Pinelli, a fourth-grade teacher who lives in Huntington Station, New York, was not only adjusting to a time filled with fear and uncertainty, but also getting used to homeschooling and raising her new 2-month-old puppy.
That’s why when she started experiencing symptoms like shortness of breath, fatigue, and back pain, she attributed it to stress.
“There were so many stressors at the time,” recalls Pinelli, 48. “I’ve had anxiety in the past and many of the symptoms were the same so I assumed my anxiety was through the roof.”
But soon her symptoms got worse, and one night when her dog Ananda woke her up, she found that she had excruciating pain in her wrists, elbows and chest. “It felt like I was in a boxing match with Mike Tyson,” she says.
She was also covered in sweat and so exhausted that she couldn’t move or get out of bed. Pinelli didn’t know it at the time, but she had just suffered a heart attack.
The next morning, she woke up extremely sore but wanted to get on with her day. A yoga teacher, Pinelli was frustrated with her physical state and decided to try some exercises.
“But I couldn’t do anything,” she recalls. “I walked on the treadmill and sweat was pouring off me. I stood on the outer edge of the treadmill as it rolled, not doing anything, and I was still sweating.”
A few days later, Pinelli was on the treadmill and doubled over in pain. She was having another heart attack, although she didn’t know it yet.
Pinelli called the doctor and got a checkup. During an electrocardiogram, it became clear that something was very wrong. She went to the emergency room, where she was treated with a stent – a small expandable tube inserted into a previously blocked artery to prevent it from narrowing or closing again.
A week later, while Pinelli and her father were walking their dog, she felt the same pain in her wrist and elbows. This was her third heart attack. She went back to the hospital and the doctors placed a second stent. Pinelli spent the night in the hospital and then went home to begin a months-long recovery.
At the time, during the height of the COVID-19 pandemic, many clinics were closed, and because Pinelli was active and healthy, her doctors did not recommend cardiac rehabilitation; she now wants access to this therapy and encourages others who have had a heart attack to use it if they can.
“I continued to walk on the treadmill, but I never ran because I was afraid I would get my heart rate up and my heart would explode on the treadmill,” she says. “I lived with that fear for 18 months before I really started running again. So I would like to have the cardiac rehabilitation program to help me feel safe and support me in the aftermath.”
Family history and risk of heart disease
Pinelli has a family history of heart disease, so she knew she was at higher risk. Her father had high cholesterol and had a heart attack at age 62. Her uncle also had a heart attack and another uncle had a blocked artery that required treatment with stents to prevent a major cardiac event.
Research has shown just how big of a role family history plays in heart disease. According to a study published in November 2021 in Journal of the American Heart Association, people with a family history of early-onset heart disease in at least one relative (parent, sibling, or child) have a 22% increased risk of heart disease after a first heart attack. Early onset is defined as younger than 55 years in men and younger than 65 years in women.
Another study, with more than 55,000 participants, published in New England Journal of Medicine (NEJM), found that the risk of heart attack or stroke was 91% higher in individuals with high genetic risk compared to those with low genetic risk.
But just because you’re at risk for a heart attack doesn’t mean you’re destined to have one. There are steps you can take to reduce this risk. The NEJM study also found that high-risk people had a 46% reduced chance of heart attack or stroke if they reported at least three of these four healthy lifestyle habits at baseline:
- Do not smoke
- a healthy weight
- regular exercise
- a healthy diet
“Knowing you are at extra risk, the doctor can work on preventive strategies at a younger age and also consider medications for high-risk individuals if needed,” says John Higgins, MD, a cardiologist at UTHealth Houston.
According to a US Preventive Services Task Force report published in JAMA as of August 2022, statins, a powerful cholesterol-lowering drug, have been shown to reduce the risk of heart attack and stroke in high-risk individuals who have not yet had a heart attack or stroke.
What is your number?
Donna K. Arnett, PhD, a volunteer specialist with the American Heart Association Go Red for Women and executive vice president and dean professor at the University of South Carolina at Columbia, says that if you have an increased family risk of heart disease, it’s important know your numbers.
“That means you should know your cholesterol number, your blood pressure number, and your glucose number and know what the normal ranges are,” she says. “For example, studies suggest that the ideal total cholesterol is around 150 milligrams per deciliter (mg/dL), a normal blood pressure level of less than 120/80 millimeters of mercury (mmHg), and a fasting blood sugar level 99 mg/dL or lower.”
Shortly after Pinelli’s father suffered a heart attack in 2004, she and her two brothers went for check-ups and it turned out that she had inherited his high cholesterol. Familial hypercholesterolemia, or FH, is a genetic form of high cholesterol that can pass from parent to child. From birth, people with FH produce more cholesterol than their body can safely handle, and the fat and plaque that builds up in the arteries can cause serious problems down the road.
More than a third of the population has high cholesterol, according to the Centers for Disease Control and Prevention (CDC), and about 1 in 200 adults are affected by FH in the general population. That means about 1.3 million people in the United States have FH, including children.
Pinelli started taking statins and made healthier lifestyle changes, losing 100 pounds.
“I also work out, do yoga, and meditate,” she says. “So I thought I was doing everything I could to stay healthy.”
But sometimes, despite a person’s best efforts, a heart attack still occurs. That’s why it’s important to recognize the signs, especially if you’re at high risk.
Know the signs of a heart attack
“The most common sign of a possible heart attack is pressure in the chest or a feeling of heartburn that gets worse with exertion,” says Samuel Kim, MD, a preventive cardiologist at NewYork-Presbyterian/Weill Cornell Medicine in New York City. “If someone has a strong family history of early heart disease, be aware of these symptoms so you can be evaluated early by a doctor.”
Some heart attacks present differently, especially in women. According to the American Heart Association, other common signs of a heart attack include:
- Jaw, neck or back pain
- nausea or vomiting
- Pain or discomfort in the arm or shoulder
- Shortness of breathe
- cold sweats
“I thought a heart attack was what you see on TV, a guy clutching his chest and falling to the floor,” says Pinelli. “My symptoms were severe pain in my wrists and elbows, so it was really eye-opening for me to have symptoms that weren’t typical of TV.”
Today, she works with an online fitness coach, running, exercising, and practicing yoga and meditation regularly. She focuses on a healthy diet and takes medication prescribed by her doctor. At her two-year checkup in July 2022, her doctor told her that her heart was as healthy as a 20-year-old’s.
Pinelli now volunteers with the American Heart Association’s Go Red for Women “Real Women” initiative to share her story to empower others to listen to their bodies and reach out for help when something feels wrong.
“We know our bodies better than anyone else,” she says. “Maybe you have a strange pain, but who knows? These strange pains can translate into serious problems and can be a matter of life and death. So we have to take this seriously and be empowered to defend our own health.”