
Future pregnancies are not recommended.
Besides taking care of her physical body, Bales’ works hard to stay positive and manage her stress.
“My mom can’t get over that when Isabella cries, I laugh,” Bales said. “Nothing good can come from my getting upset. I have to focus on my baby and think about how it’s me and her and how we’re going to get through this.”
“Physicians must be attentive and willing to collaborate closely with patients to build and nurture a successful, follow-up plan for continued health care,” Dr. Tucciarone stressed.
Self-motivation, Bales added, is also key.
“I would love for other women to understand: we have to be our own advocates,” Bales stressed. “It’s a life or death matter.”