'Underdiagnosed' variety of heart attack striking new moms
After the birth of her third child, Nadia Lappa, 37, marvelled at how easily she was recovering compared to her previous pregnancies — until she suffered an unusual type of heart attack while visiting her co-workers at the office with her newborn son, Nicholas.
"It started out as a regular day. I went for lunch with my friends and visited my colleagues. I was a proud mom and I wanted to show off my baby at work," said Lappa.
In April, the civil engineer was signing in at the front desk of the Transport Canada building on Sparks Street, her seven-week-old son beside her in the stroller, when she was suddenly hit with an overwhelming sense of anxiety. Pressure started building up in her chest to the point where she says it felt like an elephant was sitting on her. Her arms began to grow numb.
Despite becoming nauseous and violently ill, Lappa tried to downplay the situation as a possible allergic reaction to her lunch, or mastitis from breast feeding. But her colleagues, alarmed by her ashen appearance, dialled 911.
With sirens blaring the ambulance rushed her to the Ottawa Heart Institute where she was immediately rolled into the catheterization lab for an angiogram.
The x-ray revealed that Lappa was suffering from a spontaneous coronary artery dissection (SCAD) — a type of heart attack that occurs when artery walls tear, preventing blood from getting to the heart. Cardiologists say it's an underdiagnosed type of heart attack that primarily affects a very small group of women.
In the operating room Lappa was told one major artery had collapsed and a second smaller artery was torn. She immediately underwent an angioplasty and three stents were placed in her arteries to restore blood flow to her heart.
Apart from the physical damage, Lappa says the experience forced her to contemplate her own mortality much sooner than she ever anticipated.
"When you have a baby you're looking forward to the future and hopeful for the child, you don't think about you. You don't worry about, how am I inside? Am I going to make it? If something happens to me who will be here to raise the kids? The baby was just seven weeks old."
SCAD strikes younger women, new mothers
SCAD accounts for roughly four per cent of all heart attacks that are treated in hospital, but it overwhelmingly affects women. It also tends to strike younger victims — the average age of a SCAD patient is 50, whereas the typical heart attack patient is a 65-year-old male.
But perhaps SCAD's most devastating statistic is that it strikes hardest in women who have recently given birth.
"Patients with peripartum SCAD have a larger degree of heart attack in larger parts of the vessels," says Dr. Jacqueline Saw, the country's leading expert in spontaneous coronary artery dissection. The University of British Columbia researcher says the higher levels of hormones such as estrogen and progesterone released during pregnancy, combined with the intense physical and psychological stress of labour, can weaken artery walls.
Women are also advised against getting pregnant if they've had a previous SCAD attack because there is strong likelihood of them getting a future tear.
Saw's research also shows a correlation between SCAD and fibromuscular dysplasia (FMD), abnormal cell growth on the walls of medium and large arteries. FMD also primarily affects women.
Saw says much more research is needed and that's why she's spearheading a long-term nationwide study of SCAD patients. So far only 350 patients are enrolled in the study, but researchers are looking to sign up more.
Ottawa Heart Institute in SCAD study
Dr. Chris Glover of the Ottawa Heart Institute says the hospital is registering more cases of SCAD because staff there have gotten better at identifying arterial tears, and because angiograms are now being conducted on all heart attack patients.
"We are starting to recognize when the anatomy doesn't fit the garden variety heart attacks."
Glover says it is now routine to look for SCAD when a woman under the age of 50 goes into cardiac arrest. The Ottawa Heart Institute is one of 22 hospitals tracking patients in the Canada-wide study.
Among the patients signed up to participate in the study is Nadia Lappa. Doctors will monitor her health closely over the next few years. She will have to undergo regular ultrasounds, angiograms and CAT scans. Researchers will meticulously track her medication, and observe how long it takes her to circle the hospital's indoor track.
These days she's not moving very quickly, but three months after her heart attack Lappa has a new-found appreciation for life in the slow lane.
"I was an A-type personality and I would create projects for myself because I wanted to feel busy, but now that I'm having to convalesce, I'm enjoying the finer things like walking around the block with my kids and my dogs."
Lappa no longer takes her health for granted, and says she will never again minimize any sickness or pain she feels.
"We have to be willing to have things get checked out. Let the hospital send you home and tell you it's nothing, but go if you think something's off."
Contact Judy Trinh @JudyTrinhCBC or at judy.trinh@cbc.ca
