On the morning of August 7, Christine Pepoy picked up three friends and began driving to a golf outing at Pleasant Hill Golf Course in Chardon. At one point their conversation turned to guardian angels.
Shortly thereafter, Pepoy needed the help of her own guardian angels when she collapsed as she walked to the registration table. Her husband Joe – a former paramedic who was already at the course – and another golfer raced to her side and began mouth-to-mouth resuscitation and chest compressions. Paramedics from the Burton Fire Department took over for them five minutes later and transferred her to University Hospitals.
“Her breathing was labored,” recalls Joe. “Then, all of a sudden, she just stopped breathing. When you think of a heartbeat, you think of thump thump. Well, there was no thump thump.”
Doctors at University Hospitals initially believed Pepoy had suffered a heart attack. However, subsequent tests revealed one of her main coronary arteries was in spasm. Dr. Sahil Parikh, director of UH’s Experimental Interventional Cardiology Laboratory, diagnosed her condition as Prinzmetal’s angina, also known as variant angina. Conventional angina is chest pain or pressure caused by a progressive narrowing of the coronary arteries by plaque that restricts blood flow to the heart. Prinzmetal’s angina is caused by spasms of the arteries’ muscular layers. Parikh estimates that less than 1 percent of patients who suffer cardiac arrest have the condition. Although physicians aren’t quite sure what causes it, they typically see it in people with mild narrowing of the arteries. “They are almost all smokers,” he adds. “And most of them are women.”
The diagnosis was shocking. Although she smoked an occasional cigarette, the 43-year-old, stay-at-home mother appeared healthy and fit, a women who walked three miles almost every day and played softball. But, there had been warning signs. During the last few months, Pepoy had experienced occasional bouts of what she thought was mild heartburn, a symptom commonly found in women who present with heart disease. “It felt like it started in my throat and moved down through my chest,” she says. Parikh believes the discomfort actually was caused by coronary artery constriction. Pepoy has since been placed on medications to control the spasm with an excellent response. “Her chances of a recurrence are low, probably less than 5 percent,” Parikh says, “however, we elected to implant a cardiac defibrillator because this episode resulted in cardiac arrest.” The defibrillator should shock her heart into a normal rhythm if it stops again during such an episode.
Pepoy was released on August 24 with prescriptions for medications to relax her blood vessels, prevent spasms and lower her cholesterol. She immediately stopped smoking and cut her red-meat consumption. Seven weeks after her release from UH, she returned to Pleasant Hill for another golf outing. “I played all 18 holes and felt great,” she says. “I didn’t miss a beat – no pun intended.”
By Lynne Thompson, as featured in the American Heart Association Go Red for Women special section of Cleveland Magazine, February 2012