What does it feel like to have a heart attack?

Since my heart attack in December of 2010, many people have asked me what it felt like.  Women especially want to know.  I think we all felt a certain amount of shock that someone like me who is relatively young woman (44 at the time of my heart attack) and without history of cardiac symptoms suddenly experienced this event.  It’s scary for people to think this could come out of seemingly nowhere and strike us down in the prime of life.  Sure, I had some risk factors, but none that my doctors found alarming.  I have tended to have elevated triglycerides and a mildly elevated total cholesterol, but not high enough for doctors to agree that I needed lipid lowering medication.  I have been overweight all my life, but had lost a lot of weight and have been much healthier the last few years.  I have been able to keep my blood sugar within normal limits with this weight loss.  I did not have high blood pressure.  What I did have was stress, and lots of it.  More on that later.

Prior to my heart attack, I had no prodromal symptoms.  I felt fine, about like normal.  Looking back, I realized I did have one very brief episode of sudden onset severe pain in the middle of my chest two weeks earlier.  I had walked into the bathroom and suddenly felt the pain.  I took it for a bad case of heartburn which I have dealt with frequently since I was about 19 years old.  I took a dose of Mylanta and the pain immediately subsided.  Total duration was less than two minutes with no other symptoms, no nausea, no sweating, no pain radiating to the arm or jaw.  I decided stress was getting to me and increased my usual dose of Prilosec from once a day to twice a day.  I didn’t give it a second thought.

The night of my heart attack, I didn’t notice any problem.  I had been off work that day but was taking call that night.  I had already talked to my co-workers about how things were going and they were thinking I most likely would not need to come in to work that evening.  I was relaxing in bed, sitting up with pillows behind me watching TV.  My husband was already asleep beside me.  With no warning I suddenly felt severe pain in the middle of my chest.  After a few seconds, I woke my husband and asked him to get me some Mylanta.  I knew it could be cardiac chest pain, but thought the first step would be to try ruling out GI pain by taking the antacid.  My husband got out of bed and retrieved the Mylanta from the bathroom and then went back in to pee.  I swigged the Mylanta straight from the bottle.  The pain was intensifying even as I swallowed and I knew whether the pain was of cardiac or GI origin, I had to get medical help.  I was calling out to my husband to call EMS.  My phone was right beside me but I could do nothing but feel the incredible pain.  I could hear he was still urinating and I was crying out for him to call NOW.  The poor guy was trying to finish as fast as he could.  All this occurred in the course of 10 or 20 seconds.

As my husband called 911, I was assessing my symptoms.  I could now feel the pain radiating to both armpits.  My breathing was labored, but I think this was more a factor of dealing with the pain than being short of breath.  I could hear my husband talking to the 911 operator and they were telling him to give me aspirin.  I may have told him to get the bottle from the kitchen that we used to use for our dog, who had had arthritis in his later years before he died.

My husband brought the aspirin.  I knew I should chew it, but couldn’t stand the thought of the bitter taste so I just swallowed it, one regular 325 mg aspirin.  My husband closed our dog in the bathroom and went to open the door and wait for the firemen and EMS.  I was still sitting in the exact same place, almost paralyzed by the crushing pain in my chest.  By this point I was thinking it was the worst pain I had ever had in my entire life.  Prior to this, my worst pain had been after I woke up from a knee surgery several years before.  This pain blew it away.  By now I had tipped myself over on my side.  I desperately wanted to find a position that relieved the pain.  It made no difference and I simply lay there where I fell on the bed, kind of twisted on my side.  I didn’t have the energy to straighten myself out.  I felt tingling in my hands and a numb, tingly feeling coming in waves up the front of my neck.  I just concentrated on breathing.  It felt like the pain had knocked out that automatic function and I was having to take each breath consciously.  I could hear the sirens outside and the clomping of the firemen’s boots as they came toward the bedroom.

