When an over-committed 43-year-old banking professional and mother of two started to experience ongoing pain in her shoulder, she brushed it aside as tension from the long hours spent working at her laptop each day – totally unaware that a near fatal heart attack was just weeks away.
Looking back now, Elana Malgas says she knew something was not quite right but simply believed she needed to set aside some time for herself, a priority that lay at the bottom of her lengthy to-do list.
“I work in a high pressured corporate environment and for many months I had been taking strain at work, performing two roles due to ongoing staffing shortages, as well as trying to finish my Bachelor of Commerce degree in finance. I was continuously doing 12-hour work days but as a woman in the corporate world, I did not want to fail so I just kept pushing – beyond my limits, as it turned out,” she says.
Dr Adriano Dello Iacono, a cardiologist practising at Netcare Olivedale Hospital notes that, like many heart attack survivors, Elana recalled having other symptoms as well, including numbness in her left arm which she attributed to her suspected shoulder tension and – just days before her cardiac event – heart palpitations, which she read as a sign of anxiety. However, as she had felt no chest pains, it did not occur to her that her heart might be in danger.
Needing to spend some quality time together, Elana and her family had planned to have a special lunch at Hartbeespoort Dam in early May but during the drive from their home in Randburg she began to feel nauseous. Once at their destination, she was too ill to sit at the table, opting to lie down in the car in the hopes that her illness would soon pass.
“I was vomiting, I had unbearable pain in my shoulder and upper back, and my hair was wet with sweat. I have never been a sickly person but I knew something was very wrong and finally agreed to my fiancé’s suggestion that we seek medical attention.
“Instead of finding a local GP my fiancé wanted to make the one-hour’s drive to Netcare Olivedale Hospital so we could be near home. I did not communicate to him the level of pain I was experiencing – it felt like the drive would never end, but it brought me to the right place, and just in time,” she says.
Upon arrival at the hospital’s emergency department (ED) Elana’s condition had deteriorated significantly and within a matter of minutes she was in cardiac arrest.
According to Dr Gina Karam, a medical doctor practising in the Netcare Olivedale Hospital ED, as a woman in her forties Elana had almost no risk factors for heart attack, however her blood pressure was extremely high and an electrocardiogram, or ECG, was done to measure her heart’s rhythm and electrical activity.
“Women often do not present with chest pain in the months and weeks before a heart attack and can therefore misinterpret the signs until it may be too late. Looking at the results of the ECG it was clear that her heart was under enormous stress and had gone into an abnormal rhythm. In this state, it is almost as if the heart is shivering and there is very little blood pumping through.
“Dr Dello Iacono was on call and immediately began making his way to the hospital – we could see from the results what was about to happen. Moments later Elana’s heart stopped and we had to do a full resuscitation, shocking her to get her back. It was an incredibly quick series of events – if it happened moments earlier we may have been too late,” notes Dr Karam.
Surviving the ‘widow-maker’
Dr Dello Iacono explains that the heart attack Elana was having – an anterior stemi – is known as the ‘widow-maker’ because it occurs in the largest coronary artery responsible for blood supply to the heart and without rapid medical attention the chances of survival are minimal.
“Not only was it fortunate that Elana got to an emergency department in time, but also to a hospital with a specialised cardiac centre. Once stabilised in the ED, we moved her to the hospital’s catheterisation laboratory, or cath lab, where we have diagnostic imaging equipment that helps us to see the arteries and chambers of the heart more clearly,” he explains.
Dr Dello Iacono and his team performed an angiogram for Elana with a new technique, whereby access to the radial artery is gained via the wrist with a special wire to get up into the heart, with x-ray imagery guiding the process. A catheter is then inserted along this route and once the heart is reached a dye is injected to show up the blood vessels and the blockage.
“We then use another type of wire to get past the area that is blocked, inflating a small balloon that dilates the artery and helps restore blood flow. Once that is achieved, a stent can be inserted to keep the artery from collapsing but in Elana’s case there were too many clots and the blockage would have reoccurred. We therefore administered a strong blood thinner to help clear the pathway overnight and by the next day the repeat angiogram was normal with all clots cleared and no blockage present.
Elana recalls waking up on a ventilator two days later, struggling to comprehend what had happened but within less than a week she was able to be discharged and, according to Dr Dello Iacono, has made remarkable progress, though her heart is still recovering.
“Timing is everything in achieving better outcomes for heart attack patients. Having immediate access to specialised care and equipment dramatically minimises the chance of permanent damage to the heart, the brain and other vital organs,” he notes.
“Apart from being a smoker the stress, insufficient sleep and hours spent sitting at her desk certainly contributed towards a build-up of plaque that caused the clots in Elana’s arteries. The combination of just these few lifestyle factors put Elana’s life on the line – even though she is incredibly young to have a cardiac event of this nature, and one that typically presents more in men.
“A healthy diet, an active lifestyle and going for regular check-ups are key to avoiding an event like this which is highly likely to affect your quality of life – that is, if you survive. Just incorporating 20 to 30 minutes of walking a day is a good start and can be very protective for your heart,” he points out.
Elana says that the experience was a rude awakening to just how imbalanced her life had become. “I have two grown children, a baby granddaughter who is about to turn two and a fiancé who I am building a life with – they are what matters most and I am eternally grateful to Dr Dello Iacono and his team, as well as to Dr Karam, her colleague Dr Francis-Marie Els and the nurses in the emergency department for acting so quickly. They were instrumental in saving my life, and I have so much to live for.
“This experience has totally altered my perspective. I want to share the message that even at a young age, you can literally work yourself to death – and is it worth it? I am now back at work and still performing well while completing my studies on the side but at the end of the day, there is more to life than the daily grind. It’s about how you choose to spend your life,” she concludes.
Notes to editor
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