Margaret Sullivan

Margaret Sullivan almost did not go to hospital. At fifty-eight, the retired schoolteacher had never had a serious illness, and when she woke one Tuesday morning feeling nauseated, with a strange ache in her jaw and a heaviness in her arms that she couldn't explain, her first instinct was that she had slept badly. She made herself a cup of tea and sat in her garden. The nausea worsened. Her neighbour, who came by to return a borrowed book, took one look at Margaret and called an ambulance. The ECG performed in the ambulance showed unmistakeable signs of a heart attack. Margaret arrived at Silvaris Heart Institute in Newark twenty-four minutes later. She was taken directly to the cardiac catheterisation laboratory without stopping at the emergency department.

The interventional cardiologist who performed her procedure introduced himself briefly and explained in four sentences what he was about to do. There was no time for more. A wire was passed into the blocked coronary artery, a balloon expanded it, and a drug-eluting stent was deployed to hold it open. The procedure took thirty-one minutes from arrival in the laboratory. Blood flow was restored to the front wall of her heart. Margaret was moved to the coronary care unit, where her consultant cardiologist — who led the heart attack service — visited that evening. "He sat down," Margaret recalls. "He wasn't in a hurry. He explained what had happened, why it had happened, what the stent had achieved, and what would need to happen next. I hadn't understood any of it until then. And he made sure I did."

The coronary care unit admission lasted three days. An echocardiogram performed on day two showed that the heart muscle had sustained some damage — the ejection fraction was reduced — and a programme of medications was started to protect and gradually recover function: a beta-blocker, an ACE inhibitor, a high-dose statin, aspirin, and a second antiplatelet agent. Each medication was explained by the cardiac pharmacist who visited Margaret on day two, going through her new prescription card entry by entry with unhurried thoroughness. The cardiac rehabilitation nurse visited to introduce the six-week programme that would begin after discharge. Margaret was given a heart attack pack — written information, contact numbers, a medication schedule — before she left hospital.

Cardiac rehabilitation at Silvaris Heart Institute ran twice weekly for twelve weeks. Margaret joined a group of nine other patients who had experienced cardiac events of varying severity, and the solidarity she felt with those fellow survivors surprised her. The supervised exercise sessions were graded carefully: walking first, then a cycling ergometer, then a treadmill, heart rate and rhythm monitored throughout. The educational sessions covered diet, stress, sleep, smoking cessation — Margaret had been a light social smoker and stopped entirely after her heart attack — and medication compliance. A session specifically on women's heart disease, discussing the atypical symptom presentation that had nearly cost Margaret her life, resonated with her deeply. "I had no idea that women often don't get the crushing chest pain," she says. "I want every woman to know this."

Three years after her heart attack, Margaret's ejection fraction has recovered to 54% — a remarkable result that her cardiologist attributes to the combination of rapid revascularisation and optimal post-infarct therapy. She walks five kilometres every morning, has maintained the dietary changes she made after rehabilitation, and remains entirely smoke-free. She attends annual cardiology review and has never missed a dose of her protective medications. She also volunteers as a patient representative for the hospital's cardiac patient experience committee and has twice spoken at nursing education days about the atypical presentation of heart attack in women. "I am alive because a neighbour came to return a book," she says. "But I am thriving because of the team at Silvaris. Those are two entirely different debts."