Not a Panic Attack

Read This First

If you have chest pain, pressure, squeezing or tightness, even if it's mild, or pain spreading to your arm, jaw, neck or back, or sudden breathlessness, or a cold sweat, nausea or light-headedness with any of these:

Stop reading. Call your local emergency number now. That's 999 in the UK, 911 in the US, and 999, 112 or 911 in Kenya. Don't drive yourself.

The full list of emergency signs is on the Go Now card at the back of this book. Find it now, before you need it.

Women die of heart attacks that were called panic attacks, indigestion, a pulled muscle or "just stress." Not because they ignored the warning, but because they never knew what the warning could feel like, and because the person in front of them didn't think of their heart either. This book exists so that doesn't happen to you, or to the woman you love.

Who this book is for

• Women, mostly 30 to 65, whose chest pain, breathlessness or exhaustion keeps being put down to anxiety, hormones or being busy.
• Women with a pregnancy complication behind them, an autoimmune disease, a family history, or a heart scare they were told was "rare."
• Partners, daughters, sons and friends who want to know when to stop arguing and call for help.

What this book will do

It will show you how heart disease actually shows up in women, including the heart attacks that happen in clear arteries, in fit young mothers and in the week after a funeral. It will show you which parts of your own history (pregnancies, the pill, menopause, lupus, diabetes) quietly change your risk. And it will give you the exact words to use in the emergency department and the GP's office, plus the tests to ask about.

You'll finish with a Heart Advocacy Pack: your risk timeline, a symptom diary, the scripts, and a record of every test. It lives at the back of the book.

What this book will not do

It is not medical advice and it can't examine you. It won't tell you to stop, start or change any medicine. It doesn't replace an assessment by a clinician. It is here so that you walk into that assessment knowing what to say, what to ask, and when "it's probably anxiety" is not a good enough answer.

How to read it

Read Chapters 1 and 2 first. They cover why women get missed and what a heart attack can feel like. After that, jump to whatever fits your life:

• A "normal" angiogram but still having pain? Chapter 3.
• Young, fit, pregnant or recently given birth? Chapters 4 and 6.
• Had a terrible shock or loss? Chapter 5.
• On the pill or HRT, or past menopause? Chapters 7 and 8.
• Living with lupus, diabetes, PCOS, high blood pressure or sleep apnoea? Chapter 9.
• Going to the doctor soon? Chapter 10, then the pack at the back.
• Already had a heart event? Chapter 11.

Stories in this book

Some stories in this book come from public records, such as inquests and published research, and are cited where they appear. Others are composites: names and details are changed, and they're labelled as composites where they appear. No quote in this book is invented and attributed to a real person.

About this book

This book is educational. It is not medical advice, and it is not a substitute for a clinician who knows your history. If you have warning signs now, use the Go Now card or call your local emergency number. For everything else, take the questions in this book to a doctor, nurse or pharmacist.

Do this now: turn to the Go Now card at the back, take a photo of it on your phone, and send it to one person you live with.

Sent Home

Mariona Garcia Ramon was 26. She was a Spanish student living in Brighton, working at a bar on West Street. The pathologist would later describe her as incredibly fit and healthy. On 30 April she phoned her boyfriend from work feeling unwell and asked him to collect her. On the walk to a walk-in surgery she had to stop several times to catch her breath.

At the surgery she ticked the box for chest pain, but told the nurse practitioner the pain was in her throat, as if something was stuck there. Her blood pressure, breathing and heartbeat were normal. The nurse said it was probably a physical sign of anxiety, told her to see her GP, and to call 999 if things got worse.

That night she woke up unable to breathe, with the same stuck feeling in her throat. It passed after a couple of minutes. The next day a GP spent 26 minutes taking what the inquest heard was a careful history, and also thought it was probably anxiety. The GP later said she had not suspected a heart problem at all.

The following day, 2 May, Mariona collapsed at home. Her boyfriend did CPR until the paramedics arrived. She was pronounced dead at the Royal Sussex County Hospital. At post-mortem, the pathologist found one of the three main arteries of her heart blocked. Because she was so fit, he said, her body had been able to compensate, which partly hid how sick she was. The coroner recorded a conclusion of natural causes.

Two careful clinicians. Two short appointments. The same answer both times: anxiety.

Here is the honest part. A heart attack in a woman under 30 is rare. The pathologist told the inquest that of more than 5,700 women treated at the regional heart centre since 1999, only one woman under 30 had had a heart attack. Nobody in this story was lazy or cruel. That is exactly why it matters. When something is rare, the people examining you are not thinking about it, and when your symptoms don't fit the picture they were trained on, the easiest explanation in the room is your nerves.

"It's probably anxiety" is only safe to accept after your heart has been tested. If nobody has done a heart tracing (an ECG) and a troponin blood test, often repeated a few hours later, your heart has not been ruled out. It has only been guessed about.

The moment you've already lived

You might not have collapsed. You might be reading this because of a night that ended with a leaflet about breathing exercises.

It goes like this. Something is wrong in your chest, or your jaw, or between your shoulder blades. Maybe you can't get a full breath. Maybe you're sweating and sick and so tired you can barely stand. You wait, because it might pass and because somebody has to sort out tomorrow's school bags. Eventually you go. A nurse wires you up. A doctor glances at a strip of paper and asks if you've been stressed lately. You hear yourself say "I suppose so." You go home feeling silly for wasting everyone's time.

• You've been told "it's probably stress" or "it's probably anxiety" before anyone took your blood.
• You've apologised to a nurse for "making a fuss."
• You've waited until the kids were in bed, or until after a meeting, before getting help.
• You've typed "heart attack or panic attack" into your phone at midnight.
• You've decided not to go back, because last time they sent you home.
• You've thought, "I'm too young for a heart attack," or "women don't really get those."