Cardiologist When not If

June 2, 2020 I had my first appointment with the cardiologist. I posted about this on social media and got lots of well wishes… I appreciate them, but heart disease was never an “If I get it” it was a “when” I get it. At 24, I had elevated cholesterol. At 25 even after trying to become a vegan it was even higher. At which point my gynecologist gave me some of the best medical advice I have ever gotten… “YOUR body produces excess cholesterol it is common in women with PCOS and that’s not even taking into account your father has congenital heart disease. Limit your fatty foods intake, but if you want to enjoy a cheeseburger or fried mozzarella sticks once in a while, you might as well, because even if you don’t, you are going to have high cholesterol.”

And for the last 15 years, I have tried to limit the fat in my diet and made sure I was eating plenty of fiber and guess what when the test was repeated at 35 it was still elevated. I have had an abnormally fast resting heart rate (over 80) since at least 8 years old and my mom admits my doctor at that time told her I’d grow out of it… guess what… I didn’t. It’s still abnormally fast, which is just normal for me.

Eventually, I will have a heart attack. That’s just the way it goes. The cardiologist confirmed that the occasional chest pain I feel is angina. Here’s the thing; I KNOW IT. If an ounce of prevention is worth a pound of cure, how much is understanding and knowledge worth? My guess is more. Because when the heart attack does happen, I will be well versed in even the weird and unusual symptoms and I will get help faster than most.

Both my primary and the cardiologist said the same thing “Until someone has a heart attack, I’ve never had a patient come to me and say ‘Hey, I think I’m suffering occasional angina and I know that my father said he had angina for nearly a decade before his first heart attack, so let’s start watching for this.'” Especially given I won’t be 40 years old for a couple of months yet.

Yes, it took a little while for me to figure out it was probably angina and not GERD (prilosec doesn’t prevent it), but everyone thinks GERD not angina. Even my primary originally thought GERD and I consider him very skilled and knowledgeable in everything I’ve had to deal with… So that is excusable and as I pointed out, it started at 39 not 44 or 49 or 55. I am ahead of the curve on my understanding and knowledge about heart disease. And knowledge is power.

So, yes, I have heart disease, I’ve known it for decades… it just wasn’t an issue and now, it’s going to become a bigger issue for me because like everyone I am aging. But twenty years ago, when my father had a seizure in a restaurant and it turned out to be a massive heart attack…. I knew I had a 50% chance that serious congenital heart disease was in my future. Two years later when I was told I had Polycystic Ovarian Syndrome and I learned it was an endocrine disorder not a “woman’s problem” and that nearly 75% of all women with it have increased problems with high cholesterol, insulin resistence, and diabetes I knew that I had heart disease and that I was just asymptomatic due to age.

I have taken some precautions over the years. But I have also enjoyed life. I took my gynecologist’s advice and on occasion I went ahead and ate the cheeseburger or the mozzerella sticks or the onion rings.

This means all the cardiologist did was start the confirmation process on what I was pretty sure was starting to happen… like angina. Tomorrow, I won’t swear off cheeseburgers and pizza and onion rings. I will eat them less, but even if I become vegan tomorrow and never eat another piece of fried food, processed food, or cookie again I will still have high cholesterol. I suspect that since 2015 it has gotten high enough that we are going to start talking about medication for high cholesterol. And we will more intensely discuss the fact that I have gone up a shoe size in the last couple of years, meaning I probably have edema (at least mildly) another sign of heart disease.

The “oh no” will be revealed if imaging shows that I also inherited my father’s heart defects. His aortic valve had 4 flaps, not the normal 3, which caused it to start leaking and stop opening properly… when he was 59. Now, if I have backwards heart ventricles like he did, I’m 39 my body has adjusted to it and it’s not a big deal except that all my cardiologists for the rest of my life will need to be informed about it, but as I said it’s been that way all my life and my body adjusted to it and oddly, it makes the right ventricle work harder, but in my dad it was the left ventricle that was starting to weaken in the years leading up to his death. However, genetics influence both defects. And it isn’t as big an “oh no” as it was 20 years ago… we’ve come a long way in heart valve transplants and it just means eventually, I will probably need one if my valve has an extra flap.

Essentially, this is all part of my ounce of prevention. I’m 39, I’m very high risk for heart disease, and I ate the cheeseburger… Now I get a cardiologist and more knowledge so that WHEN the heart attack happens, I have enough knowledge to know it and respond accordingly in time to save my life.

PS: In case you’re baffled by the seizure/heart attack comment about my dad…. seizures while an uncommon symptom of a heart attack they do happen and for that matter my father had a lot of “uncommon” symptoms with his heart disease. For instance in people with an extra flap on a valve there is nearly always a heart murmur, but until the valve failed it never made a sound. This means as a woman, I need to be aware of the “common” symptoms of heart problems for women and men as well as the “uncommon” symptoms.

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