The Dr Louise Newson Podcast - 161 - Jill’s experience of heart attacks and hormones

Episode Date: July 19, 2022

Until a few years ago, Jill was in denial about her age, the menopause and what that meant for her future health. She had worked for 30 years as a fitness instructor and sports massage therapist; she was incredibly fit and had never given her heart health a moment’s thought. This abruptly changed in 2021 when Jill had sudden and severe pains in her chest and after some doubt and misdiagnoses by the medical team in A and E, she was found to have had at least one significant heart attack, possibly more. Since then, Jill has had ongoing intermittent chest pain, especially when having hot flushes, and she realised her continued cardiac symptoms were potentially linked to her changing hormones. Dr Louise Newson explains the link with estrogen deficiency and cardiac symptoms, and the increased risk of heart attacks after menopause. Together they discuss gender bias in heart research, the difficulties diagnosing heart attacks in women, the possible reasons for poorer outcomes compared to men and the cardiovascular benefits of HRT. Jill’s 3 tips to women if worried about your heart: Listen to your body, you know it best Do your own research, such as balance-menopause.com, Blood Pressure UK, British Heart Foundation websites Have someone with you at appointments, or over the phone if not in person If you know there’s something wrong with your heart, ask for a troponin blood test You can read Jill’s story here

Hello, I'm Dr Louise Newsome and welcome to my podcast. I'm a GP and menopause specialist and I run the Newsome Health Menopause and Wellbeing Centre here in Stratford-Bron-Avon. I'm also the founder of the Menopause charity and the menopause support app called Balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based, information and advice about both the perimenopause and the menopause. So today on my podcast, I've got someone called Jill, who yet again, like many of my guests, I've never met real life, but I have read her story. And really it resonated with so many stories that I've heard over the

years from the clinic. So I'm very grateful that she's come to share her story and talk more about how we can improve awareness about the perimenopause and menopause in other areas of medicine including cardiology. So welcome Jill today. Thanks ever so much. Thank you and it's such a privilege. It's so exciting. I get to meet and speak to Dr. Louise Newsom. It's brilliant. Oh well, there isn't really much special about me. I've just got a mouth and I want to try and help more women. But it's a joint. We're doing it together with lots of people including yourself. So tell me a bit about you if you don't mind and if I'd said to you a few years ago you're going to come onto a menopause podcast you probably would have said no maybe would you and it's not lost on me the irony that I never ever wanted

anybody to know my age that you know when I was internet dating I never gave my I always knocked a few years off yeah and I would never I just blocked out the menopause completely and utterly blocked it out. And I think that's one of the big difficulties in spreading information about it because even someone like me who's an anatomy nerd, I don't want to know I'm getting old. No, of course. No, absolutely. And you're right. And what's very interesting, I think, with the menopause is, well, two things actually. One is that it can affect any age. It doesn't have to be associated with old. But also the second thing is it's often something we don't think happens to us. And even when I remember sitting there.

in a clinic quite a few years ago and saying to the consultant, how do you recognise the perimenopause? He said, Louise, it's just obvious you'll know when it happens. And it was literally around that time that my memory was terrible, my mood was awful, my migraines were worse. But I just thought, that's not me. Why would I be perimenopause at age 45? Of course, there's every reason that I would be. But I think as women are often in denial as well, aren't we, even when we've got the facts. Absolutely. And it was, I had another issue. 2014-15-ish but in 2019 I was back in the gym I had an excellent trainer who was helping me because I've been fit all my life from the age of five I was dancing I did gymnastics

ballet badminton you name it I did it and I've been like that the way that I was brought up my mom and dad were like that it was just normal for us to exercise. I feel really grateful for that because it's not a chore. It's part of my life. It's just what I do. So for 44 years, I've been fit. My job from the age of 22, I think it was. I was a fitness instructor, full-time personal fitness trainer, then sports massage therapist. I organized the aerobic classes and a number of health clubs so that you can imagine my brain amazing yes know exactly where 25 aerobic teachers were at one time and in 2019 i was doing a plank in the gym and i looked to the right in the mirror and i saw my tummy sag and i thought oh my

God, I'm not actually engaging my core. And then I realized I was engaging my core. And it was the skin. And in 2000, end of 2018, 19, I met my current partner. And I said, oh my God, I've never actually had that before. And he said, everybody has that. I was like, I don't. This is new. And for me, that was the first sign that my body was changing. no matter what I had done in the past. And that was another reason I was a bit freaked out. And I thought, no, I'm not impressed with this idea. But I've always been fit.