Over the years I had dealt with EMS many times, as a concerned friend who called for someone else, as a manager who had an employee collapse at work, as a nurse calling EMS to a patient’s home, and a couple times as a victim of car accidents myself.  I knew exactly what to expect as they came in, several big guys in blue t-shirts with red suspenders carrying big cases full of equipment.  They helped me straighten out on the bed and the lead paramedic asked me what was happening.  Another one was getting history and medications from my husband.  I described the pain and the radiation to the armpits and the tingling in my hands between deep breaths.

At this point, I will describe something that has happened to too many women (and some men).  The paramedic asked me, “Do you know why your hands are tingling?”  I felt a sinking feeling.  I recognized this man’s voice and knew what he was going to say next.  I couldn’t see, as I had my eyes closed and didn’t have the energy to open them, but I knew this paramedic.  He had responded to my home two years before when my husband had an allergic reaction and used his Epi-pen.  He said almost exactly the same thing to my husband that time.  The paramedic continued on to describe the tingling one feels from hyperventilation and to tell me that my anxiety was making me hyperventilate and tingle.

Brief time out to explain the physiology here:  When a person hyperventilates (breathes too fast) whether from anxiety or some other cause, they “blow off” too much carbon dioxide causing a respiratory alkylosis.  With the rise in serum pH, symptoms such as tingling of the hands and face, dizziness, and even chest pain occur.  I knew the tingling I was experiencing was different.  I had had an episode of severe anxiety causing hyperventilation one time many years before and I knew how that kind of tingling felt.  I was not able to explain this to the paramedic due to my extreme pain.  It was all I could do to take a breath and tell him to put on the ekg leads.  Then we had to have the “Oh, are you a health care worker?” conversation.

By this time I was becoming nauseated and beginning to retch.  I was sweating.  I have had a surgical procedure to my stomach that makes me incapable of vomiting, but my nausea became so severe I was retching uncontrollably and actually produced a small amount of bile.  This worried me because I had not come anywhere near vomiting in over 4 years.  Even when I had food poisoning I did not throw up.  This meant I was seriously ill and this guy is telling me my symptoms are due to hyperventilation.

They tried to get 12-lead EKG’s between retching episodes.  They gave me oxygen.  They lifted me onto a stretcher and carried me out to the ambulance.  I was trying desperately to control my breathing so this man would not keep talking about the hyperventilation and anxiety.  In the back of the ambulance the paramedic made 2 more attempts to get a clear 12-lead.  Then he gave me sublingual nitroglycerin.  This made no difference in my pain.  My blood pressure was too low to try any more nitro.  The paramedic started an IV and gave me medication for nausea.  I was afraid.  I was afraid we’d mess around in the street in front of my house and then I would have a fatal arrhythmia on the way to the hospital.  My other big fear was that we’d get to the hospital and the ER doctor would think I was just anxious, too.  I have dealt with an anxiety disorder for most of my life and I knew this problem was much more than anxiety.

On the way to the hospital I was given IV fluid to help my blood pressure and fentanyl for my pain.  The fentanyl finally took the edge off.  By the time we reached the hospital I was able to open my eyes and converse with the doctor and nurses.  I was wheeled into a crash room and another EKG done.  By now my nausea was relieved so I could lie still.  I remember looking up at the doctor as he read the EKG and told the staff to call the STEMI alert.  STEMI is ST elevation myocardial infarction.  I looked up at the monitor above my head and could see the pronounced ST elevation in the V lead.  The crash cart was wheeled in.  My clothes were removed and replaced with a hospital gown.  Defibrilator pads were stuck on my chest.  Within minutes the cardiologist arrived and told me he was taking me to the cath lab.  They started moving me out and my husband arrived in time to give me a kiss.  The paramedic came by and was told I was on my way to the cath lab.  I think he looked surprised.  My husband says his jaw dropped when they told him.

Next post I’ll tell about the rest of that night.  I invite you to share your experience if you have had a cardiac event.