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Melanie McCauley is a tenacious person, and she’s a perfect spokesperson for self-advocacy in heart care. When she had an uncommon type of heart attack in November 2021, she saw several cardiologists who couldn’t pinpoint the cause or suggest a treatment to keep her chest pain symptoms at bay.
Unwilling to take “I don’t know” for an answer, Melanie came to see me after getting a referral to the MedStar Heart and Vascular Institute at MedStar Washington Hospital Center.
Using the Coroventis CoroFlow Cardiovascular System, a diagnostic tool that’s only available at a handful of U.S. heart centers, our team found the cause of Melanie’s symptoms: coronary microvascular dysfunction (CMD). This condition involves blockages in small blood vessels of the heart that are too tiny to be seen on standard imaging but are large enough to cause a heart attack.
About half of patients with chest pain, including Melanie, do not have blockages in their large coronary arteries. Sometimes these patients are dismissed from the emergency room with a diagnosis of heartburn or anxiety—when they’re actually having a heart attack.
Once known as “Cardiac syndrome X”, CMD occurs more often in women, especially younger women, than men. Risk factors include diabetes, high blood pressure, and high cholesterol.
Once we pinpointed the cause of Melanie’s symptoms, we prescribed a treatment that has helped control her symptoms and improve her quality of life. In honor of American Heart Month, I invited Melanie to share her story.
From a Mystery to Feeling Like Myself Again.
By Melanie McCauley
I was 44 when I had a heart attack. Before that, I didn’t really have any heart problems. My blood pressure was a bit high, but I was on medication for that. So, when I started to feel some unusual tightness in my chest while watching my husband’s bowling tournament, I excused myself to the restroom—the thought of a heart attack didn’t cross my mind, and I didn’t want to alarm him.
I thought maybe I was having indigestion, but then I felt a strange sensation in my arm, and I got very warm and nauseous. I went out to the car and cranked up the air conditioning. Even though it was November, the cold air made me feel a little better.
That’s when I checked the symptoms of a heart attack on my phone. Other than shortness of breath, I had every single one. Chest pain, nausea, arm pain, back pain. I texted my husband and said, “I think I might be having a heart attack.”
He left his tournament right away and insisted we go to the nearest hospital. I argued a bit—I didn’t have time for this. Ladies, you know what I mean. My mind was busy with plans for hosting Thanksgiving dinner and a gender reveal party coming up for our first grandchild.
Melanie and her husband.
I didn’t want to go home without an answer.
At a hospital near the bowling center, the provider team immediately brought me back to check my heart. My EKG and blood pressure were normal, but my troponin level indicated I was having a cardiac event. Troponin is a protein that is released when the heart muscle gets damaged. The more troponin, the more damage. I had plenty to indicate a heart attack.
When they gave me nitroglycerin, my symptoms went away immediately. Nitroglycerin, a medicine called a nitrate, helps the blood vessels relax and boosts the oxygen supply in the blood while reducing its workload.
I said, “Great! I can go home and start cooking Thanksgiving dinner.” But the nurse chuckled kindly and said I’d need to stay for a while. If I had been well, the nitroglycerin wouldn’t have done anything. So, feeling a little better wasn’t entirely good news.
I spent three days in the hospital getting every test you can imagine: echocardiograms, angiograms, blood tests, everything. It all came back normal. Every provider I saw was kind, but no one could explain what was wrong. One cardiologist after another said, “We don’t know what happened. You’re a medical anomaly. We can’t explain it.”
They thought it could be anxiety or stress and suggested that I try to relax. That’s a tough assignment when you have chest pain, and it felt dismissive. I was frustrated. I didn’t want to go home without an answer. I worried that it could happen again and that the next time might be worse. So, when I was sent home, I followed up with my cardiologist.
The hospital had given me a medication to help keep my vascular system open, and it caused terrible migraines. After five weeks of severe headaches—and no relief of the pain and tightness in my chest—I told my doctor my quality of life was suffering and I needed to try something else.
My cardiologist knew I needed advanced care, and she referred me to Dr. Hashim at the MedStar Heart and Vascular Institute. She said I fit the criteria for CMD, and that Dr. Hashim could perform a special test to find a diagnosis.
The right test that led to answers.
I reached out to Dr. Hashim’s coordinator because I was nervous about having another invasive test. Dr. Hashim is a specialist, and he’s very busy—but I said I’d like to speak to him, and he made time to give me a call.
I asked Dr. Hashim a million questions, and he very patiently answered every one. He calmed my nerves about the test and explained the procedure in detail. Using the Coroventis CoroFlow Cardiovascular System, he would insert a thin, flexible tube into a blood vessel in my wrist. Then he’d use a specialized instrument to check the blood flow of the large blood vessels in the front of my heart and the small vessels in the back to determine if there were blockages.
Related reading: Coronary Microvascular Dysfunction: New Diagnostic Tools Offer Quick Answers and Treatment.
During the CMD test, Dr. Hashim found that the tiny blood vessels behind my heart were blocked. He diagnosed me with CMD, and we developed a treatment plan to help me get back to living my life.
Honestly, I don’t know if I’d be here today if I hadn’t gotten that referral to Dr. Hashim. I’m confident I would have had another cardiac event—I was so miserable I couldn’t even sleep. Now, I’m on the right medications and I feel like myself again.
Don’t take ‘I don’t know’ for an answer.
Today I’m doing great. I have a remote job, so I can work from home and have flexibility to go to my follow-up appointments. My husband and I set up a home gym, and we encourage each other to exercise regularly. I’ve never been much of a gym rat, but we have a lot of fun motivating each other.
I have so many important reasons to prioritize my health. I want my family, especially my granddaughter, to understand that it’s important to stay on top of your own health.
Women, we know our bodies best—how things are supposed to feel and when something’s not right. If one doctor can’t find anything, go see another until you can get answers. There are incredible doctors out there with the right tools and dedication to figure out what’s going on. Don’t take “I don’t know” for an answer.
I’ve been so fortunate to have a wonderful team of cardiologists working together for me at MedStar Washington Hospital Center. They communicate, they collaborate, and they’re so responsive. I love my team, and I’m in a good place. I encourage other women to make time for self-care. If you’re not well, you can’t take care of anyone else—and Thanksgiving dinner can wait.