Spontaneous Coronary Artery Dissection

You’re Too “Young and Athletic” (and Other Myths)

February 18, 2024

In March of 2023 I experience what I now know were a series of SCAD heart attacks. I had a range of very classic heart attack symptoms: the feeling of an elephant sitting on my chest, sudden bouts of nausea, and weakness in both arms. After a hospital stay that included an EKG, X-ray, CT scan, echocardiogram, and an angiogram as the super-fun grand finale, I was told that I have the “heart and arteries of a marathon runner”. This made some sense, since I am, in fact, a marathon runner.

I was told that I shouldn’t worry about the baffling bloodwork results that indicated I’d had a heart attack. (When I arrived at the Emergency Room, my first blood draw was cause for concern. The normal range for the high-sensitivity troponin test they administered is <= 15 pg/mL, and my levels were currently at 995 pg/mL. By the time the day was over my levels would peak at 4,008 pg/mL.)

The very cheery on-call cardiologist who discharged me from the hospital the next day kept referring to the troponin numbers as “voodoo” (I’m still not sure what he meant by that) and hypothesized that it could be a coronary artery spasm. He insisted that since I am “young” and “athletic” there was nothing to be concerned about, and I should go home and go on with my life. I had a 10th birthday party to host the next day for my daughter, so I wasn’t going to argue.

For the coming weeks and months, the only explanation from my cardiologist continued to be a possible coronary artery spasm, even though I have none of the risk factors and there was no evidence of spasm during my angiogram. I began marathon training with no issues, but the uncertainty about what had happened back in March, and the seemingly unlikely explanation ate away at me and I couldn’t let it go.

Upon the recommendation of my general practitioner, I sought out a second opinion at the Women’s Heart Center at Cedars-Sinai in October. Within 20 minutes I was diagnosed as a survivor of three SCAD heart attacks.

The real kicker: this was one week before I was scheduled to run the New York City Marathon. Since my SCAD appeared to have healed on its own and I’d spent the past six months training without any recurrence, my new (wonderful) cardiologist hesitantly gave me her blessing to proceed with the marathon – with the agreement that I would go very slowly – and that this would my very last full marathon. I immediately started on a low-dose of beta blockers as a preventative measure and had a wonderful slow-and-steady marathon retirement in NYC (while obsessively monitoring my heart rate for all 26.2 miles).

The process of wrapping my brain around this diagnosis continues, even months later. I’ve done follow-up testing which seems to have ruled out fibromuscular dysplasia (FMD) as the root cause of my SCAD. However, the other major risk factors aren’t going anywhere: I’m an otherwise healthy woman in my mid-40’s. The prime SCAD target. So, I’m learning to embrace the uncertainty, and feel grateful that I at least finally know what this thing IS, even if I may never know WHY it is.