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A Patient's Point of View, Chest Pain in Women with Large Breast

Breast Attenuation and Heart Disease

I’m not a doctor or medical professional but I am one who nearly died from undiagnosed heart disease. Women and even men with large breasts who suffer from chest pain and have had a normal stress test should definitely read this story.

Over twenty years ago, I started having heart palpitations and became acutely aware of this occasional irregular heartbeat. I saw a cardiologist and he explained to me that this is very normal and that I should decrease my use of stimulants such as caffeine. I immediately switched to decaffeinated coffee. I was also told that I had an irregular EKG which shows something called Q-waves which indicates that I may have had a previous heart attack. As explained to me, although abnormal for most people, this was normal for me.

About 15 years ago, I started having random sharp pinching pain up under my right rib cage which traveled straight through to my back. I mentioned this to my PCP and he ordered a nuclear stress test. The results were normal. Many other tests were done yet the pain continued to come and go. It was then that my PCP said to me (I believe jokingly), “I guess you will have to fire me since I cannot figure out what is causing your pain”. So I did.

I found a new PCP and she was kind and understanding and again ordered all kind of tests including an MRI of my spine. I was told that I had a herniated disc at the T10 level of my spine. I saw an Orthopedic Spine Surgeon and eventually I was referred to the Pain Management Clinic. As a medical secretary for many years, I had seen patients sent on this route and felt that I was being treated like a hypochondriac or drug seeker. To add to this, I am mildly obese and began to feel that medical professionals just look right through me. I felt as if I had become invisible. Several doctors had told me to lose weight and exercise (which I have done several times).

The doctor in the Pain Management Clinic did what they call a nerve ablation to the nerve root within the T10 disc. This procedure was extremely painful and did nothing. I still had the pain and I was back to square one. I could actually feel the pain management physician’s frustration and opted not to return there for treatment.

I was subsequently referred to to the Henry Benson Mind and Body Institute. I spent several weeks doing stress management. I enjoyed the course and went on to have acupuncture, but ultimately still had this annoying pain that would come and go.

Then, one day, just by a stroke of pure luck, I was walking thru the main corridor of the major hospital in which I worked when I came across a Vascular Screening. I stopped and had an ultra sound on my neck and discovered that my right carotid artery was approximately 99% blocked. This was such a sensational find that the hospital published it in their news bulletin. A local TV crew came out to my house for an interview  and broadcast my story on the local evening news. I even made the local newspaper in my city. In addition, the hospital’s development office published this story twice as a fundraiser and made quite a bit of money on my miracle story.

Now you would think that this was a happy ending to a wonderful story but, unfortunately for me, it goes on. After having this carotid artery surgery, I continued to have chest pains. I even asked my PCP, “Is it possible that I could have another clogged artery in my heart?” She said yes and ordered yet another Nuclear Stress Test. By this time, I had had at least three nuclear stress tests and had been ruled out for a heart attack in the emergency room, at least three times.

Frustrated, I  made and appointment to see a Cardiologist outside of the circle of care I had been receiving. He listened to my story and ordered another nuclear stress test and again, it was normal. I felt that I was at witt’s end and started to ignore these chest pains and I convince myself that they was probably nothing to worry about. I even had one doctor tell me that if they were anything serious, they would have gotten worse.

I do consider myself one of the luckiest human beings on this earth because as luck would have it, my daughter-in-law is a cardiac catheterization technician. Shortly after my last stress test, I had another episode of chest pain and she advised me that I should ask the doctor to do a cardiac catheterization. She explained that because of my large breasts, they may not be able to see through my breast tissue and I could still have a clogged artery.

I took her advice under consideration but still feared asking my doctor to do a cardiac catheterization. I felt that if I walked into the doctor’s office and told him that I think I need a cardiac catheterization, he would think that I was totally crazy. Once again, the pain goes away and  I wait. Along with this pain came an incredible feeling of frustration and depression. I truly thought that I was crazy.

Last May, I knew that I needed to lose weight so I asked my husband to buy me a Fitbit for Mother’s Day so I could start walking and measure my steps. Half way around the block of my house, I felt the pain and fatigue. I called my cardiologist and was told to go to the emergency room. I called my daughter-in-law and she insisted that I ask for a cardiac catheterization. Again, I still felt awkward asking.

When I arrived, the emergency room doctor mentioned another stress test. It was at that point when I said, “Doc, I’ve been around this block before. I’ve had at least three or four nuclear studies and I’ve been ruled out f0r a heart attack, at least three times, right here in this emergency room. Is there any other test you can do that would show if there is something wrong with my heart?” He offered to do an CT Scan of my heart. It was there that they could see two blockages. I was admitted for a cardiac catheterization and was told that the blockages were far beyond the stenting process and that I would have to have open heart surgery. After the surgery, I found out that three vessels were replaced and I ended up with a triple bypass!

A year later now, I am feeling so much better. I have completed 12 weeks of cardiac rehabilitation and I am out walking with my Fitbit almost every day! I have learned that the only thing I can do to keep myself alive is exercise. So if you are like me, get out there and walk and use any device you want to track your steps and strengthen your heart!!

Incidentally, I have never really had a high cholesterol and I don’t smoke. Until last year, I had never heard of breast attenuation. I thank god every day that my daughter-in-law enlightened me.  I am writing this article for several reasons. 1) Hopefully you are sitting here reading it and I am saving your life, just like my daughter-in-law saved mine 2) Maybe the American Heart Association will try to educate the Primary Care Physicians that if a patient’s nuclear cardiology stress test is normal and the patient still complains, follow it up with a CT Scan or a cardiac catheterization. Also, ER doctors should be educated in breast attenuation.

In summary,  I would advise anyone with chest pain, a normal stress test, and large breast tissue to never let anyone repeat this very expensive nuclear stress test over and over again. Who knows how much exposure to radiation and nuclear medicine I have received and what effect it will have on me in the future? At this point, I should be glowing in the dark. A good friend sent me this quote today, “the definition of insanity is doing the same thing over and over and expecting different results”~~ Albert Einstein. Also, never let any physician treat you as if you are invisible. You truly deserve better care and treatment.

A sincere loving thank you to my daughter-in-law Kristy Sinagra.

Special thanks to the Newton Wellesley Hospital Cardiac Rehabilitation Crew for putting me back on the right track and to my Cardiac Surgeon, Dr. Thomas McGillivary.