Leslie Pham MD is a an ophthalmologist and heart attack survivor whose passion is educating women about heart disease. View Profile
Learning the symptoms can save your life.
Hi, my name is Leslie Pham. I’m a physician and eye surgeon living in Orange County, CA. Two weeks ago, I celebrated my 40th birthday. I didn’t feel over the hill. I was able to run 20 miles effortlessly without breaking a sweat, I ate a healthy pescatarian diet (mostly plant based with occasional seafood), I had never smoked a cigarette and I had no significant medical conditions. I was known as the “Energizer Bunny” and considered to be a pillar of health so what came next threw us all for a loop.
The Heart Attack that Struck out of Nowhere
Nine days after turning 40, I had a heart attack and nearly lost my life. I had just completed my daily long distance run (still trying to prove to myself that 40 is the new 30) and I was home alone when I developed a heavy sensation in my chest. It felt more like pressure than pain, but my arms, especially my left, became extremely painful and eventually numb. The pain was intense, I found it hard to breathe and I felt like I was going to vomit. As I crawled to the bathroom, I caught a glimpse of myself in the mirror. I saw a sweating ghost that I could hardly recognize as my own reflection.
Recognizing the Symptoms Saved My Life
I am so grateful for my medical training which allowed me to recognize the classic symptoms of a heart attack. With no history of heart disease, no risk factors and being relatively young I might have been tempted to ignore my symptoms or wait for them to pass, however, I knew that if this was indeed a heart attack, I needed to act fast. Somehow I summoned the strength to get to the phone and call for help. Rescue came and paramedics did an EKG which showed ST elevation which is a strong indicator of a heart attack. The paramedics weren’t convinced however. They saw my gender and my age and likely presumed that I was having a panic attack rather than a heart attack. I was told that this was probably nothing, but it would be a good idea to go get checked out in the hospital. Throughout the ambulance ride, they continued to reassure me that my vital signs were just fine. My heart rate and blood pressure were in normal range. But I knew that the pain I was experiencing was not normal.
From Running Outdoors to Having a Mechanical Pump “Run” My Heart and Lungs
In the ER, I had to go through a battery of questions about my health, my symptoms, my history. I tried very hard to stay calm because I’m well aware that my presentation was characteristic of a panic attack or anxiety and I could tell that’s what they must have been thinking. In a way, I was lucky that it was a large heart attack because my cardiac enzymes came back quite elevated which meant I bought myself a trip straight to the cath lab, where they could see that I had suffered a very rare condition called a spontaneous coronary artery dissection (SCAD). The treatment choices were stenting the vessel or coronary bypass surgery. Within two hours, I was in the operating room, my chest wall was open, my lungs and heart were operating on a pump and my talented surgeon was grafting my mammary artery onto my heart. Although I’ve spent countless hours in the hospital as a medical student, intern, resident and now surgeon, this whole experience was from a completely new vantage point. I had a very good outcome and I consider myself very lucky, but it wasn’t just luck that saved my life. The factors that contributed were being in good shape prior to the event, recognizing the symptoms, and the speedy and excellent care provided by the entire heart team.
What is SCAD? Who’s at risk?
SCAD stands for Spontaneous Coronary Artery Dissection. It is a little known cause of heart attack that results from a spontaneous tearing in the coronary artery wall. The walls of the arteries have three layers and when a tear occurs, blood is able to pass through the innermost layer and become trapped. This narrows the artery and can cause a heart attack because blood flow cannot reach the heart muscle. This can lead to a heart attack, cardiac arrest and sometimes death.
Most people have not heard of SCAD, however, it is the #1 cause of heart attack in women under the age of 50 and those who are pregnant or peripartum. What makes SCAD different from your “traditional” heart attack is that it affects healthy, young, active women with no pre-existing heart disease and usually minimal to no atherosclerotic risk factors. The average age is 42 and almost 90% are female.
The Heart Attack Symptoms Every Woman Needs to Know
I know for sure that my outcome would have been very different had I had not sought immediate medical attention at the onset of my symptoms. SCAD is difficult to diagnose before it causes a heart attack because it doesn’t have warning signs. Therefore, it is crucial that every woman knows the symptoms of a heart attack. Here are the symptoms you need to know:
- Chest Pain
- Pain in the neck of Jaw
- Pain radiating down the arm(s)
- Nausea
- Lightheadedness or Dizziness
- Profuse Sweating
- Shortness of Breath
- Fatigue
While chest pain is the most common symptom of a heart attack in both women and men, each woman’s symptoms can be slightly different. That is why it is important to know them all. The bottom line, however, is that any type of chest pain is abnormal. If you are a young healthy female and you experience chest pain, you need to get immediate medical attention.
The Silver Lining & Encouraging Women to Live Their Life to the Fullest
Most people don’t experience a life-threatening health event until they are much older. I actually think I’m lucky to have had this happen so young. Now I can start implementing changes geared towards living the happiest and healthiest life that I can. (And I’ll have so many extra years to experience these changes!). SCAD has changed my perspective on life. My wish for all women, not just heart attack survivors, is that they take the time to reflect on how precious life is and how quickly it can be taken away from us. Please don’t wait for a near death experience to start living the life you want to live. Be kind to yourself and live every day as if could be your last.
Lots of love from a grateful survivor,
Leslie Pham
Short Article Review
- Young, healthy, active women can have heart attacks.
- Spontaneous coronary artery dissection (SCAD) is an important cause of heart attack for young women to understand.
- SCAD is the #1 cause of heart attacks in women under the age of 50.
- Most women with SCAD do not have the traditional risk factors for heart disease; this is one reason their diagnosis may be delayed.
- All women need to learn the warning signs of a heart attack, these include:
- Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes, or goes away and comes back.
- Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
- Shortness of breath with or without chest discomfort.
- Other signs such as breaking out in a cold sweat, nausea or lightheadedness.
- As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.
