‘Back to My Best’
Two miles from home, a sudden pain stopped Sara Rutledge in her tracks. As the feeling, now burning, crept into her chest, her black lab, Goose, turned and looked back, curious why their daily run was being cut short.
Maybe it was the poor air quality, a consequence of smoke migrating to the Green Mountains from the summer wild fires out West. Convinced she was dehydrated or had briefly overexerted herself, Rutledge caught her breath and took a few sips of water. But rather than improving, the pain intensified, shifting to her back and arms.
“I didn’t know what was happening, but I knew something was very wrong,” says 44-year-old Rutledge from her home in Fayston, Vermont. “I knew I had to get help.”
Reflecting on that early August morning in 2021, Rutledge remembers she could barely lift her hands to use her cell phone, and when she could, she found there was no service.
About an hour later, after walking herself home, Rutledge arrived at the emergency department of UVM Health Network - Central Vermont Medical Center accompanied by her husband, Jeremiah. There she met Amos Hare, a physician assistant. Concerned by the symptoms Rutledge described, Hare ordered a battery of medical tests.
These tests would later confirm that Rutledge had suffered a heart attack.
Not Your Typical Heart Attack
“It was a surreal time – I was so confused,” Rutledge recalls. “How could I have had a heart attack? I was a healthy person. I ate well, exercised every day and had none of the risk factors you often associate with heart problems. Yet there I was, sitting in a hospital bed.”
She was not the only person wondering what had caused her heart attack. After reviewing her blood work, Hare consulted with his UVM Health Network cardiology colleagues at the University of Vermont Medical Center, concluding that she should be transferred there for further testing and care.
While awaiting her transfer, Rutledge forged a tight bond with her caregivers. “With everything going on with COVID-19, I expected them to be strained to the max, but they were so reassuring and made me feel so comfortable,” she says. “I’m really grateful for their efforts.”
At the UVM Medical Center, Rutledge learned that she had experienced a type of heart attack known as a spontaneous coronary artery dissection, or SCAD. These occur when a tear in an otherwise normal artery blocks the flow of blood to the heart. Chest pain or discomfort, shortness of breath, pain in the arms, back, neck or jaw and nausea, lightheadedness and sweating are classic symptoms.
While rare, SCAD heart attacks are most common in women under the age of 50. And like Rutledge, they often affect women who are otherwise healthy, with no preexisting conditions that put them at higher risk of heart problems. This leads many patients with SCAD to be misdiagnosed.
Recovery also looks different from typical heart attacks, where many people have a stent surgically implanted to open blocked arteries. With SCAD, the tear in the artery makes it fragile and a stent can actually end up making things worse. So instead, most patients with SCAD are prescribed a combination of rest, medication and cardiac rehabilitation. With this regimen, the damaged artery typically heals on its own over the course of several weeks or months.
Rehab Rebuilds Confidence
Rutledge returned home a day after her SCAD diagnosis feeling overwhelmed by the task ahead of her.
“I had lost all confidence in my body,” Rutledge recalls. “Being physically active was such a big part of who I was, and suddenly this seemed so out of reach. I was really scared that it was just going to happen again.”
Thankfully, Rutledge says, she found herself in good hands. Cathy Fetten, RN, a member of the cardiac rehabilitation team at Central Vermont Medical Center, had worked with SCAD survivors before.
“I remember how scared and frustrated Sara was when she first arrived,” Fetten says. “With people who have suffered from SCAD, I think it’s important to focus on goals that also help them to reduce their stress. In Sara's case she loved to run – so we focused on gradually restoring her confidence in a safe environment.”
They started small, with Rutledge taking slow walks on the treadmill while the rehab team monitored her heart for any signs of trouble.
About a month into Rutledge's rehab, Fetten says, she thought she was ready to start jogging again. "It was only for a few minutes at first, but it was a turning point for me," Rutledge says. "After that moment, I really started to feel like everything was going to be OK and I would get back to my best."
It was rewarding for Fetten as well. “It was great to see Sara more comfortable and return to running with confidence again.”
’They Saved My Life’
It’s been six months since Rutledge received her diagnosis. “I’m back to running and snowshoeing with Goose – two things I never thought I’d do again.”
Reflecting on her journey to recovery, Rutledge says that connecting with the global community of SCAD survivors has been particularly rewarding.
“Online forums have introduced me to so many women like myself, and it reminds me of how fortunate I am,” she says. “Too many of these women are sent home from ERs or misdiagnosed because they don’t look like typical heart attack patients. Looking back, it would have been easy for a doctor to think the same thing and brush me off, chalking it up to a panic attack. Instead, they saved my life.”