Rachel's Story

A Risk of Heart Disease Due to Personal and Family History

Rachel was in her forties and had rheumatoid arthritis (RA). She occasionally saw a rheumatologist in New York City for management of her RA and rarely saw her primary care physician. In fact, she had only seen her physicians twice in the last five years.

Rachel was keeping busy with work and her kids and was generally feeling well when she felt a twinge in her chest. She chalked it up to stress, noting that the sensation of pressure in her chest came and went for the next two weeks. It often was accompanied by some stomach upset. She took some over the counter heartburn medication but had no relief.

At her son's soccer game the next weekend Rachel began to feel dizzy and the pressure in her chest suddenly increased. Aware now that her symptoms matched what she had read about for heart attacks, she immediately asked her husband to get the team doctor. The doctor confirmed that her symptoms could be the result of a heart attack, gave Rachel an aspirin and called for an ambulance. Rachel was evaluated in the emergency department of a local hospital and found to have a blockage in one of her main coronary arteries. She underwent surgery to place a stent in the artery to hold it open, staying 2 days in the hospital.

Rachel had not thought she was at increased risk for a heart attack. The last time her primary care doctor asked about her family history she had confirmed that she did not have any close relatives with a history of heart disease. She hadn't thought to mention the two cousins who had heart attacks in their 40s, thinking they were too distantly related to be important. Recent studies have shown that two distant relatives with heart disease on the same side of the family can increase risk to the same degree as having a single close relative with heart disease - Rachel's family history meant that her risk for heart attack was 3 times as high the general population risk.

Further, Rachel's personal history of RA impacted her risk of heart disease: It was only recently discovered that patients with poorly controlled RA have a significant risk for heart disease regardless of cholesterol levels. Inflammation plays a large role in sudden heart attacks and the warning signs were definitely there for Rachel.

Rachel was lucky that she was able to get to a hospital quickly. Had she understood her risk for a heart attack, she would have pursued increased screening and made sure her RA was as well controlled as possible. She would also have known not to ignore her symptoms.