RA & Heart Disease

Much of the public still has a hard time correlating rheumatoid arthritis with onset of heart disease. Even medical professionals have a hard time making the connection. Unfortunately, I got a close up and personal glimpse into the fact that RA is a risk factor for heart disease this past week when I was hospitalized and received two cardiac stents on 3/10/2014 without any significant cardiac history.

I’m writing this blog as a warning to others with RA to make sure that you learn about the ways that RA contributes to heart disease and to seek a cardiology referral. It could mean the difference between life and death.

On Friday, March 7th, 2014, I began having chest pressure mid-day when out shopping with my mother and sister. The chest pressure felt like my bra was suddenly a wee bit too tight and I felt I was out of breath (called shortness of breath in medicine). I’d been having these episodes over the last year and had a prescription for nitroglycerin spray under the tongue. I took a spray then went and sat down for a bit, thus ending the shopping spree. When I got home and unloaded my purchases, I had another episode requiring a spray of nitro; however, it went away and exhausted I decided to lie across the bed and close my eyes for a bit which turned into a two hour nap. I was awakened by chest pressure and the need for a good breath. That has never happened before. Chest pressure has always occurred when I was awake.  It took two nitro sprays for it to diminish and I was quite shaken. To make a long story short, I ended up following my gut instinct and went to the ER for evaluation. Nitroglycerin paste was placed on my chest and oxygen placed by in my nose for treatment and the chest pressure and shortness of breath dissipated. I was admitted to the hospital for observation and further cardiac study which required frequent lab draws, EKG tracings, and a heart monitor to detect arrhythmia and heart muscle damage (heart attack).

While hospitalized, my lab work and other diagnostic tests mostly came back within normal limits with only a few quirky oddities. Episodes of chest pressure was relieved by application of the nitroglycerin paste every four hours. When a nurse held the dose of nitro paste during the night due to a low blood pressure reading, I awoke with chest pressure. My cardiologist scheduled me for an angiogram (heart cath) telling me that with the cath I’d have peace of mind knowing one way or another what was going on with my heart. I had been telling him for months that my chest pressure only occurred when I was experiencing increased RA symptoms. I even told him at this point, “In the pit of my gut I know this is RA related,” and he humored me. He indicated if the cath was clean, showing no disease, I’d be going home that evening. On Monday, March 10, 2014 I shocked them all, including myself. The heart cath revealed I had two major blockages in my coronary arteries with one being 95% occluded and the other 75% occluded requiring ballooning and stents. In addition, I was told I have two other vessels that are at 45% that were left untreated as it is their practice not to stent unless the vessel is more than 50% occluded.  Let me say, this was not the kind of validation I was seeking!

How does RA affect the heart and why is it so important to know this? As stated on a webmd article* it is the chronic inflammation associated with RA doubles the risk of a heart attack in the first 10 years of RA diagnosis in patients who do not have a cardiac history. Also certain drugs used to treat the inflammation associated with RA also contribute to heart disease. Another great article from Arthritis Today** explains how the inflammatory process of RA affects the heart by describing how RA inflammation causes narrowing the vessels, promoting plaque deposits. The inflammation associated with RA can cause a false cholesterol reading as well.  The information in these articles is sobering. In my opinion, there is no excuse a rheumatologist not to make a cardiology referral for each rheumatoid arthritis patient regardless of symptomology or test results. In turn, that cardiologist should be aggressive in looking for heart disease in rheumatoid patients.

In summary:

• Trust your body no matter what others tell you. You know when something is wrong. If you have a deep, nagging feeling that something more is going on with your body than what the doctor is telling you then speak up and don’t be dismissed. Doctors are trained to listen to the patient and take into consideration what the patient is saying to dig deeper.
• Don’t ignore chest pressure thinking it is nothing. I could tell the pressure was different from anything else I’d experienced, especially when accompanied by shortness of breath. My episodes of chest pressure occurred only when my RA was starting to flare or I was in a flare which was confusing and led to dismissal of it being true angina.
• Know the symptoms. Women experience chest pain differently from men in most circumstances as a band-like feeling as if your bra might be a bit too tight. Men more frequently report extreme pressure described as an elephant sitting on the chest or severe pain to the chest that can radiate to the jaw or down the left arm. This is not to say that men can’t experience band like pressure and women can’t experience the more extreme pressure or pain. Just be aware of the differences and not excuse away the symptoms.***
• “Most of all, be pushy. Encourage your doctor to be aggressive in evaluating and monitoring your cardiac status. You want her/him to treat you just like any other high risk patient.” **This includes your cardiologist. Cardiologists are just now learning about the effects of RA on the heart. Don’t be afraid to print the above mention articles and discuss them with your cardiologist. I wish I had.

It’s been five days since my stents were placed. It’s rather sobering to realize I have added another chronic condition, CAD (Coronary Artery Disease), to my list of diseases that can kill me. I am on three new medications that I will have to take the rest of my life to keep the stents open and my heart functioning. I feel rather fortunate to be alive. Had I dismissed the chest pressure that woke me up from that nap and went back to sleep rather than going to the ER, I could have had a full blown heart attack Friday night based on the severity of 95% blockage of the LAD coronary artery. My medical team response after the angiogram was a reminder to them that not every patient follows a cookie cutter picture of disease. They even said, “you don’t look sick” which I know influenced them not to pay as close attention to my case as they would have if I did look sick. I saw a shift in attitude among the medical staff once they learned of my blockages. Even my cardiologist was surprised that I had blockages as it had been anticipated I’d have a clean cath and be sent home that day. Perhaps one day through education and sharing of stories like mine, RA patients will have a greater voice and our symptoms will have merit in the medical community.

References: *www.webmd.com/rheumatoid-arthritis/guide/heart-disease-rheumatoid-arthritis

**www.arthritistoday.org/about-arthritis/types-of-arthritis/rheumatoid-arthritis/what-to-expect/effects-on-body-and-health/ra-and-your-heart-2.php

***www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Symptoms-and-Diagnosis-of-Heart-Attack_UCM_002041_Article.jsp