Out of nowhere, a heart attack


Looking back, Jessica Miller can’t fully explain why she made the turn on Route 2 and walked into the Emerson Emergency Department (ED) last June. In fact, she can’t remember much of what happened that day. She was told later that she mentioned having reflux — discomfort in the upper GI tract that can develop after a meal. The Acton resident then drove east to pick up her husband in Cambridge. What saved her life was that she decided to instead go to the Emerson ED.

Mrs. Miller was informed later that she told the nurse at the front desk she was having chest pain and needed an EKG; an electrocardiogram can quickly diagnose a heart attack. “I was told they took me right in,” she says, “but I can’t remember it.”

Emily St. Germain, a patient care technician, was applying the leads to Ms. Miller’s chest when she lost consciousness and slumped over. Ms. St. Germain and Sharon Lamont, PA, quickly moved Mrs. Miller onto a stretcher and raced into a trauma room while calling out for Laura Frank, MD, an emergency medicine physician who was nearby.

“Her heart and lungs had stopped,” says Dr. Frank. “Jessica was essentially dead. We used a combination of medicines, electrical current and CPR, which brought her back. Once her heart was pumping on its own, there were EKG changes consistent with the most serious type of heart attack. She did not regain consciousness and remained extremely unstable.” Mrs. Miller seemed young to have suffered a heart attack. She was 39 at the time.

Dr. Frank decided to call Boston MedFlight, a helicopter service that specializes in the quick transport of unstable patients. Mrs. Miller needed to get to a cardiac cath lab; if one of her coronary arteries was blocked, it could be reopened with a catheter.

Later that day, Dr. Frank learned more: Mrs. Miller had suffered a heart attack due to spontaneous coronary artery dissection (SCAD), when the artery wall is torn and blocks blood flow to the heart. No intervention was performed, as the artery wall can heal on its own. SCAD tends to occur in relatively young, healthy individuals, the majority of whom are women.

Mrs. Miller fit that profile, but there was another element to her story: she had given birth three months earlier. During the postpartum period, women are vulnerable, perhaps due to hormonal changes and stress on the body. “We now consider SCAD to be a complication of pregnancy, similar to gestational diabetes and pre-eclampsia,” says Dr. Frank.

“Jessica’s case was one in a million,” she adds. “If we didn’t get oxygen to her and CPR started when we did, she would have suffered brain damage. If she hadn’t pulled into Emerson when she did, Jessica would not be alive today.”

Learning to get beyond the anxiety

That fact was difficult to comprehend when Mrs. Miller woke up in an ICU a couple of days later. “I thought ‘what am I doing here?’” she recalls. “I was so shocked.”

After spending a week recovering from the trauma she experienced, Mrs. Miller — a pharmacist who was on maternity leave at the time — went home to her husband, three-year-old daughter and three-month-old son.

“I was happy to be home, but I had to deal with the worry that I would never be back to normal. I began to understand that I was a perfect storm for SCAD: postpartum, not getting enough sleep and pushing my body.”

She returned to the Emerson ED a few weeks later with heart palpitations. Robert Partridge, MD, who had been there the day Mrs. Miller came in and so was familiar with her case, checked her thoroughly and, more importantly, took time to talk with her and reassure her. She returned again with symptoms that troubled her, but the former runner was found to be fine. From there, she has steadily recovered, with plenty of support from family and friends.

“I was encouraged to enroll in the cardiac rehab program at Emerson,” Mrs. Miller says. “First they ask what your goal is; mine was to run again without fear, but at the time I couldn’t imagine getting my heart rate up. The mental part is harder than the physical recovery.”

Cardiac rehab staff understand completely. “We know that when someone has a rare condition, they have reason to worry,” says Virginia Dow, RN, who worked closely with Mrs. Miller, along with Esther Burchinal, an exercise physiologist. “We’ve guided several SCAD patients through the early anxiety.”

Mrs. Miller got to where she could exercise without wearing a heart monitor and, after graduating from cardiac rehab, signed up for the maintenance program. She is slowly beginning to run again. “I still think about what happened every day, but meditation and yoga are helping.”

Dr. Frank considers Mrs. Miller to be one of those unforgettable patients. “She knew something was wrong, and she did the right thing. I tell patients all the time: if something seems totally abnormal, get to the ED.

“When a patient is found to have nothing wrong and says to me, ‘sorry I wasted your time,’ my response is: ‘I am happy to tell you that you are fine, but it’s my job to find out if you are not.’”

Mrs. Miller is grateful. “All I know is that I went to the Emerson ED that day, and I had a dream team taking care of me,” she says. “I have another dream team in cardiac rehab. I feel like the universe had my back that day.”

What is SCAD?

As spontaneous coronary artery dissection (SCAD) is studied, a clearer picture is emerging. Individuals who have connective tissue disorders are at risk, as are women during the postpartum period.

  • The average age of patients is 42 years old; the vast majority are women.
  • Among women under the age of 50 who suffer heart attacks, SCAD is the cause in 40 percent of cases.
  • At least 15 percent of cases occur to women who are in the postpartum period.
  • SCAD patients tend to be healthy with no risk factors for heart disease, such as diabetes, being overweight or smoking.
  • Repeat episodes of SCAD occur in about 20 percent of cases.
  • SCAD symptoms include chest pain or discomfort; shortness of breath; pain in the arms, back, neck or jaw; and nausea, lightheadedness and sweating.