The Heart Knows

Despite years of struggle, Barbara Fleeman didn't give up on getting a correct diagnosis


In her late 50s, Barbara Fleeman considered herself a poster child for heart-healthy numbers. She maintained high HDL cholesterol (the good kind), low LDL (the bad one), low triglycerides and normal blood pressure. A longtime tennis player, she loved being active and cooking healthy foods.

"You can have normal EKGs and excellent cholesterol and still have (coronary microvascular disease)."

- Barbara Fleeman

So why did her heart hurt? Why did she sometimes feel like a volcano was erupting in her chest? What explained her chronic cough, shortness of breath, exhaustion?

These were among the questions Fleeman asked a series of physicians — all male — for nearly two years. "No one would listen to me or think the problem was my heart," she recalled. "I needed someone to believe me when I would tell them 'my heart hurts.'"

Every echocardiogram (EKG) she had, along with every blood panel, came back normal. A few doctors told her the cause was her sinuses or her esophagus — or worse, her imagination.

Last winter, frustrated and discouraged, she burst into tears when her gastroenterologist, Leo Treyzon, MD, clinical chief of Gastroenterology at Cedars-Sinai, said, "You don't look like you feel good." By then, Fleeman, a professional caterer and private chef, was so tired that she had cut back on her craft services business for film and TV productions.

Treyzon referred her to a cardiologist. But, after another round of tests, the cardiologist reported, "Your heart's in excellent condition." Fleeman promptly left the office and began her search for a second opinion.

She got that opinion — and her elusive, correct diagnosis — at the Barbra Streisand Women's Heart Center, where doctors immediately ordered a cardiac magnetic resonance imaging (MRI) scan. It revealed coronary microvascular disease (CMD), a condition of the heart's smallest arteries that is more common in women than men and doesn't show up in conventional tests.

"You can have normal EKGs and excellent cholesterol and still have this," Fleeman said.

Further testing with cardiac catheterization and an angiogram showed that behind Fleeman's CMD was endothelial dysfunction, which meant the lining inside her arteries was weak and her heart wasn't getting enough blood flow.

"I finally knew what was wrong," said Fleeman. "In a way, I always knew." All at once, she felt validated, relieved and scared.

She met with C. Noel Bairey Merz, MD, director of the Barbra Streisand Women's Heart Center, director of the Linda Joy Pollin Women's Heart Health Program and director of the Preventive and Rehabilitative Cardiac Center at the Cedar-Sinai Heart Institute. Bairey Merz told Fleeman that the proper medications along with regular exercise would be critical to strengthening her heart and helping prevent future problems.

In June, Fleeman began a three-day-a-week schedule of appointments in the Preventive and Rehabilitative Cardiac Center, working out on a treadmill and other equipment. In between sessions, she's taking longer and longer walks. She is also part of a clinical trial led by Bairey Merz that's examining a drug shown to improve endothelial function.

Together, the center's faculty and nurses "make me feel safe and well taken care of," Fleeman said. She in turn takes care of them, baking heart-friendly treats to bring to her rehab sessions. These include oil-free carrot cake baked with applesauce instead of oil.

Now 59, she's regained her optimism. "I'm getting back to the fully healthy lifestyle I had before the chest pains started," said Fleeman. "The Barbra Streisand Women's Heart Center saved my life. It's just that simple."