And then my jobs as a sports massage therapist, obviously that's a very physical job, always very strong. When patients come into the clinic and they see me, they're like, well, you're not going to be very good, because I'm small. Yes. But, you know, I'm mighty.

So the thought of A being Perry and menopausal, I was in complete denial about that. But if you had said to me a couple of years ago, you'll have had a heart attack. That's like, what? No way. That's madness. That's madness.

So tell us what happened then. February 28th. 2021, I had a sudden pain in my chest, which made me have to sit down. But after about 15 minutes, it kind of went away. And then because it was lockdown and there wasn't much else to do, my partner and I went for a drive. I did have a feeling of worry, which was within my body. it wasn't a conscious worry. And then a couple of days later, after I'd meditated, whilst I was having a cup of tea,

I had a much bigger pain in the chest, which brought me to my hands and knees. My partner was on a work call at the time, so he was like, what are you doing? And I said, I don't know. So my breathing was shallow. I had a pain in my chest. chest and that lasted a severe pain for about half an hour and then I just sat there and the chest

pain continued at maybe five out of ten and because again neither Cameron nor I would ever think that I would have had a heart attack Cameron said shall we see if we can walk it off and just for the record people it doesn't help so you're having chest pain in denial about having anything serious going on with your heart and you went for a walk. Most people would have called an ambulance by this day. So then what happened? So after about 10 minutes, I thought, no, this isn't a good idea. And I went back home and just rested.

And I kept thinking maybe it's a muscle spasm, but I'm not sure. But I managed to, again, because it was COVID and lockdown, I thought to myself, if someone like me, you know, I'm small, I'm fit. If I walk into A&E in the middle of a global pandemic, I'm walking, talking, breathing, kind of. I'm not bleeding. They'll just, they won't. So I just carried on with my day,

went and did the shopping for my dad, took it up to his flat. And then later on in the afternoon, Cameron, And thankfully, he has private health care through his work. So he got me a GP appointment, a virtual GP appointment, but that wasn't until half past 10 at night. And by half past 10, the other thing that is actual reality is that impending feeling of doom.

Yes, which is very common actually for people that have heart attacks. I've seen many people over the years and they do have this. So then what happened? So I actually, by that time, I called Cameron over to my house for the appointment. And the GP, like yourself, said, why are you not at A&E? And I repeated what I've already said. I would have been taking up time. It's a global pandemic, et cetera, et cetera.

And she said, go to A&D now. So we did. And as I anticipated, with chest pain, you are. taking straight to the top of the queue, but interestingly, the ECG is normal, the oxygen levels are normal, all my vitals are normal, so by now, as I anticipated, because I've not had great experiences with some NHS care, they don't believe you. They do not believe you. Once they've done your blood pressure and your ECG and it's beating, my heart was beating. I did not have a Hollywood style drama, you know, I'm loath to say it, but I'm going to,

male type heart attack. Yes. I wasn't screaming going, my God, I'm going to die. I was just saying I have a pain on my chest. It's been there for about 11 hours. and I'm really, really worried. It did refer just up to the side of my, just up the side of my neck a little bit to my ear.

So then they took me through once I'd managed to get through triage and that was a bit of a fight. I was then in A&E for about three hours. They did take blood tests. You know how when you're in A&E, you have to repeat your story about three. 300 million times, 300 million different people. And eventually the last doctor who was going to discharge me told me that I had gastritis.

Oh, dear. So again, if you're not that balshy and you're not that confident and you're not feeling very well, that's really difficult. You'll just say, okay, that's fine. Cheers. And because it was a COVID pandemic, my partner wasn't allowed in the hospital. So he's sitting outside in the car park. I phoned him to say, it looks like I'm getting out.

