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Woman, 53, who collapsed in pain, was told to ‘forget it’

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Irene Birtwhistle dropped to the bathroom floor with crushing pains in her chest and was convinced she was having a heart attack.

‘I was terrified,’ recalls Irene, 53, who lives in Turriff, Aberdeenshire, with husband Simon, a retired council road worker, and their children, Christopher, 18, and Sophie, 13.

“The stabbing pain in my chest had woken me early at 6 a.m., my skin was clammy and sweaty, and I was breathless and nauseous. I ran to the bathroom and vomited, then I yelled at Simon to call an ambulance. I was terrified because my symptoms ticked all the boxes for a heart attack.”

The ambulance arrived within ten minutes, but before the crew had time to do an EKG to check her heart’s activity and rhythm, Irene’s pains had mysteriously disappeared.

“It was like a switch had been turned,” she recalls. “By the time we got to our local hospital, all my symptoms had disappeared and my EKG reading was completely normal.”

Irene, a retired water company sampler, was transferred to a larger hospital, where a nurse initially diagnosed with indigestion.

Irene Birtwhistle (pictured) fell to the bathroom floor with a crushing pain in her chest and was convinced she was having a heart attack.

But further blood tests showed Irene had elevated levels of a chemical called troponin — high levels indicate the heart has been damaged and could be a sign of a heart attack.

However, a cardiologist ruled out a heart attack because an angiogram (X-ray of the blood vessels) six weeks earlier showed that her blood vessels looked clear.

The consultant instead identified a coronary artery spasm, which affects the muscles of the artery wall, temporarily reducing blood flow to the heart — this can happen spontaneously or be triggered by stress, exercise, cold weather, or even the menstrual cycle.

So Irene was sent home the next day, told to ‘forget it’.

She would go through two more terrifying episodes – in October 2016 and October 2017 – again with aching chest pains, sweating and vomiting.

Ambulances were called and each time her symptoms resolved within about 15 minutes and her EKG readings were normal.

“I had the feeling that they thought I was hypochondriac or neurotic and having a panic attack,” she says.

Irene, a retired water company sampler, was transferred to a larger hospital, where a nurse was initially diagnosed with indigestion

Irene, a retired water company sampler, was transferred to a larger hospital, where a nurse was initially diagnosed with indigestion

On a third occasion, a consultant again concluded that her seizures were due to coronary artery spasm — and reassured her that she had nothing to worry about.

Skeptical, Irene began her own research online and came across support groups for people with spasms and a lesser-known type of heart attack, a MINOCA (myocardial infarction with unclogging arteries).

While a traditional heart attack is caused by a blockage of an artery, a MINOCA is caused by a temporary blockage – also due to spasm of the coronary arteries – and so angiograms will show that the blood vessels are clear.

MINOCA symptoms can be similar to a classic heart attack. “But they can also increase and decrease over several days because the artery is open and any blockage is only temporary,” said Colin Berry, a professor of cardiology and imaging at the University of Glasgow.

According to research published in June, MINOCAs are responsible for 5 to 15 percent of all heart attacks.

They are more common in women and people under the age of 55. They can be hereditary and can occur for a number of reasons, including a buildup of fatty deposits that rupture and detach from the artery’s mucosa, creating a temporary blockage that clears as the plaque spreads. Other causes include coronary artery spasms.

Diagnosing a MINOCA is complex: It includes a blood test to measure troponin levels and an immediate follow-up with an angiogram, as well as functional tests and a cardiac MRI, which will reveal any damage to the heart.

Despite being a recognized medical event, MINOCAs are underdiagnosed in the UK, says Professor Berry. “Part of this has to do with how heart attacks are taught in medical school — students are told they are caused by blocked arteries,” he says. “They weren’t told that you can have heart attacks with unblocked arteries, which is actually a gender bias because more women than men suffer from MINOCAs.”

A person is much less likely to die suddenly from a MINOCA heart attack than from a heart attack arising from a blocked coronary artery — less than 5 percent died within 12 months of a MINOCA compared with a death rate of about 10 percent for heart attacks from blocked arteries. according to a review published in the journal Circulation in 2015.

However, in a study published in the International Journal of Cardiology in 2018, one in four of 9,000 MINOCA patients studied experienced a serious adverse cardiac event such as a heart attack, hospitalization with heart failure or stroke, or death within four years.

Professor Berry says: ‘When patients are monitored in the weeks and months after their attack, they are at risk for complications such as atrial fibrillation [an irregular heartbeat that raises the risk of stroke], heart failure, or any other heart attack that could be fatal.”

Professor Berry, one of the authors of an article published in June in the journal International Cardiology: Reviews, Research and Resources, told Good Health that MINOCAs are not “rare.”

On a third occasion, a consultant again concluded that her seizures were due to coronary artery spasm - reassuring her that she had nothing to worry about (stock image)

On a third occasion, a consultant again concluded that her seizures were due to coronary artery spasm – reassuring her that she had nothing to worry about (stock image)

‘There are at least 100,000 heart attacks a year in the UK – if MINOCAs make up 10 per cent, that’s at least 10,000,’ he says.

He fears that some of these patients will have died from the effects of an unrecognized heart attack. “What happens is that some patients with heart attack symptoms get angiograms instead of the tests they need, and if the angiograms are clear, it’s presented to them as good news,” he says.

“By that time, MINOCA patients are often stable and well enough to go home. But if MINOCA is suspected, a patient should have a cardiac MRI scan if an angiogram is clear.’

“They may then need additional functional testing for coronary heart spasm and receive specific treatment for that,” he adds.

However, access to cardiac MRI varies widely in the UK ‘with scarce facilities in Wales and Scotland’, according to research published in the journal Heart. Wait times also range from 25 days in London to 180 days in Northern Ireland.

Professor Berry says that in addition to better access to cardiac MRIs, more research is needed to find treatments for MINOCAs.

‘We are currently in the process of transferring treatments for classic heart attacks to MINOCAs,’ he says. “Cardiologists will recognize a MINOCA, but the problems unfold after that in managing what happens next.”

Irene has suffered from daily chest pains since 2017 and is sometimes so breathless that she has trouble climbing stairs and having to drive everywhere.

Frustratingly, her medical record still says she didn’t have a heart attack. She would like to have a more specialist function test done at a regional center but cannot get a referral.

“It’s always in the back of my mind that I could have another heart attack and this one could be fatal,” she says.

SECRETS OF AN A-LIST BODY

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This week: Sienna Miller’s cleavage

How to get the enviable physique of the stars

This week: Sienna Miller’s cleavage

Sienna Miller recently showed off an elegant cleavage at the Met Gala. The 39-year-old actress does yoga “three times a week” and has tried the intensive indoor Soul Cycle classes.

What to try: Resistance band pulses are a great way to strengthen the chest muscles. You will need a small loop of resistance or you can use old pantyhose tied in a small loop.

Stand with feet hip-width apart and place the band around your wrists, arms stretched out in front of you. Your arms should be about shoulder-width apart when the band is tight.

Pull your shoulders back and down, then pulse your outstretched arms out to the sides, out a few inches and back to the starting position. Continue for 60 seconds, rest, then repeat three more times. Aim to do this four times a week.

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