Your family history of coronary heart disease: Why you need to know about your risk
Marybeth Neyhard was 64 when she began experiencing what she describes as "very strange symptoms," including nausea, tightness around her upper abdomen, and a jittery feeling. Over the next seven months, her primary care physician would order a battery of tests, including an abdominal scan and an electrocardiogram (ECG or EKG) that measures the heart's electrical activity while at rest. Every test came back negative.
It was in the summer of 2017, after Neyhard had endured three days of unusually intense symptoms―tightness in her upper back, the jitters, and what felt like horrible indigestion―that she and her husband Bill decided to head to the emergency department at Lankenau Medical Center, part of Main Line Health.
Once again, the tests conducted during her ED visit were negative. However, the emergency medicine physician caring for Neyhard strongly advised her to follow up with a cardiologist for a thorough evaluation. As soon as she returned home, Neyhard scheduled an appointment with Lankenau Heart Institute cardiologist Andrea J. Becker, MD.
"On my first visit, Dr. Becker ordered a cardiac stress test, also known as a treadmill test, to evaluate how my heart performed during exercise," recalls Neyhard. "It was planned for the following week. And then she handed me the phone number for scheduling at Main Line Health Radiology and said, 'You need to get a coronary calcium scan right away.'"
A coronary calcium scan uses computerized tomography (CT) to detect calcium deposits in the coronary arteries of your heart. A higher coronary calcium score suggests a greater chance of significant narrowing in the coronary arteries, and accordingly, an increased risk of future heart attack.
Neyhard called immediately to schedule the test and completed it the following morning.
"Later that same day, I received a voicemail message from Dr. Becker with four different phone numbers to reach her. She said to call her back as soon as possible," says Neyhard. "I thought, I'm in trouble."
Family history of coronary heart disease presents much greater risk of heart disease
"For any patient who comes into my office, I look very carefully at their risk factors for heart disease which include high cholesterol, high blood pressure, obesity or being overweight, physical inactivity, age, diabetes, alcohol use, smoking and family history of coronary heart disease," explains Dr. Becker. "Alarms go off when a close family member has had heart disease. Then, I treat you like you have heart disease until I prove you don't."
Neyhard had shared with Dr. Becker that her mother had undergone a triple bypass at the age of 68. Neyhard was also aware that her grandmother had a history of cardiac issues, although she would not learn until later on in her own journey that her grandmother suffered a heart attack at the age of 28, while pregnant with Neyhard's mother.
She returned Dr. Becker's call right away.
Dr. Becker revealed that Neyhard's coronary calcium score was 2,181. A normal score is typically between zero and 400. The diagnosis was coronary artery disease (CAD), meaning the arteries carrying blood, oxygen and nutrients to the heart muscle have narrowed due to a buildup of plaque, cholesterol and calcium.
Then Dr. Becker asked, "What are you doing on Wednesday?"
Neyhard responded hesitantly, "Traveling to Maine?"
To which Dr. Becker replied, "You'll have to change your plans. You need a cardiac catheterization as soon as possible."
Cardiac catheterization is a medical procedure used to diagnose and treat certain heart conditions. A long, thin, flexible tube called a catheter is placed into a blood vessel through the patient's wrist or groin and threaded into the heart. Using contrast dye solution, the physician is able to take a close look inside the heart to identify concerns, and perform additional tests or interventional procedures as needed.
Life-saving cardiac stent placement
Neyhard's catheterization was performed by interventional cardiologist Amid A. Khan, MD, also with Lankenau Heart Institute. He found three blockages, each over 80 percent, meaning blood flow to the heart has decreased by that percentage. A complete blockage can cause a heart attack. Neyhard's partially blocked arteries were the cause of her symptoms.
Dr. Khan placed stents―tiny expandable mesh tubes that keep the arteries open―in two of Neyhard's arteries. There was difficulty placing the third stent, and Neyhard was scheduled to come back five days later to complete the procedure.
At the return visit, Dr. Khan once again attempted to place the third stent. But Neyhard's artery was so calcified and tortuous, a stent could not be delivered. Performing a rotational atherectomy―a procedure to help break up calcified plaque in the coronary artery and then place a stent―was deemed extremely high risk. The safest option would be urgent bypass surgery to save the coronary artery.
"During a catheterization, you're relaxed from the sedative, but you're still kind of awake," says Neyhard. "Dr. Khan explained to me I needed emergency coronary bypass surgery. He let me know Dr. Sutter and his team were standing by. I was so relieved to hear Dr. Sutter's name, because I knew his reputation."
Francis Sutter, DO, FACS, is campus chief of cardiac surgery at Lankenau Medical Center. He is a world-renowned heart surgeon and the nation's leading expert in minimally invasive, robotic coronary bypass surgery.
"Dr. Sutter's team entered the room almost immediately," recalls Neyhard. "When the anesthesiologist introduced himself, I remember saying, 'Please don't wreck my throat. I'm a music and voice teacher.' Then, Dr. Sutter bends down over me, his face upside-down to mine, and he says, 'Your heart is very strong. You're going to be just fine.' He held my hand until I fell asleep."
