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Heart Attack at 43

Women’s symptoms are often dismissed—with dangerous consequences

Think heart attacks don’t happen to women under 50? Think again... or talk to Rebecca Jakubowski of Hainesville, Illinois. At the relatively young age of 43, she experienced a serious heart attack.

Expert care from Northwestern Lake Forest Hospital’s cardiology team and Northwestern’s Bluhm Cardiovascular Institute is helping to manage her heart disease. Now, Jakubowski wants all women to put their health first and learn about their risk factors—before it is too late.

 

An Early Warning

Jakubowski has worked as a reading specialist at Oak Grove School in Green Oaks for nearly 20 years. She and her husband Paul have three children, Megan, 15, Katie, 13 and Tommy, nine. Although she has been healthy most of her adult life, she admits to gaining a few pounds over the years, and she often puts work and family before her health. When a primary care physician became concerned about her cholesterol reading of 245 (over 200 is high), Jakubowski turned a deaf ear.

“I felt fine, and there’s no history of heart disease in my family,” she says. “So I told my doctor, let’s make a deal—I’ll lose the weight, and we hold off on medication.”

But Jakubowski never did lose the weight or pursue the matter further. Heart disease is the number one cause of death in America, and the “silent killer” reveals no symptoms until moments before an attack. Like many, Jakubowski had little knowledge about her own heart disease risk.

 

Women’s Symptoms Often Dismissed

“If Becky had been a man with the same risk profile, most physicians would have ordered some further cardiac testing,” explains Ian Cohen, MD, a board-certified cardiologist and medical director of cardiology at Northwestern Lake Forest Hospital. “However both patients and physicians tend to devalue younger women’s symptoms. Heart disease is often the last consideration, especially when risk factors are associated with vague or atypical symptoms.”

Dr. Cohen explains that in fact many younger women do have heart attacks, and since the 1980s more women than men have died from heart disease each year. It is not just about weight and cholesterol—a range of factors and underlying conditions put women at risk.

 

Time Runs Out

Things began closing in on Jakubowski on Labor Day weekend, 2011. Visiting her hometown for a class reunion, she felt short of breath climbing the stairs at the event. She was also nauseous and felt pain in both arms.

“I ate a half bottle of antacid, convinced I picked up the flu that was going around my school,” she recalls.

Jakubowski stayed home from work for a day, and her symptoms cleared up except for shortness of breath. She stopped into a pharmacy clinic, thinking she might need some treatment for her breathing. To her surprise, she was advised to go to an emergency center immediately. At the Northwestern Grayslake Emergency Center, an electrocardiogram was performed and Jakubowski learned she had a heart attack. She was taken to the intensive care unit at Northwestern Lake Forest and seen by Dr. Cohen.

“I suspected that one of Becky’s arteries had completely blocked, probably days or weeks before she arrived,” says Dr. Cohen. “We could have performed an angiogram and angioplasty here at Northwestern Lake Forest Hospital, but I felt that, as the artery had probably been blocked for some time, there was a good chance that a bypass surgery might be required. I chose to transfer Becky to Northwestern Memorial Hospital so that if surgery was required after an angiogram, it could be done in one admission.”

“If you’d told me at the time that I was having a heart attack, I’d have laughed,” says Jakubowski. “I’ve always pictured the ‘Hollywood heart attack’—you clutch your chest and stagger around. Now I know that symptoms are different in women, and they can even go away.”

 

Dismantling the Bomb

A cardiac MRI and other tests at Northwestern’s Bluhm Cardiovascular Institute proved Dr. Cohen exactly right: Jakubowski’s artery was completely blocked. Before attempting to open the artery with an angioplasty, further testing was performed which revealed that Becky also had an undiagnosed blood clotting disorder that likely aggravated the blockage.

But how did she survive the heart attack, and continue her activities for days afterward?

“Becky was incredibly lucky,” explains Dr. Cohen. “Her artery had probably narrowed slowly before closing completely. This slow progression allowed another artery on the back of her heart to grow in feeder vessels called ‘collaterals’ that helped maintain some blood flow to the artery that finally closed down. These small collateral vessels prevented a massive heart attack, but did not supply enough blood for her to feel normal. Her heart function was also quite weak due to the heart attack. She was a ticking time bomb, and things might have been different without timely expert care.”

A specialized cardiac MRI confirmed that the collateral vessels supplying the blocked artery had prevented a complete injury to the heart muscle, and the injured muscle was likely to recover if blood flow was restored. Keith H. Benzuly, MD, an attending cardiologist at the Northwestern Memorial Cardiac Catheterization Laboratory and the Coronary Care Unit, was able to open the blocked artery via an angiogram procedure (insertion of a catheter to restore blood flow in the artery) and place a stent across the blockage to keep the artery open. At Becky’s last follow up, an echocardiogram of the heart (a noninvasive test) revealed that her heart function had indeed improved.

Thanks to the seamless integration between Northwestern Lake Forest and Northwestern Memorial, Drs. Cohen and Benzuly were able to take a team approach: they discussed the appropriate tests and procedures for Jakubowski and arranged for follow-up care in Lake Forest.

“A heart attack is not fun; it’s scary, and you feel bad,” says Jakubowski. “But between Northwestern Lake Forest and Northwestern Memorial, I had this full-service experience. I liked not having to make all of those decisions or coordinate between different hospitals. Dr. Cohen arranged everything, and I could stay with the same doctors even after I left the hospital.”

 

First Steps Toward Wellness

The best heart care programs do not simply send patients home with medication—they provide effective options for long-term wellness. After her release, Jakubowski was able to receive rehabilitation close to home, in Northwestern Lake Forest’s advanced cardiac rehabilitation program.

“It was absolutely the best thing for me,” she says. “I was afraid of everything—afraid of moving or eating the wrong thing. But the cardiac rehab staff was great. They educate you about diet and exercise, cheer you on and offer a lot emotional support.”

Jakubowski appreciated spending time with others who had similar heart experiences; she developed a bond with the support group and came to rely on them. She also observed that at Northwestern Lake Forest “everyone knows everyone”—physicians worked as a team with rehab staff, nutritionists and other clinicians to ensure the best possible outcome. And since cardiac rehab, Jakubowski has achieved a steady decline in her weight.

“I thought cardiac rehab would be just about working out, but you get great ideas about healthy foods and how to develop new habits,” she says. “They’re going to have to kick me out when I’m done. I learned so much, and I’ll miss their support.”

 

Teacher Learns a Lesson

Today, Jakubowski is back teaching, eating well and checking in with Dr. Cohen. But the heart attack, and what it might have meant for her family, is still fresh in her mind.

Both she and Dr. Cohen have the same advice for other women: educate yourself about your individual risk factors for heart disease and discuss possible cardiac screenings with your PCP. Never dismiss or underrate how you are feeling. Take time for yourself, even if you are taking care of others. And if you experience any symptoms of a heart attack, don’t wait—call 911.

“When I first heard my diagnosis, I broke down crying,” she recalls. “But Dr. Cohen assured me that he and his colleagues do these cardiac procedures all of the time, that I would get through it and be stronger for it. There was an incredible amount of compassion and support. Thanks to my team of doctors and the cardiac rehab staff, I’m alive—and I intend to live a long time.”

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