Johannesburg – When an over-committed 43-year-old banking professional and mother of two started to experience ongoing pain in her shoulder, she brushed it aside as tension.
She had been working long hours at her laptop every day and was completely unaware that a near-fatal heart attack was just weeks away.
Looking back now, Elana Malgas explained that she knew something was not quite right but simply believed she needed to set aside some time for herself, a priority that lay at the bottom of her lengthy to-do list.
“I work in a high-pressure corporate environment and for many months I had been taking strain at work, performing two roles due to ongoing staffing shortages, as well as trying to finish my Bachelor of Commerce degree in finance,” she said.
“I was continuously doing 12-hour work days but as a woman in the corporate world, I did not want to fail so I just kept pushing – beyond my limits, as it turned out.”
Meanwhile, Dr Adriano Dello Iacono, a cardiologist practising at Netcare Olivedale Hospital, noted that, like many heart attack survivors, Malgas recalled having other symptoms as well.
This included numbness in her left arm which she attributed to her suspected shoulder tension and – just days before her cardiac event – heart palpitations, which she read as a sign of anxiety. However, as she had felt no chest pains, it did not occur to her that her heart might be in danger.
Breaking point
Needing to spend some quality time together, Malgas and her family had planned to have a special lunch at Hartbeespoort Dam in early May, but during the drive from their home in Randburg she began to feel nauseous.
Once at their destination, she was too ill to sit at the table, opting to lie down in the car in the hope that her illness would soon pass.
“I was vomiting, I had unbearable pain in my shoulder and upper back, and my hair was wet with sweat,” she explained. “I have never been a sickly person but I knew something was very wrong and finally agreed to my fiancé’s suggestion that we seek medical attention.”
And instead of finding a local general practioner (GP), Malgas’s fiancé wanted to make the one-hour’s drive to Netcare Olivedale Hospital so they could be near home.
“I did not communicate to him the level of pain I was experiencing – it felt like the drive would never end, but it brought me to the right place, and just in time,” she said.
Upon arrival at the hospital’s emergency department (ED), Malgas’s condition had deteriorated significantly and within a matter of minutes she was in cardiac arrest.
According to Dr Gina Karam, a medical doctor practising in the Netcare Olivedale Hospital ED, as a woman in her forties, Malgas had almost no risk factors for heart attack. However her blood pressure was extremely high and an electrocardiogram, or ECG, was done to measure her heart’s rhythm and electrical activity.
“Women often do not present with chest pain in the months and weeks before a heart attack and can therefore misinterpret the signs until it may be too late,” Karam explained.
“Looking at the results of the ECG it was clear that her heart was under enormous stress and had gone into an abnormal rhythm. In this state, it is almost as if the heart is shivering and there is very little blood pumping through.”
She added that Dello Iacono was on call and immediately began making his way to the hospital.
“Moments later Elana’s heart stopped and we had to do a full resuscitation, shocking her to get her back. It was an incredibly quick series of events – if it happened moments earlier we may have been too late,” said Karam.
Surviving the ‘widow-maker’
Dello Iacono explained that the heart attack Malgas was having – an anterior stemi – is known as the “widow-maker”, because it occurs in the largest coronary artery responsible for blood supply to the heart. Without rapid medical attention, the chances of survival are minimal.
“Not only was it fortunate that Elana got to an emergency department in time, but also to a hospital with a specialised cardiac centre,” Dello Iacono said.
“Once stabilised in the ED, we moved her to the hospital’s catheterisation laboratory, or cath lab, where we have diagnostic imaging equipment that helps us to see the arteries and chambers of the heart more clearly,” he explained.
Dello Iacono and his team also performed an angiogram for Elana with a new technique, whereby access to the radial artery is gained via the wrist with a special wire to get up into the heart, with X-ray imagery guiding the process. A catheter is then inserted along this route and once the heart is reached, a dye is injected to show up the blood vessels and the blockage.
“We then use another type of wire to get past the area that is blocked, inflating a small balloon that dilates the artery and helps restore blood flow,” he said.
“Once that is achieved, a stent can be inserted to keep the artery from collapsing but in Elana’s case there were too many clots and the blockage would have recurred.”
They, therefore, had to administer a strong blood thinner to help clear the pathway overnight and by the next day, the repeat angiogram was normal with all clots cleared and no blockage present.
Meanwhile, Malgas recalled waking up on a ventilator two days later, struggling to comprehend what had happened. Within less than a week, she was able to be discharged and, according to Dello Iacono, has made remarkable progress, though her heart is still recovering.
“Timing is everything in achieving better outcomes for heart attack patients. Having immediate access to specialised care and equipment dramatically minimises the chance of permanent damage to the heart, the brain and other vital organs,” he noted.
“Apart from being a smoker the stress, insufficient sleep and hours spent sitting at her desk certainly contributed towards a build-up of plaque that caused the clots in Elana’s arteries,” Dello Iacono said.
Meanwhile, the combination of just these few lifestyle factors put Malgas’s life on the line – even though she is incredibly young to have a cardiac event of this nature, and one that typically presents more in men.
“A healthy diet, an active lifestyle and going for regular check-ups are key to avoiding an event like this which is highly likely to affect your quality of life – that is, if you survive,” Dello Iacono said.
“Just incorporating 20 to 30 minutes of walking a day is a good start and can be very protective for your heart.”
Malgas said that the experience was a rude awakening to just how imbalanced her life had become.
“I have two grown children, a baby granddaughter who is about to turn two and a fiancé who I am building a life with; they are what matters most and I am eternally grateful to Dr Dello Iacono and his team, as well as to Dr Karam, her colleague Dr Francis-Marie Els and the nurses in the emergency department for acting so quickly.
“They were instrumental in saving my life, and I have so much to live for. This experience has totally altered my perspective. I want to share the message that even at a young age, you can literally work yourself to death – and is it worth it?
“I am now back at work and still performing well while completing my studies on the side, but at the end of the day, there is more to life than the daily grind. It’s about how you choose to spend your life,” she said.