Coronary bypass surgery involves taking a healthy blood vessel from the chest, arm or leg, and connecting it above and below the blocked arteries in your heart, hence, bypassing to create a new pathway for blood flow to feed the heart muscle. Despite the fact that Dr. Sutter performs nearly 80 percent of his surgeries using a minimally invasive, robotic approach, this particular set of circumstances necessitated traditional incisions and open-heart surgery.
When Neyhard awoke, she was surrounded by her husband, siblings, children and grandchildren. And the healing began.
"Marybeth is incredibly fortunate she was at Lankenau when her artery dissected," says Dr. Becker. "Unlike most institutions, we always have a surgical team standing by during catheterization procedures, although this worst-case scenario is quite rare. Because Marybeth was here, she didn't suffer any permanent damage to her heart."
Neyhard shares that like most people, she was not fully aware of the critical role family history of coronary heart disease played in her own heart health. And although she realized how differently heart disease presents in women than in men, she did not recognize that her symptoms were actually those of cardiovascular disease.
"I was a walking timebomb," says Neyhard. "I was very lucky to have the right people in my life at the right time. I never experienced any of the classic symptoms associated with heart disease in men, like pain or pressure in my chest. The coronary calcium test Dr. Becker ordered saved my life."
Heart disease in women
In the United States, heart disease is the leading cause of death in women over the age of 25, regardless of race or ethnicity. According to the American Heart Association, heart disease and stroke cause one in three deaths among women each year―more than all cancers combined. In many cases, heart disease is preventable.
According to the American Heart Association, heart disease and stroke cause one in three deaths among women each year―more than all cancers combined.
"It's very common for women not to recognize the symptoms of heart disease, or understand the risk factors, including family history," cautions Dr. Becker. "If you have a mother, father, grandmother, grandfather, sister, brother, or any family member who has had heart disease before 60 years of age, you should have a cardiac screening and a coronary calcium scan by age 50. It's my belief that everyone, regardless of family history, should have a coronary calcium scan by age 50. You should also know your cholesterol, blood pressure and blood sugar numbers. Screening for heart disease, just like getting a regular mammogram and colonoscopy, is essential in your preventative care."
Neyhard is now a tireless advocate for raising awareness about the symptoms of heart disease in women and the importance of understanding the role of having a family history of coronary heart disease. She has become deeply involved in the Women's Heart Initiative at Main Line Health since noticing a sign about it in the elevator at Bryn Mawr Hospital, where she participated in the outpatient cardiac rehabilitation exercise and workshop program following her bypass surgery.
The Women's Heart Initiative is a comprehensive health care program aimed at helping women recognize the warning signs of heart disease and encouraging them to have open discussions with their physicians about heart care. Neyhard is an integral member of the Women's Heart Initiative's Heart 2 Heart ―a support group for women with heart disease― and she has spoken publicly about the connection between heart disease and genetics.
Evaluating cardiovascular genetic risk
Many cardiac disorders can be inherited, including arrhythmias, cardiomyopathies, congenital heart disease and high cholesterol. To determine predisposition, Main Line Health offers a Genetics and Risk Assessment Program for cardiovascular genetics, as well as for cancer genetics and prenatal genetics. Experienced genetic counselors are prepared to assess individuals at increased risk for cardiovascular disease due to family or personal history, and provide guidance in developing a plan to manage that risk through lifestyle changes and preventive measures.
"It wasn't until I was diagnosed with coronary artery disease that I realized the significant impact of genetics on heart health," says Neyhard. "Yes, there are many other factors involved, like diet and exercise, but genetics plays a big part. I'm the oldest of six children, and I'm the one who's always ripped the cheese off my pizza. I never had a significant weight problem and appeared to be in good health. My family members were shocked when I was diagnosed with blockages in my arteries. Now, I'm committed to helping everyone understand the connection, and supporting other women with heart disease as they navigate through their own journeys."
"I'm the oldest of six children, and I'm the one who's always ripped the cheese off my pizza. I never had a significant weight problem and appeared to be in good health. My family members were shocked when I was diagnosed with blockages in my arteries. Now, I'm committed to helping everyone understand the connection, and supporting other women with heart disease as they navigate through their own journeys."
Neyhard, who recently turned 69, sees Dr. Becker twice a year for bloodwork and undergoes a stress echocardiogram every two years. She does her best to spend 30 minutes a day walking or exercising, watches her diet, and controls stress levels by meditating, journaling and playing the piano. Now retired from her career as a schoolteacher, Neyhard and her husband of 46 years enjoy traveling the world, including visits to Alaska and London, where two of their three children live. For each of her children's 40th birthdays, Neyhard is gifting them coronary calcium score tests.
"Knowledge is everything," says Neyhard. "My story sounds dramatic, but the more I hear about other people's experiences, it's just another story. I'm actually one of the lucky ones, because my heart disease was caught in time. I'm grateful to live in an era when technology is so advanced. I'm grateful to have received the very best care possible. I'm grateful for my family and friends. I'm grateful for life."