Glenna Stearman Park, “MAY-DAY! MAY-DAY!!”

“A Beautiful Older Woman”

The ER Cardiac Routine, Again

Sitting in the comfortable wing back chair after the late evening news, I suddenly felt like wet plaster was being shoved up my neck to my jaw where it turned to follow the jaw line and move behind my ear and then spread out like a tree root system over my brain. Pain in my jaw was familiar.  I always have nitro-patches and pills in my pocket.  I immediately put a nitro-patch on my jaw bone near my ear.  The pain stopped immediately as the nitro dilated the blood vessels in my head.  I put another nitro-patch on my chest and a nitro pill under my tongue.  At the same time I told my husband and son that I needed to go to the hospital. 

Dan, my son, brought me a whole regular aspirin to chew, and Joel, my husband, brought my hospital bag which I usually kept partially packed. They called EMS, where I am a “Frequent Flier” and we were on our way. Basically the medics check blood pressure, temperature, and heart rate while doing an ECG. They offer oxygen but I do not usually need it. I do not let them put in an IV as I wait for the doppler sonogram at the hospital, which finds more accurate blood veins. I often think that the bumpy ambulance ride in a converted truck is just backwards to the Cadillac that delivers a body to the graveyard.  

In the ER, my pain is almost gone and the cardiac routine starts. Right away the phlebotomist arrives and the troponin blood tests start, about one every hour, checking to see if the numbers go up, stay the same, or decrease. Another specialist nurse with the skill of a mosquito inserts the IV line. Of course the nurse interviews me for the sequence of related activity leading up to the cardiac event. Then we wait for subsequent blood tests.  Cardiac problems usually get a 23-hour observation,  timing dictated by the insurance companies. If blood troponin (a component in the heart muscle) settles down, you go home at the end of the observation.

“Someone” Having a Bad Day

This past May,  I spent two days in the hospital and was going through paper work to be checked out. That can take several hours as the hospitalist writes a report and follow-up directions for home. I always have a book with me and I was peacefully reading when I heard the code call that indicates trouble and gets the doctors and nurses running down the hospital halls. I thought some poor bugger was having a bad day and kept on reading. Suddenly everyone was surrounding my bed and checking the electronics and asking how I felt. I said I was fine and they all said, “No, you’re not.”  I was totally unaware my heart was flipping out with rapid irregular rhythms. It was hard to believe, but they assured me that they picked up a wild rhythm in telemetry. Suddenly, I remembered that I had a heart monitor in my pocket. 

It became clear that I was not going home. They started giving me IV meds and a blood thinner. Then they started talking about doing a Watchman surgery. In this procedure the cardiologist goes through an artery to put a tiny umbrella device inside the heart, closing off a cul-de-sac area of the heart where blood flow often starts the circular flow pattern that can become a blood clot. I spent two more days on observation, where I heard several pep talks about getting the Watchman and taking care not to fall while taking a blood thinner. 

Drawings as a Diagnostic Tool

When I got home, my doctors had arranged for me to meet the electro-cardiologist who specialized in Watchman surgery. I stayed on the blood thinner and used a walker as I have had numerous falls. And, yes, I found my sketch book where I made drawings of how I feel during these frequent cardiac events. 

My first major cardiologist was the head of the department at the University of Tennessee when I lived in Memphis. I told him that my heart felt bruised. I often felt like someone was borrowing my heart for batting practice and giving it back to me after hitting it over and over with a baseball bat. I do not have experience with movie-style heart attacks. I don’t grab my chest and fall in the floor. Anyway, from my drawings he felt like I was explaining the pain better than with words. I shared my drawings with him so he could show them to his students along side his slides of scientific illustrations. 

That doctor did a cardiac catheterization and said my veins and arteries were clear, but that I appeared to have microvascular disease.* In this disease, the blood flow delivery system at the end of the line, the capillary level, is messed up.  However, it seems to continually repair itself and is a consequence of diabetes.  My fingertips and toes are purple and cold. 

I had a fair introduction to the heart and circulation because at UCSD. I worked for a bio engineer doing heart research, and I made his heart drawings. Then, I worked with doctors and medical illustrators at the University of Texas Health Science Center in Dallas. I understood the value of a drawing. 

The Various Symptoms of Heart Attacks

My cardiologist in Tennessee told me that women present with heart attacks that are often missed. My son, JT, a hospitalist in Providence, RI, says only 30% of patients present with a “Hollywood” heart attack—where they grab their chests add fall to the floor.  But 70% of both male and female patients present feeling dizzy, faint, difficulty breathing, pain in the left arm, or flu type nausea, all of  which may signal a heart attack.

