Sarah Nelson had her first heart attack five days after giving birth in February 2020. A second one followed less than a month later.
The 33-year-old teacher had never had any heart problems and enjoyed good health, but she was jolted by a sudden sharp pain radiating across her chest, felt nauseous and sensed her left arm going numb.
“I kept questioning myself — why is this happening to me? What is going on?” Nelson, who lives in Kenmare, North Dakota, told TODAY.
“When I went into the emergency room… they said that I was a healthy young woman. They weren't thinking that I was having a heart attack. But after checking some blood levels, they knew something wasn't right.”
Nelson suffered a spontaneous coronary artery dissection (SCAD) — a tear or a bleed within the layers of a heart artery wall. It’s the No. 1 cause of a heart attack among pregnant women, those who have recently given birth and women under 40, said Dr. Sharonne Hayes, a cardiologist and lead researcher for the Mayo Clinic SCAD Research Program in Rochester, Minnesota.
She studies women like Nelson who are blindsided by the sudden cardiac crisis.
Up to 99% of heart attacks involve a blood clot that slows or blocks blood flow to the heart, leading part of the heart muscle to be starved of oxygen and die. With SCAD, the tear or bleed causes a flap or bulge in the artery, causing the same effect.
Women make up 90% of SCAD heart attack cases. They’re often young, healthy and fit, and don’t have risk factors for heart disease such as high cholesterol. The youngest patient on the Mayo Clinic SCAD registry was 19 and had a heart attack while skiing on spring break, Hayes said.
“The things that I hear often from these women are, ‘I thought I was doing everything right. I’m exercising, I'm going to the gym, I'm staying fit, I eat healthy, I’m a vegetarian. Why did this happen to me?’ And it has nothing to do with those lifestyles because it’s a split in an otherwise normal artery,” Hayes said.
“SCAD has given me PTSD because I've seen so many women who were ignored for this… in part because they're in their 20s, 30s and 40s and don't look the part” of a heart attack patient, she said.
Women can show up at the hospital with all the classic symptoms of a heart attack — chest pressure or pain that may radiate up to the neck, arms and jaw; shortness of breath; a sweaty feeling — but still be sent home by doctors who don’t recognize it’s a SCAD.
The exact cause of the artery tearing is unknown, but the trigger may have something to do with hormonal fluxes, Hayes said. Extreme emotional stress — when people report having the worst time of their lives — or physical stress — like furniture moving or similar repeated lifting of heavy objects — is involved in about a quarter of patients, she added.
About 40% of SCAD patients have a history of migraines and up to a third have high blood pressure, Hayes found in her research.
Pregnancy precedes the event in about 5-10% of cases. It may be more common in women who’ve had several children.
Nelson, the North Dakota teacher, had her two SCAD heart attacks after giving birth to her third child. She ultimately received four stents.
When Hayes treats patients, she prefers conservative treatment that avoids stents whenever possible because the majority of SCAD tears heal on their own within weeks, she noted. But if the blockage is severe, a stent or an emergency bypass operation may be needed.
Nelson said she is doing well today. She’s exercising but avoiding strenuous workouts or lifting heavy weights.
“I had to go through cardiac rehab and I was the youngest one there. And they couldn't believe it, like, ‘Why are you here?’ I got a lot of looks,” Nelson recalled.
“I still have that in the back of my head every single day. Like, is this going to happen again? Because it can.”
It’s why doctors advise women who’ve had a SCAD to not get pregnant again, Hayes said.
Pregnancy affects heart health for all expectant moms because their blood volume and heart rate go up, while blood pressure goes down. In that sense, it may be the first stress test a woman experiences, but the average heart is fully capable to adapt to these normal changes, Hayes said.
She once believed the physical strain of giving birth contributed to SCAD, but the heart attack also happens in patients who never went into labor because they had a planned cesarean section.
“So it stands to reason that there's something probably in the hormonal milieu that leads to it,” Hayes noted. “The SCADs that occur related to pregnancy are more severe — they are bigger heart attacks, they're more fatal, which is why they're kind of scary.”
“Take it seriously. If you have any kind of pain whatsoever, go get it checked out,” Nelson advised other women.