I've got gastritis, but I know it's not gastritis. So then what happened then in the end? How did it, was it diagnosed? Then she went away and she said, I'll go and get your bloods. And when she came back with the bloods, she was apology personified. She said your troponin levels have been elevated and you have had at least one, if not two heart attacks. And within about two minutes, my cubicle was full of so many people doing things. So, and this is, we'll go on to what happened in a bit.

But actually, this is very important because we know that a lot of research in heart disease is done in men. And a lot of it is then transferred into women. And in fact, when I was at medical school, as you might know, I had no menopause training. But I was taught that women are less likely to have a heart attack than men. Absolutely right when they're younger. women. And I was taught that this is because estrogen protects the heart system. So that was good. But no one actually told me that menopause was an estrogen deficiency and low estrogen increases risk of a heart attack. The second piece of the jigsaw wasn't told, or I didn't

learn until 25 years later, in fact. But actually we know that. So we know that, but once women become perimenopausal or menopausal and hormone level, especially estrogen, but probably also testosterone decline, then women are more likely to have heart. heart disease, more likely to have a heart attack, but also they present in a different presentation, you know, this central crushing chest pain radiating to the jaw or down the left arm, very classic for men having heart attacks. Women don't have it in the same way. And, you know, although you were having some features suggestive of a heart attack, there are other times people just feel a bit lightheaded. They feel a bit dizzy. They don't feel the same. And we're not taught that at medical

school. So all, and the clinicians you would have seen probably weren't taught that either. And so it's very hard to recognise a heart attack in women. But we also know, and I'm sure you do as well with your extensive reading, that women who have a heart attack actually have a worse prognosis compared to men. And is that because they're left longer? Is that just because they're not picked up? Or actually, is there more inflammation and problems going on? And we don't know because, I don't know, you might tell me How much research is done on women and heart disease compared to men and heart disease? It's very different, isn't it? It's very different.

I have got to quote somewhere from somebody who said that the majority of heart research is done on men, which is then sexist because what happens when a woman has a heart attack. Yes. And the final doctor who was a woman of probably menopausal age, she said, you are the quietest heart attack patient I have ever seen. And I'm going to go up to the acute medical unit and warn them. Very good. So that was good.

That was good. But the other thing, I haven't been able to get in contact. but there is a professor Colin Berry who was quoted in a newspaper and he's at Glasgow University and he said when he's at medical school they are taught that you have a heart attack if you have a blockage and they're not taught about anything else now I'd not been able to contact him to verify his quote but that is what he apparently said. So when a woman presents with no blocked arteries, they don't know quite what to do with you. So, yes. And this is very interesting because a lot of people, it is an atheromus and buildup, a fearing of

the arteries and the clock goes and causes blockage. But for a lot of women, I was taught at medical school something called syndrome X, where you get spasm of the arteries. And the spasm then causes the narrowing, but it's not a blockage. And so there's a lot of, and so there's a lot of, lot of women who then have investigations and told, well, you haven't got any blockage. You haven't got any disease there. So therefore, you're fine. And I've seen a lot of women over the years who have had very classic chest pain angina when they've been cycling or exercising. But their cardiologists have said, well, they're fine. You haven't got a structural problem. Exercise through it. Well, they can't. They're in absolute agonizing pain.

And we know that actually giving estrogen can help relax the arteries, cause some basodilation, so make them more relaxed bigger, really improve symptoms. But people have been very scared of giving hormones to women with heart disease for the wrong reasons, actually. So fast forward, you've had your heart attack. And then what happened? And then it was, I was lucky with that in that the guy who did the angiogram, again, I'm unfortunate, I don't know his name, because he was brilliant. I think he already knew about SCAD. Because he was, Because he said there is a type of heart attack that affects younger, healthy, fit females. Yes.

