Pat Burgess was out shopping with her husband, Graham, one afternoon when a sharp pain made her cry out. ‘I was sitting in the car as the pain shot up my neck, into my ear and down my arm,’ says Pat, who lives in Bourneville, Birmingham. ‘I was terrified, as it was the worst pain I’d ever experienced.
Pat Burgess was out shopping with her husband, Graham, one afternoon when a sharp pain made her cry out.
‘I was sitting in the car as the pain shot up my neck, into my ear and down my arm,’ says Pat, who lives in Bourneville, Birmingham. ‘I was terrified, as it was the worst pain I’d ever experienced.’
It was so intense it was ‘worse than childbirth’, she says, and fearing it could be a heart attack, Graham drove her to A&E at one of the city’s hospitals where she works as a housekeeper.
‘I saw my friends and colleagues,’ she says. ‘It was so strange being a patient. I was rushed through and a cardiac surgeon came to examine me.
‘He wanted to do an ECG to check the rhythm and activity of my heart, and an angiogram to check whether the arteries were narrowed or blocked,’ says Pat, 53, a mother of three — husband Graham, 57, is a coffee shop manager.
‘The consultant had just started the ECG, when I began to feel really unwell,’ Pat adds. ‘This terrible pain came again in my left side. I called out to a nurse and held her hand — then everything went black.’ When she came to hours later, she was in a recovery room.
‘I opened my eyes and a nurse explained that I’d had a cardiac arrest, meaning my heart had stopped pumping blood around the body, following a heart attack in the car,’ says Pat. ‘I couldn’t take it in. Graham was at my side and looked terrified.’
She’d ‘died’ for a few seconds and had to be resuscitated.
A cardiac arrest is not the same as a heart attack, but it can follow one. With a heart attack, the arteries supplying the heart muscle with blood become narrowed by a build-up of fatty deposits. If a piece of this fat breaks off, it can block the artery, causing the heart to be starved of blood and oxygen.
Prompt treatment is vital, as a delay can result in a cardiac arrest, where the heart stops pumping blood round the body. This robs the brain of oxygen, leading to the person losing consciousness. Without immediate treatment, it can be fatal within minutes.
The consultant said that, in fact, Pat had suffered not one but two heart attacks. One while shopping and another ‘silent’ one, at around 5.30am that day, which she had thought was indigestion.
Dr Maurice Pye, a consultant cardiologist at York NHS Trust and Leeds General Infirmary, explains: ‘With a silent heart attack, the patient doesn’t have chest pains, but might feel unwell or sweaty.’
A cardiac arrest is not the same as a heart attack, but it can follow one. With a heart attack, the arteries supplying the heart muscle with blood become narrowed by a build-up of fatty deposits. If a piece of this fat breaks off, it can block the artery, causing the heart to be starved of blood and oxygen.
Some people experience indigestion or stomach pain, because the nerve supply to the upper gastrointestinal system and the heart are closely related and so pain in one can be felt in the other.
Often, it’s only when a scan — carried out for another reason — shows up an inadequate blood or oxygen supply to parts of the heart, that doctors realise a silent heart attack has occurred.
Pat had suffered months of stomach pain, but had thought something else was causing it. In 2016, she had been diagnosed with a hiatus hernia — where part of the stomach protrudes into the diaphragm, causing symptoms such as heartburn, stomach pain, and shortness of breath. ‘I just thought the stomach pain I often felt was related to that. So I ignored it,’ she says.
‘I was so shocked to learn it was related to my heart. I’d been going to work, acting normally when I’d actually had a heart attack, but just didn’t know it.’
In Pat’s case, the pain she would normally have felt in her chest was felt in her stomach, masking the pain of the heart attack. However, their silent nature doesn’t mean these heart attacks aren’t serious. In fact, a silent heart attack is just as dangerous, despite the lack of pain.
‘They can cause the same level of damage and, if you’ve had a silent heart attack, you are more likely to have a standard heart attack,’ says Dr Pye.
Silent heart attacks are more common in women. It isn’t certain why, but it could be due to them having a higher pain threshold and so disregarding chest pains.
As well as being more common in women, they also occur in those with diabetes and older people.
‘In type 1 and type 2 diabetes, patients get what we sometimes call autonomic neuropathy [where, over time, uncontrolled blood sugar levels damage the nerves in the chest] causing a lack of sensation there and preventing the pain of a heart attack from being felt,’ says Dr Pye.
Silent heart attacks are more common in women. It isn’t certain why, but it could be due to them having a higher pain threshold and so disregarding chest pains. As well as being more common in women, they also occur in those with diabetes and older people.
Julie Ward, senior cardiac nurse at the British Heart Foundation, adds: ‘Symptoms can vary from one person to another. Typically, they include pain or discomfort in the chest that doesn’t go away; it may spread to the arms, neck, jaw, back or stomach. You may also feel light-headed, dizzy; be short of breath, nauseous or vomit.
‘Different pain thresholds may well be a reason for some people not noticing the symptoms of a heart attack.’
Dr Pye stresses that, while patients should not dismiss stomach pain or heartburn, if symptoms rapidly clear up after using antacids, ‘they are almost certainly not cardiac’.
If the ‘indigestion’ pain at rest is not relieved within half an hour of taking Zantac (Ranitidine) or Gaviscon, then the patient should ‘call 999 immediately and order a paramedic ambulance for a suspected heart attack’, he advises.
This message is really important. If the pain is intermittent and unrelieved by the antacids, then you should go straight to hospital.
For Pat, her heart diagnosis had come just in time.
SCANS picked up a permanent ‘dead’ area at the back of her heart, a result of her heart attacks.
The consultant explained that Pat had a total blockage in her left coronary artery — one of the two main blood vessels that take oxygen-rich blood to the heart — and a smaller one lower down in the same artery, putting her at risk of further heart attacks.
She was taken to theatre where two stents were inserted in the blood vessels to remove the clot and open up the arteries. Three days later, Pat was allowed home.
‘I was put on seven pills a day,’ she says. ‘Beta blockers to make my heart beat slower and reduce my blood pressure, and anti-platelet drugs that stop the blood being sticky and make it less likely to clot.’
Pat is now all too aware of heart attack symptoms and believes many more women might not realise they are at risk. She believes that, because family members —her mother and paternal uncle —have died of heart problems, she has always been at a higher risk.
Now, three years on, Pat is well and has been discharged from her consultant. She has had no heart problems since, although still takes pills for it. And while she is still on medication for her hiatus hernia, the stomach pains have completely stopped.
‘With heart attacks, women have different symptoms — some feel a pain in their stomach, others in their shoulders,’ says Pat. ‘There’s no one specific symptom.
‘I want to raise awareness, because I don’t think women’s heart health is taken seriously. I thought I just had indigestion but could have died. I am so lucky to be here.’
