Mystery of Chest Pain in Women Less Mysterious

For an entire year, Marianna Juarez was afraid to hold her infant granddaughter in her arms.

"I felt so shaky, I was afraid I was going to have cardiac arrest and drop her," said the 57-year-old mother of two, who has two grandchildren.

What made her situation even scarier is that doctors at her local hospitals near Ontario, California, kept telling her nothing was wrong. It wasn't until Juarez sought out specialists at the Barbra Streisand Women's Heart Center at the Cedars-Sinai Heart Institute that her heart's mystery was unlocked.

The mystery began one night in March 2013 when Juarez, an accounting professional at a public utility company, was taking her dog outside and felt an alarming flutter in her chest and pain that radiated to her arm. She had experienced small flutters before but her doctors had written off the sensations as harmless.

The next day Juarez went to the emergency room to have her heart checked. The staff conducted a series of blood tests to detect enzymes that would indicate a heart attack, but they found no sign of one. An electrocardiogram (EKG) showed that her heart's electrical activity was normal, too. She was discharged, knowing no more about her heart's condition than when she checked in.

At follow-up visits to a cardiologist, Juarez was repeatedly told her heart was fine. She didn't smoke or drink and enjoyed frequent exercise walks, so her physicians didn't think she fit the profile for heart disease. They only recommended she try to lose a few pounds.

One year after that first episode, Juarez was back in the emergency room with chest pains, shaking and dizziness. The physician wanted to give her a spinal tap and test for a stroke, even though she insisted she felt overpowering fluttering in her chest.

"They kept saying they couldn't see anything with the EKG," Juarez recalled. "I said, ‘I'm not a hypochondriac; I know what I'm feeling.'"

In the months after that, the fluttering became so intense that it would wake her up at night, with numbness radiating from her chest to her arm and jaw. Her husband, Michael — her devoted partner since they were high school sweethearts 41 years ago — was worried.

"He would find me lying awake at 1 a.m.," Juarez said. "He wanted to take me to the hospital, but I said, ‘For what? They will say there's nothing wrong.'"

Juarez's shaky condition and the veil of uncertainty around it took a toll. She started sitting out of active family events like camping and helping her daughter move.

"My grandchildren are a blessing to Michael and I; they fill our cup," she said. "We used to take care of my grandson quite a bit, but during that horrible time I didn't feel comfortable having the children by myself."

Juarez carried on in a state of recurrent pain until a friend at work brought in a magazine article about Cedars-Sinai physician C. Noel Bairey Merz, MD, medical director of the Women's Heart Center.

"When I read the article, I said, ‘Oh my goodness! It sounds like someone is listening to individuals about their hearts!" Juarez said.

Bairey Merz is one of the nation's leading authorities on women's heart disease.

Bairey Merz led groundbreaking research that showed women with chest pain are less likely than men to have major blockages in their coronary arteries. Instead, the cholesterol plaque spreads evenly throughout the artery wall, causing narrowing in very small vessels and choking off oxygen flow to the heart. The condition, called coronary microvascular disease, is not detected by standard tests, which are designed around the male pattern of looking for major blockages. Many women with microvascular disease are not diagnosed and therefore are never treated for chest pain, high cholesterol or heart attack risk.

When Juarez read about the research, it resonated.

"But I told my husband it would be a huge commitment to try to see a doctor at the Women's Heart Center because it's a long trip to Beverly Hills," Juarez said. "He said, ‘You have to go, because if you don't do something, you won't be able to go anywhere anymore.'"

Juarez saw Puja Mehta, MD, who directs the Non-Invasive Vascular Function Research Lab at the Barbra Streisand Women's Heart Center.

"The first day I saw her, she said, 'Give me six months and we are going to help you feel better.' It makes me emotional to remember it," Juarez said, holding back tears.

"Dr. Mehta and her entire team became my advocates," Juarez said. "Within a couple of months of taking the right medication, I was well enough to go to Disneyland with my granddaughter to celebrate her first birthday."

Mehta explained to Juarez that the medication would help improve the function of the lining of Juarez's blood vessels, reduce her angina (heart pain), and lower her blood pressure and cholesterol levels.

"Women with Juarez's condition are at a 2.5-percent risk per year of future events based on Bairey Merz's research — including heart failure, sudden cardiac death, heart attack or stroke," Mehta said. "We are reducing her risk with medication and therapies."

Juarez is doing everything she can to protect herself by exercising and reducing stress.

"My sister treated me to a meditation retreat and that was a new experience — to be still and be quiet and try to breathe," she said. "I'm doing my part to save my life."

Juarez is also looking forward to retirement in five years.

"Michael and I have big plans to purchase a fifth-wheel trailer and take road trips with the grandchildren," she said.

For now, she is savoring one of her favorite activities: dancing around the house with her granddaughter in her arms.