And when they did the angiogram, I heard him over the screen going, look, there it is, there it is. So a scad is short for spontaneous coronary artery dissection. That's right, yeah. When an artery spontaneously tears or bruises, they haven't decided which comes first. and they saw it. Now, yes, I had that. It was healing within a week because I took part in a research thing and they had a look and it was healing within the week. But it was after that that I continued to have ongoing cyclical chest pain. And initially that can be in my head, it's like, well, I've torn something in my heart. So it's going to take time.

to recover. But because of the, when I say hot flushes, that's a real general, general, general description. When I had a hot flush, my heart really got involved in the party. So I would start to feel a bit of a warmth and then my heart rate would get faster and faster and faster. not because I'm anxious. It would just get faster and faster. And then I kind of like pass out. My body just goes, no enough, we can't do this. And then I realized that the hormone issue and the heart issue for me had to be related.

Yes. They had to be. And then I did end up back in hospital about 10 days later. but because they see, I've been in Ward 109, a heart ward, as long as my heart's fine, they then said, we don't know what's wrong, we don't know what happened, because one of those hot flush things lasted about three hours. He said, we don't know what that was, but it's not your heart so you can go home. That's great, thanks.

And then the 5th, 6th of June, I had another big bang, I call it. I had another big bang, which felt exactly the same as my scad heart attack. So Cameron was there. He called the paramedics. I'm on my hands and knees again. But within about 20 minutes, it had passed. And to me, this is my self-diagnosis. Nobody's confirmed it. To me, that was definitely a spasm. When I got into hospital, they did take my troponin levels, they kept me in again overnight. And my tropon levels were nothing like what they were during the heart attack, but they did have a curve. So through my research, I've now learned that if there is a curve, they call it a delta curve, that needs investigation. And after that

episode, a really lovely cardiac registrar decided to give me a GTN sprint. And, and after that episode, a really lovely cardiac registrar decided to give me a GTN spray. That was then what led me to research what a GTM spree was for. So yeah, so those that you're listening, it's glycerol trinitrate, which actually just causes some dilatation of the arteries and can really make a difference. So going forward, is anyone giving you any HRT at all? Have you had any hormones? Yes. I had emailed the clinic after the Devina program. I'd emailed the News and Clinic because I was at that point, I think it was about me. I've not written that down. At that point, I knew that there was something hormonal happening with my heart.

So I thought, I wonder, so I sent an email and I had an appointment at the end of July. And then on the 6th of June, I had that other massive episode. And I sent an email to the clinic and a wonderful member of your staff called Sally. She was lovely. I've written her name down. So she got me an appointment the next week due to the severity of the issue. And I started estrogen and progesterone

and within two and a half weeks, my heart issues had resolved by 80 to 90%. Wow. Like that. And what did your medical team or the cardiologists say to you? Do they know about it? They don't care. They don't care.

No. What have they said? then? I did have a follow-up. My first appointment with a cardiologist was sometime in June. And when I asked him the questions, I spent four hours preparing for that appointment. And he said, your symptoms will be something else. There's nothing wrong with your heart. And when I asked, for example, when I asked, she dies, take aspirin. He said, well, you can if you want many people do. So that wasn't brilliant. So then I did have an appointment with the SCAD specialist. There's only one in the UK. But unfortunately, their line is if you can get through the menopause without HRT, all the better. And if you have to

have it, the lowest dose for the shortest period of time. So that's very disappointing, isn't it? So that was disappointing. So I then the positive bit, it's not what you know, it's who you know, a friend of mine, her wee brother is section head of vascular medicine at the Cleveland Clinic, Ohio. And he was kind enough to have a chat with me. I must say it was not an appointment. I don't want to get him. It was not an appointment. We just had to chat with my pal's brother. And he explained everything to me and showed me papers, like changes in estrogen are independent predictors for Minoka, for myocardial infarction with non-obstructive coronary arteries. Now that's amazing.

