To this day, Kathy Hoseth can remember the first time she felt that sharp pain in her chest.
“I was maybe 7 or 8 when it first happened,” she said. “I was a very active child. And I had this sudden pain, like a knitting needle stabbing into my heart. I told my mom, but the pain just as quickly disappeared.”
Her mother took her to a doctor, wondering if the little girl might be battling something. A type of arthritis? Maybe lack of oxygen while running and playing?
Growing pains? As a child, Hoseth had complained about aches and pains in her legs and arms, too.
But an explanation never came.
The incident soon passed.
For a spell.
“The next time that happened was when I was in my 20s,” said Hoseth, 58, of Lowell, Michigan. “To say I was busy at that point in my life is an understatement. I had two little boys. But the pain was unbearable. I felt a crushing pressure on my chest.”
She went to a hospital emergency department to have it checked, but the doctor chalked it up to stress and sent her home.
“So I went home and had a hot bath and a glass of wine,” she said, shrugging.
Yet the pain wouldn’t let go.
Through her 20s, Hoseth slogged through daily episodes of chest pain. She continued to attribute it to stress.
“You could say I got kind of used to coping with it,” she said. “By the time I was in my 30s, the pain increased and was sharper. But when I went in to see a doctor, they saw that I looked healthy. I was thin and active and nothing showed up on tests.”
A true diagnosis eluded her.
The recurring explanation: “Just stress.”
One doctor told her she might have pericarditis, an inflammation of the membranes surrounding the lungs and chest cavity that can cause pain when breathing hard.
She got orders to take Motrin.
Then, about seven years ago, Hoseth, a sales manager at AAA, had another episode—strong enough to put her into emergency care. She landed at Spectrum Health Butterworth Hospital.
“I felt like my heart was having spasms,” Hoseth said. “There was a lot of pain. I told my husband, David, that I needed to go to the hospital.”
Spectrum Health doctors referred her to a cardiologist.
“I had a stress test and I passed with flying colors,” Hoseth recalls. “I began to think I was insane.”
A clear head
Her heart troubled her, but her head worked perfectly.
Using a smart watch to monitor her heart, Hoseth saw her heart rate reach close to 200 during her daily walks of about 5 miles.
“The exhaustion was becoming overwhelming,” she said. “I was short of breath and I found myself walking less and less and avoiding hills. Something was really wrong.”
She returned to her doctors and requested “the works,” she said.
She wore a heart monitor for a few days and it showed a few episodes of increased heart rate.
A nuclear stress test, used to determine risk of a cardiac event, finally showed a first sign of trouble: a blockage.
After a few heart catheters, doctors sent Hoseth to Spectrum Health cardiothoracic surgeon Marzia Leacche, MD, for evaluation.
Dr. Leacche is among the 5 percent of women cardiothoracic surgeons in the United States. She specializes in heart and lung transplant and mechanical circulatory support and all aspects of adult cardiac surgery.
When Dr. Leacche met her new patient, Hoseth had already undergone a coronary angiogram.
Results suggested a condition called a myocardial bridge.
“She was referred to me for surgical evaluation,” Dr. Leacche said. “Kathy Hoseth underwent another test which suggested flow limitation in her native LAD, or left anterior descending artery, but the myocardial bridge appeared to be thin.”
Hoseth had never heard of a myocardial bridge.
She learned it occurs when the coronary artery is not on the surface of the heart but goes into the muscle for a segment and then emerges again.
“For many patients, the condition is present since birth but is without consequences,” Dr. Leacche said. “A few patients, however, develop ischemia, or a restriction of the blood supply, because when the heart contracts, the muscle band constricts the artery by pinching it.”
These were the moments when Hoseth experienced pain.
“Surgery involves a median sternotomy and cardiopulmonary bypass that consists in unroofing the muscle, which is lying on top of the artery,” Dr. Leacche said.
A median sternotomy is a surgical procedure during which an incision is made along the sternum and then dividing, or “cracking open,” the sternum to access the heart.
A cardiopulmonary bypass requires stopping the heart during surgery and allowing the blood flow to be maintained by a machine until the heart is repaired.
While Hoseth’s heart had stopped, the surgeon “unroofed,” or moved the muscle from the top of the artery, to a spot where it no longer affected the function of the artery.
The elephant leaves the room
Hoseth’s recovery from the April 2019 surgery came gradually and surely.
She stayed at Spectrum Health Fred and Lena Meijer Heart Center for nearly a week.
“As I got better it felt like an elephant had been taken off my chest,” Hoseth said.
Since the operation, her condition has improved further.
“I have my life back,” she said. “I sleep better. Everything is better. And my resting heart rate is now a phenomenal 71.”
Hoseth urges women to take chest pain seriously and never give up on getting an answer for the pain.
“Be your own advocate,” she said. “Look for answers and push harder to get them.”
Dr. Leacche agrees.
“This case highlights the difficulty of (finding) the correct diagnosis but also the disparity that women face when complaining of chest pain,” the doctor said. “More women die from cardiac distress because of late diagnosis, especially when younger.”