One time I suddenly had perspiration making my hair wet and dripping off my face.  Several times I have had jaw pain, shoulder pain, and most commonly back pain, and just a sudden feeling of flu.  Sometimes I have the feeling of a giant tight rubber-band around my chest creating tightness or pressure but not real pain. 

I have had several cardiac catheterizations where they take cameras up the arteries and into the heart to look for blocked veins and arteries. I am free of that problem. 

Doctors identify a heart attack when the blood troponin values go up.  A heart attack is an injury to the heart muscle and leaves a bit of scar tissue. The micro-vascular problem is all over the body, including the heart and major organs.  Heart disease has clogged arteries or veins, causing a lack of oxygen that gets to the heart. The cause needs to be identified as it informs the treatment. Medications have side effects that have to be considered. But it is significant to repeat that only about 30% of heart attacks are Hollywood style, and 70% are presented with all kinds of symptoms and documented by the blood troponin test, which is repeated to see if it registers high on the scale and if it is going up. Cardiac problems often require an interim 23-hour observation, between the ER and the admission to cardiology. That 23-hour observation is often long enough to make an accurate evaluation and establish the medical recommendation. For a first time event, the patient has a longer duration cardiac admission and a number of tests. I have been fortunate to be near medical schools where the cardiologists are research-oriented and have chased my particular issues with five cardiac catheters. Each time the diagnosis and treatment is refined. 

Being Ready for – and Avoiding – Emergencies

I have learned to keep emergency medication in my pocket, my purse, and by my bed. My experience has taught me that most of the time one survives these cardiac events. I have been having these events for 30 years. Over time the doctors have refined my cocktail of medications and they have remodeled some of my heart function. One has to take the medications and stay out of those 100 degree days in Kansas and elsewhere!  Many women survive these cardiac events until they don’t.  

A follow up appointment with my regular cardiologist in the DC area convinced me that my situation in May was not urgent.  I could avoid heart surgery and the Watchman for now; the device would always be there when I needed it. 

My maternal grandmother had numerous heart attacks (now more often called cardiac events), and she lived to 101 years old.  Fortunately she had all her marbles, a good nature, read the newspaper and her Bible everyday. She played Anagrams every time she could talk us into a game and did the crossword puzzles in the Wichita Eagle. 

I have plans that will get me to 100 or longer and I am going to read banned books!

( Note:  My oldest son JT has an MD/PhD from Brown University and has been a hospitalist at Rhode Island Hospital for 20 years. He read over this report and gave me the 30%—70% stat on heart attack cases and said that women and men should be willing to get checked in an ER if they are feeling really sick or dizzy, because only the troponin blood test is the real indicator of heart attack. Women often do not have obvious warnings. )

 *MICRO VASCULAR DISEASE

February 1, 2023

    By Julie Corliss, Executive Editor, Harvard Heart Letter

Thanks to the growing use of specialized diagnostic tools, this stealth condition is becoming more widely recognized.

The squeezing chest discomfort known as angina happens when heart muscle cells don’t get enough oxygen-rich blood. Much of the time, the underlying cause is a buildup of fatty plaque that restricts blood flow inside the heart’s largest arteries. But sometimes, angina arises from problems in the network of tiny blood vessels in the heart — a condition called coronary microvascular disease.

Doctors suspect microvascular disease in people with angina who have no evidence of artery narrowing on coronary angiography. This test, which uses dye and x-rays, shows only the outline of the lumen, the inner channel of the arteries (see illustration). “But the resolution isn’t high enough to visualize the smaller vessels, where most of the resistance to blood flow occurs,” says Dr. Viviany Taqueti, who directs the cardiac stress laboratory at Harvard-affiliated Brigham and Women’s Hospital. These tiny vessels — some no wider than a few human hairs — regulate blood flow to match the heart tissue’s changing needs.

Glenna’s Icon. About the Picasso painting at the top of this story, Glenna wrote: “I love having the Picasso as a portrait of how I feel and as my concept of “a beautiful older woman.” All those angles and rearrangement of body bits hint of stories to tell about an older woman’s life.  I see Picasso’s female as a  sign that face lifts and tummy tucks are not about older  me trying to go back in time, but rather a fearless female living various life-changing moments and still having a basic humanoid presence.  I am not hotly in pursuit of the past, but definitely keeping myself present for new and continuing experience.”