And this is exciting. In comparing women who have Minoka to women who have an atherosclerotic normal heart attack, the difference is that in Minoka there is a dysregulation of the estrogen receptors. And that was in a paper predictors for myocardial infarction with Noka, paper by Barrett T.J. at New York University. And that was in 2018. So the information is they don't yet know why women are more predisposed to it, but the majority of patients are women. And I think the fact that 90% of SCAD patients are women with an average age of 44 to 53. Yeah. Well, this begs a question with so much, doesn't it, in what I'm trying to unearth and show. And common sense has to prevail

with a lot of this. So, you know, we see increasingly people who've had SCAD, spontaneous carotid archery dissection. And even when I was doing a cardiology job many years ago, we saw lots of women with it, but never put the pieces together. So it's really important that we do research in this area. But it's also really important that women are not denied HRT and certainly do not need to have it for the lowest dose, shortest length of time. Estrogen is very anti-inflammatory in the endothelium, the lining of the blood vessels, can help the conducting system of the heart,

but it also can help build the collagen. It can help support the vascular tissue. So people are less likely, I'm sure, to have a dissection. And then we also don't know enough about testosterone, and we know women with low testosterone are more likely to have heart disease. That doesn't mean replacing, reduces the risk, but we don't know because no one's done the studies, but certainly testosterone has a very beneficial effect in men

on their heart disease risk, and so it is likely to have an effect on women. So we certainly need to do so much more in this space, but I think the sort of learnings from you being so open and thank you very much about your story is thinking about heart attacks in women are not a typical presentation, and it's really important if anybody or anyone you know,

is having some symptoms that aren't right that could possibly be a heart attack. Do not go for a walk. Do not book into a doctor when you can. Regardless of whether there's a pandemic or not, you have to. So that's very important. But then also it's about if someone has had heart disease when they're being told about what could be causing it. And if SCAD comes up or anything else,

syndrome X something else, or just angina for unknown reasons. reasons, or even if someone does have established atherosclerosis and does have a clot that's caused a heart attack, all these women can still usually take HRT, especially when it's the natural estrogen through the skin, natural progesterone, and also testosterone if needed, because they often will benefit, and as you very clearly have said, Jill, can improve your symptoms as well. And so it's been led by women as well. And obviously, you've done a huge amount of personal research, knowing that the pieces of this digsaur have sort of come together.

And actually, your future health is going to improve. You're very fit and well as well. And you want to keep that way. So having you to sort of talk about that has been really interesting. But I think what we really want, because obviously we're coming to a close, is thinking about, I've always had these three take-home messages, but what are three things do you think we need to do going forward, because it's horrible hearing your story,

but for you having that, there are thousands, millions, who knows worldwide, who have had similar stories and maybe not the same outcome. So what are the three priorities, really, for sort of research and taking this forward, would you say? I would say the very, very first one for everything, listen to your body.

You're the one who knows it best. That's very good. Very true. Yep, I like that. You know, as a clinical massage therapist, it is astonishing how many people can't feel their bodies. Yes. So if you can't learn how to, but listen to your body, do your own research. Now, I know in this day and age, you could find data to prove that bananas can fly. You know, there is so much out there. But the websites that I looked at were your website, the balance website, the balance website,

the Blood Pressure UK website where you had a piece on it, the British Heart Foundation website, because that says on it, macrobascular angina is most common in women at the time of the menopause. So to me, the British Heart Foundation is, that's a reputable website. And if they know about it, why do my cardiologists don't?

When you go to an appointment, or even if you can't have somebody with you, have somebody on the phone, because that's super important. And the final little addendum, I know that's for, is that if you know there's something wrong with your heart, what I have learned is ask for a troponin blood test. Yes, very good. So it's about being your own advocate, isn't it? And having your voice and making sure that you're heard. And that's really important, not just for heart disease, but for menopause in general. But I'm hoping that you're, you're that your story will be the start of a conversation to springboard more people to think about it.

We're working with cardiologists as well, but we want to do more, certainly in this space. So hopefully with time to come, it will be more normalised. And actually, HLT will be considered as a treatment for people who have having heart attacks, because it used to be in the 80s. They used to give estrogen acutely in coronary care. So we've got a, we need to keep moving forward. So I'm very grateful, Jill, for your time today. So thank you. Thank you very much. Thank you. Thank you for the opportunity to spread the information to a wider community.

Oh, thanks ever so much. And take care. Thank you. Thank you. For more information about the perimenopause and menopause, please visit my website, balance hyphen menopause.com. Or you can download the free balance app, which is available to download from the app store or from Google Play.