‘It's Not All in Your Head': Woman Gets Answers on Heart Condition Doctors Missed

D.C.'s MedStar Washington Hospital Center is among the first hospitals in the country with new technology to diagnose coronary microvascular dysfunction or CMD. The condition is more likely to affect women can lead to a heart attack, stroke or even death but is hard to diagnose

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A Maryland woman felt chest pain for days before things took a dramatic turn during a family trip to Williamsburg, Virginia. 

“I felt this tightness in my chest and pain and discomfort in my left arm. My shoulder blade felt like someone had, you know, stabbed me and was twisting the knife around. It was very intense,” said Melanie McCauley, 46, of Fort Washington. 

Her husband was competing in a bowling tournament when she started sweating and feeling nauseous. She told him she needed to get some air.

“I turned on the air conditioner and ran the car. Now, this is November, so it's cold outside, and I ended up texting him and saying, ‘Hey, I may be having a heart attack,’” she recently recounted. 

It turned out she was right. But emergency room doctors couldn’t pinpoint the cause. They ran tests and took an X-ray of her heart but found no blockages in any of the main arteries.

“I have these doctors basically telling me, ‘You had a mild heart attack and we don't know why,’” McCauley said. 

After three days in the hospital, she went back home and was put on medication. But the pain didn’t go away. She ended up back in the emergency room several times with similar symptoms over the next few months. Each time, doctors ran tests and assured her nothing was wrong.

“I was frustrated, honestly, and it got to a point where I just started to question myself, like, 'OK, maybe it's not as bad as I believe it is,'" McCauley said. 

She finally got answers after meeting with Dr. Hayder Hashim, a cardiologist at MedStar Washington Hospital Center. She was diagnosed with coronary microvascular dysfunction, or CMD, which occurs when the heart’s smallest arteries don’t dilate properly and the heart doesn’t get enough blood. Left untreated, CMD can lead to a heart attack, stroke or even death. But it’s hard to diagnose because these tiny arteries aren’t visible on a traditional X-ray.

“Patients with coronary microvascular dysfunctions are often dismissed by their doctors as it's all in their heads. Now we have the diagnostic tool to actually unmask their condition and give them the right diagnosis,” Hashim said. 

MedStar Heart & Vascular Institute is one of the only programs in the country using a new diagnostic tool called the Coroventis CoroFlow Cardiovascular System.

“With this new technology, we’re able to measure the exact flow and the exact resistance in these small arteries without even looking at them,” Hashim explained. 

The extra step is essentially a wire that measures a patient’s blood flow and temperature. The results determine whether the heart’s smallest arteries are working properly.

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McCauley had the test done in February and agreed to let Hashim broadcast it live during a conference to hundreds of cardiologists from all over the country. She said it was nerve-wracking but she was desperate for answers. After months of pain and uncertainty came the moment she had waited for.

“I heard him say, ‘Bingo.’ So I was thinking, OK, this is great. He sees something,” McCauley said. 

“He said, ‘It's not all in your head.’ He said, ‘You really have coronary microvascular dysfunction.’ He said, ‘That explains everything. So we're going to get you treatment, and you'll be able to live your life. You'll have your quality of life back.’ And he was absolutely correct,” she said. 

McCauley takes medication to treat CMD and is doing well. The condition affects about 4 million people, with women more likely to have it than men. Smokers and people with diabetes, high blood pressure or high cholesterol face a higher risk, but it can impact anyone. 

The new screening tool is typically covered by insurance, Hashim said.

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