Chest Pain: Her Wakeup Call

Angina, Healthy Heart
on February 3, 2009
Gary Bogdon

Holly Jacobson felt dizzy and faint, her heart racing. The irony: The then-23-year-old mom from Clermont, Fla., was on duty as a cardiac nurse. Her colleagues slapped a heart monitor on her; her heart was pushing 200 beats a minute, not the laidback 75 typical for women. She had mitral valve prolapse, the cardiologist told her, meaning the valve wasn’t closing properly. It scared her, but Holly took medication and was fine until 8 years later, shortly after her sixth son was born. Suddenly, she couldn’t breathe, her heart pounded, her chest filled with pain.

This time she was diagnosed with cardiac syndrome X—not mitral valve prolapse, after all. People with cardiac syndrome X, better known as microvascular angina (MA), experience pain similar to that of a heart attack without the arterial blockages associated with coronary artery disease, says cardiologist Dr. Frank Smart, chairman of the department of cardiovascular medicine at Morristown Memorial Hospital in Morristown, New Jersey.

Despite the fact that MA patients are not at increased risk of heart attack, the kind of crushing chest pain that Holly felt was frightening. Not only that—since the pain typically occurs after physical activity, this busy mom didn’t want it to cramp her style.

Holly’s doctor prescribed a treatment called EECP (external enhanced cardiac pulsation) to increase blood flow to the small branch vessels in and around the heart where her pain most likely originated. It worked. Now symptom-free at age 44, Holly keeps her heart healthy by lifting weights and walking two miles a day, but mostly by running around with her six sons.

“When I had the illness, it awoke me to fragility,” says Holly, who quit nursing to homeschool her sons, ages 4 to 13. “It helped me realize that no one has the assurance of even the next hour, so I have to make every moment count.”

She does that by asking herself daily, “How do I want the boys to remember me: as a mom who couldn’t stand anything out of order? Or do I want this to be a joyful time?” The insight she gained from her heart scare also changed her marriage. She and her husband, Mark, don’t focus on the small stuff anymore. “Every marriage has petty arguments,” Holly says, “but now I stop and think, ‘This is stupid.'”

Of course, she’s no saint. Twenty-four/seven with six boys can fray nerves, not to mention the furniture. “Boys have a sound effect for everything,” Holly says. “And I have the opportunity to get really frustrated. But I know the day will come when the house is silent, and I will wish that I was hearing those noises. So, I say, ‘OK, let’s be quiet and then we’ll go outside for 20 minutes.”

For now, Holly knows she’s doing her part at staying healthy, at creating great memories for her kids and even keeping her hand in a little cardiac venture: “I’m working on six little hearts right now.”

The Angina Files

Microvascular angina (MA) waltzed into the spotlight when singer Toni Braxton was diagnosed with the condition just before her run on ABC’s Dancing With the Stars. But the problem is nothing new, says cardiologist Dr. Frank Smart. The condition is more common among women than men, but Smart says it’s likely to be underdiagnosed. That’s because no single test exists to detect the problem; doctors have to rule out other heart issues before arriving at a diagnosis.

The standard treatment includes prescription drugs like statins; EECP, or external enhanced cardiac pulsation, is also emerging as an option. With treatment, Smart says, there’s no reason why people with MA shouldn’t dance—or quarterback a game of touch football, like Holly Jacobson has been known to do with her six sons.

If you have chest pain, don’t ignore it, Smart says, and if your doctor can’t find a reason for it, ask about MA. “If you don’t get a satisfactory answer, get a second opinion,” he adds.