Getting unexpectedly familiar with my heart

2 July 2024

In London for a work trip, due at three events across the city that day. I felt the burn of chest pain on rising in my hotel room. Bit weird but nothing major. It steadily got worse as I got showered, dressed and drank a brew, till it felt like the classic Hollywood heart attack looks: crushing central pain with cold sweats and nausea. I knew I needed to raise the alarm so grabbed a passing hotel guest in the third-floor corridor before I lay on the floor from the pain. An excellent choice of messenger as he bolted to reception to call an ambulance.

Lay on the carpet in pain and sweat feeling both relieved and petrified. First thought: Clara. Second thought: this might be about to REALLY hurt.

Hotel staff came to relay my details to 999 and wait with me. Managed to steer me back to my room as I asked so people didn’t have to step over crying, dying (?) woman.

Pain subsided a bit on the bed and hotel staff were brilliantly calm and reassuring. I reasoned if I can talk then I’m not having a heart attack. Not entirely convincing myself.

Paramedics arrived about 20 mins later. ECG showed bradycardia – big word for slow heart rate. I remembered it from our days on the neonatal unit.

They got me in a wheelchair then into an ambulance. More monitoring; paracetamol. Thankfully short drive to UCLH. Brendan called on the way. Aussie paramedic (‘ambo’) heard him on speaker and subsequently called me ‘darl’ incessantly (I guess once he’d ascertained I must know what that meant).

More wheelchair, then handed over to resus and put in a room with a glass wall. Something about ‘incapable of mild exertion’. I think this referred to picking up a water bottle. I told the story for the first of what would be dozens of times to a series of nurses and doctors, all with that brilliant NHS persona of knowledge and skill, laced with reassuring lightness.

Industrial quantities of blood thinners administered to blast any clots. I was told they were treating my symptoms aggressively. Continuous observation: medics to me; me eavesdropping on them, then googling what I heard. INFORMATION. Wellens Syndrome, Deep-Ts, ECG, echo, some shrugging, something something. Had a wee in a chair. Heartrate still in the 30-40 bpm range.

After an hour or two, I was moved to something called Majors for more obs. Brilliant nurse called Jabu who argued with me that my name was Nicola. A gross but appreciated tuna sandwich appeared. More repeat storytelling to several members of the medical team. Apparently this isn’t just to inform a wide range of people, it can be helpful in recalling new details each time. Brendan arrived, which made a scary situation feel much better.

After another couple of hours I was moved up a floor to the Emergency Care Unit. Took my corner bed in a ward of elderly Cockney heart patients. Abandoned business trousers for open backed pink nightie and settled in for a routine of blood tests and bleeps. Much love being WhatsApped, which helped a lot.  

Then 24 hrs of:

• ·        Blood tests.
• ·        Being told I didn’t *look* like I’d had a heart attack. And had minimal risk factors. Some chin scratching.
• ·        Being asked if I had an Apple Watch. By many staff and at regular intervals. Emergency medicine are big fans. A baseline bpm would have been very useful.
• ·        Being asked if I’m an athlete (despite appearances). My resting heartbeat is SLOW. Pretty surprising for an anxious/hiNRG old stick like me.
• ·        Learning about the gender gap in heart care from the excellent BHF website. https://www.bhf.org.uk/informationsupport/support/women-with-a-heart-condition/women-and-heart-disease
• ·        A noisy night of getting tangled in wires, having various things monitored, and trying to fashion a sleep mask and ear defenders. Bloody machines and a fair bit of shouting.
• ·        Echocardiogram. Ultrasound of my heart – cool to see my heart doing its thing.

Cardiologists came to talk in the morning.

They confirmed that multiple troponin tests had come back clear – this is the reliable biomarker for heart attack. The echo was clear. Various other measures were clear (thyroid, white blood cells, other things I didn’t understand and don’t remember). Final ruling out was a D-Dimer to track any clots:  nada.

So after ruling out all probable causes of my chest pains, my diagnosis partially crosses into the murky area of stress and related. Anxiety + low heart rate = coronary arterial spasms causing pain.

I was polite but strident when checking:

a) that the cardiologist would give the same diagnosis for a man presenting the same, and

b) that we're definitely arriving at anxiety as a final explanation after all other likely things have been ruled out (my heart is not in my head).

The cardio said yes on both counts – and conceded the real possibility of implicit bias, and that he welcomes patients bringing up the topic of gender bias in medicine. I’m glad he was that way inclined.

I was discharged around 36 hrs after the initial event. Got the train back to Leeds with some GTN spray (‘just in case’) and deep reflection on life past and future.

Parting words of the discharging nurse:

"Have you thought about getting an Apple watch?"