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The first time Michelle Wheeler, RN, met Daniel Theodoro, MD, she introduced herself, and passed out.
She reluctantly had gone to the Barnes-Jewish Hospital (BJH) emergency department (ED) June 14, 2008, because she was experiencing chest pain. Her sister had to convince her to call an ambulance, even though another sister had died of a heart attack at 43.
Then 38 years old, the ED nurse at Barnes-Jewish West County Hospital (BJWCH), thought she had pleurisy, inflammation of lung lining. “I was in denial,” she says.
Wheeler coded several times and was repeatedly resuscitated by the Washington University emergency medicine team led by Dr. Theodoro. Rebecca Bavolek, MD, then a first year resident, also was there.
“I remember because her heart would stop in front of us, we would resuscitate her, and she would wake up and talk to us,” Dr. Theodoro says. “That happened a few times. We intubated her, and when she was stable, the cardiology team took over.”
Cardiologists had to perform a sternotomy to place a stent. She also was placed on extracorporeal membrane oxygenation (ECMO), a form of heart-lung bypass.
Physicians thought Wheeler would need a heart transplant. But when they went to remove her from ECMO and place her on a left ventricular assistant device (LVAD), used as a bridge to transplant, her heart started beating on its own. “I thought she would not make it,” Dr. Theodoro says. “But I’d ask about her day to day, and she was alive.”
“It’s uncommon for women to have the kind of heart attack Michelle had before menopause,” says Lynne Seacord, MD, Washington University cardiologist at BJWCH's Heart & Vascular Center, and Wheeler’s physician. “This is the classic heart attack caused by rupture of an atherosclerotic plaque, which causes a blood clot to block the artery. This kind of heart attack is much more common in men older than 40, and postmenopausal women. Partly for this reason, young women who have a heart attack tend to have a worse prognosis than older women and men. Both they and, I’m afraid, their doctors are more likely to ignore symptoms.”
“The most common symptom in men and women is squeezing chest discomfort, which may initially occur with activity,” she adds. “This may radiate to the arm, jaw, back. It may be associated with nausea, sweating, shortness of breath, and a feeling of impending doom. Women may have less typical symptoms, including pain mimicking indigestion, exertional shortness of breath and fatigue. The chest pain of a heart attack is not worse with a deep breath, or with movement of the torso. Any chest discomfort like that should not be ignored.”
After she went home, Wheeler had to return to the hospital when she started bleeding internally and have a chest tube placed. When she was recovered enough, she participated in cardiac rehabilitation at BJWCH’s Sports Therapy and Rehabilitation Center (STAR). She returned to work four months after her heart attack.
Today she stays healthy by taking medication, cardiovascular exercise, a healthy diet and following Dr. Seacord’s recommendations.
“Everyone should work to have a heart healthy lifestyle,” Dr. Seacord says. “Heart disease risk factors including smoking, high cholesterol, diabetes, sedentary lifestyle, obesity and high blood pressure, are in large part modifiable with lifestyle and medication.”
Wheeler has worked for BJC 23 years, and at BJWCH 14 years. “I love the sense of community here,” she says.
About three years after her heart attack, that community expanded when Dr. Theodoro began covering emergency care shifts at BJWCH. “Michelle walked up to me and said: ‘Do you remember me? You saved my life,’” he says.
“It’s neat working next to him,” Wheeler says. “He is fantastic. I lucked out he was there when I had my heart attack. One of the best happened to be working that day.”
In 2014, Dr. Bavolek, now at the University of California Los Angeles (UCLA), also began shifts at BJWCH. “I had kept somewhat updated on Michelle and knew that she made a miraculous recovery,” she says. “In emergency medicine, you don’t often get to see the outcomes of your effort. It was pretty amazing to get to work with her. I’m the director of the UCLA emergency medicine residency program, and when there’s chaos, and we don’t think we are making a difference, I tell the residents about Michelle.”
“Michelle’s story picks you up and keeps you going through the hard times that our job entails,” Dr. Theodoro says.
“Giving people hope” is why Wheeler shares her story. She supports the St. Louis Metro Heart Walk because it raises awareness and research funding. “Without research, I wouldn’t have made it,” she says. “Cardiac disease is a killer, and we must continue to research and educate the medical community and public.”
“It’s been recognized that women, especially younger women, are at risk of heart attacks from previously unrecognized, and still incompletely understood causes,” Dr. Seacord says. “We’ve known for a long time that women who present with typical symptoms of angina are often found to have normal coronaries on a cardiac catheterization.
Historically, women were told that their symptoms weren’t from their heart at all, yet these women continue to have debilitating symptoms and repeated hospitalizations. It’s now understood that many of these women may have a form of heart disease called microvascular coronary disease. In these patients (mostly women), the large arteries on the surface of the heart look normal, but they have problems with the auto-regulation of blood in the small arteries in the heart muscle. A lot isn’t yet understood about how best to treat this population.
Another important, though rare, cause of heart attack in young women, is SCAD, or spontaneous coronary artery dissection. This tearing of the lining of the coronary, resulting in chest pain and heart attack, is common in women around pregnancy. These women may have problems with anatomic abnormalities in other arteries of their bodies.
Male or female, it is important to know the warning signs of a heart attack and what to do if you think you or a loved one may be experiencing one.
For a referral to a cardiologist or another medical specialist, call 314-542-WEST (9378) or toll-free 844-542-9378 or search to find a doctor that meets your needs and preferences.