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A cardiac nurse’s surprising diagnosis

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Joan Jahnke, RN, got her dream job out of nursing school in 1976 working in a small hospital with a 10-bed CCU. This was back when there wasn’t always a doctor on site and RNs were the first line of hospital medical care.

Jahnke worked for several years in this setting. One of her most poignant memories from that time is of an elderly man who waited in the ER, clutching his chest, as the staff was in the midst of a mock emergency response drill with a local military base. They triaged as best they could, but he wasn’t a “mock” patient. He was having a heart attack.

As Jahnke neared retirement years later, she found herself clutching her own chest. She was short of breath and in pain. And although she’d been a cardiac nurse for many years, treating patients with these exact same symptoms, she was still surprised to discover she herself had a heart condition.

Throughout her diagnosis, treatment and painful path to recovery, Jahnke recalled the man in her ER and his quiet patience. It was in that quiet place—seeking patience as he had demonstrated—that she found relief.

Below, Jahnke shares her story with Scrubs about the surprising journey she underwent to get the right diagnosis.

Scrubs: What was your lifestyle like before your diagnosis?
JJ: I have always had a good lifestyle, lots of different types of exercise, no medical issues, never smoked and drank no alcohol until I was in my late twenties. My family history reveals occurrences of MI, so I did everything correct to avoid CAD.

Scrubs: What were the symptoms you were experiencing that led you to believe there was something wrong?
JJ: My symptoms were and are identical to someone having a heart attack. The ischemia caused by this dysfunction mimics both esophageal spasm and MI. If I were in my ER or CCU, I’d treat this as a cardiac patient with evolving MI, administer oxygen and give nitro and something for pain. Then the cardiac enzymes would show nothing and the EKG, in the monitoring of this crisis, would likely show nothing or perhaps a flattened/inverted T-wave or harmless arrhythmia.

I know the wondrous effect of administering nitro and seeing the quick tempering and relief of a patient’s symptoms. Little did I know that back in 2005 when I started using nitro SL to relieve my chest pain that in 2011 I’d be dependent on and thankful for the relief I get from one of the oldest known vasodilating medications.

I was finally diagnosed in 2008 with a drug challenge cath test at Emory University. I was a very severe case and had a cardiac arrest during that cath. It’s not very nice to have a heart go from normal sinus rhythm to v-fib and straight line. That hurt. I spent the following four days on IV nitro and was released on nitro patch and barely able to keep ADLs (activities of daily living).

I have cardiac microvascular endothelial dysfunction with vasospastic angina and each episode of angina is like having a heart attack. My attacks are sometimes multiple times during a day, for days on end, with a few periods of pain-free stability. I can have chest pain, shortness of breath, left radiating arm pain, left jaw pain, left ear pain, mid-back shoulder pain, abdominal distress and sweats. Most times, a coincidental EKG will be normal. Nitro corrects these symptoms. I have had three coronary caths, left and right with ultrasound and my coronaries are clear.

Scrubs: What has your life been like since your diagnosis?
JJ: I am now nitro-dependent 24/7 and still have frequent episodes of vasospasms with crippling angina. No matter how hard you may try, you may get an odd version of what you’ve worked so hard to avoid: heart disease. And this MVD is a form of heart disease and is found predominantly in women. The etiology is unknown and each woman with MVD can have varying degrees of “heart attack” ischemic symptoms.

Scrubs: What words of advice do you have for other nurses about taking care of their heart health?
JJ: Little did I know that I would be so involved in being my own best advocate in my search for an answer for my heart problem. I listened to my body and paid attention to my heart. Despite today’s advanced medical technologies screaming “It’s not your heart!” I listened to myself and to my body and knew it was my heart.

A nurse should be persistent, consistent and articulate when she thinks there is a problem with her heart. Keep a journal of signs, what activities were going on when the signs happened, medications tried and results, testing dates and results.

Make those journal notes clear, short, concise and without emotions (doctors hate to read too much about how you feel emotionally). When I lost my ability to sustain speech due to shortness of breath, this journal was read by my Emory doctors before they even examined me; tremendously helpful!

Don’t be put off by lack of positive medical technology and testing. If it feels like your heart, believe it’s your heart. Get the support of a physician who listens, and when that physician doesn’t know what to do, then get to a large medical center of excellence in heart care, especially one familiar with women’s heart health.

I’ve used medical school libraries and the Internet pursuing the etiology of my condition. My determination left me exhausted and discouraged, but I was fortunate enough to have medical friends who knew that I wasn’t assimilating my prior knowledge from cardiac nursing to explain my symptoms and steady decline in heart health. My new habit is to talk and write about cardiac MVD.

Joan Jahnke is now a retired RN. She has enjoyed many career opportunities and great jobs following her Navy husband around the world. She worked for two years at Bethesda Naval Hospital doing utilization review and quality assurance for its cardiac and step-down unit, and was involved in making the case for continued cardiac rehabilitation. Jahnke has worked for HMOs in Washington, DC, and South Carolina assuring healthcare access for patients.

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4 Responses to A cardiac nurse’s surprising diagnosis

  1. Joan Jahnke

    This is my interview and I’m very pleased to have this published and out there for more nurses and women to read. This MVD ( cardiac microvascular dysfunction) is quite a day to day management issue and a very isolating one as well. I hope many people read this and remember that women really do present differently with heart disease. Thanks to all who read this article.Joan.

  2. Dave Strange

    Hi Joan, thanks for providing another glimpse into your challenge. By sharing your story you are making a difference, educating your fellow nurses to not only reflect upon how they care for their cardiac patients but also themselves.

  3. Hip hip HOORAY! Hip hip HOORAY!! Thank God for you Joan. If it weren’t for you, I would not know what was wrong with me. If it weren’t for me, your cardiologist wouldn’t have understood when to STOP pushing exercise, as it does not help us, but tends to be more provocative. I will carry your story with me, as your story is similar to my story…to so many women’s stories, and if only more people would stop assuming and start looking and listening, they just might get it.

  4. Thanks SO MUCH for writing this piece, Joan. As a heart attack survivor who was sent home from the E.R. in mid-heart attack with a misdiagnosis of GERD, I especially appreciated your wise advice: “If it feels like your heart, believe it’s your heart.” Let’s face it – cardiac diagnostics have not yet caught up with the reality of women’s misdiagnosis experience in the E.R.

    Your own experience will help inform women with MVD but more important, your health care colleagues as well.

    I have a Dx of both obstructive and non-obstructive heart disease (lucky me!) but have found impressive results in managing MVD chest pain by wearing a portable TENS unit prescribed by pain specialists at our Regional Pain Clinic.

    In Europe and Canada, considerable success has also been observed in MVD symptom management with Spinal Cord Stimulator Implant surgery as well ( = still considered off-label in the U.S). That’s Plan B for me if/when my TENS unit is no longer able to manage chest pain.

    More on TENS units for MVD, including journal links, at: “How Women Can Have Heart Attacks Without Having Any Blocked Arteries” at HEART SISTERS:
    http://myheartsisters.org/2010/04/25/microvascular-disease-women-blockages/

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